Jagtap Nitin, Shah Harshal, Kancharla Anuradha, Tandan Manu, Pal Partha, Lakhtakia Sundeep, Ramchandani Mohan, Reddy D N
Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India.
Indian J Gastroenterol. 2017 Mar;36(2):141-144. doi: 10.1007/s12664-017-0741-9. Epub 2017 Mar 29.
Melioidosis, being increasing, is reported from India. Gastrointestinal manifestations are typically reported as unusual cause of liver and/or splenic abscess. We aimed to describe various gastrointestinal manifestation of melioidosis in the present study. We retrospectively collected data of culture positive melioidosis cases from hospital database during August 2014-October 2016 at Asian Institute of Gastroenterology, Hyderabad. A total of nine culture positive cases (8 male) of melioidosis with median age of 40 years (range 23-66) were analyzed. Median duration of symptoms was 45 days. Two patients were being treated as tuberculosis. Three patients presented with liver abscess with two of them having simultaneous splenic abscess, and one had prostatic abscess. Three patients (43%) with history of acute pancreatitis had infected pancreatic collection, and one patient had left empyema with splenic abscess. One patient had wound infection with left lower limb cellulitis, presented as acute in chronic liver failure and another as spontaneous bacterial peritonitis (SBP). Diabetes and/or alcoholism was present in all patients. Seven patients had disseminated organ involvement. Seven patients underwent percutaneous intervention for drainage of abscess. Induction therapy as ceftazidime (n=4) or meropenem (n=5) followed by continuation therapy as oral cotrimoxazole (n=6) and doxycycline (n=1) was given. Six patients completed therapy and asymptomatic at end of follow up. Two patients died in the study period. One patient died due to acute-on-chronic liver failure (ACLF) with acute kidney injury and the other due to cardiac failure. One patient with SBP had lost to follow up. Apart from being unusual cause of liver/splenic abscess, melioidosis can present with infection of pancreatic collection, SBP, and infection in a compensated cirrhosis which can precipitate ACLF. Early recognition and specific therapy can improve prognosis.
类鼻疽在印度的报告病例数不断增加。胃肠道表现通常被报道为肝和/或脾脓肿的不寻常病因。我们旨在描述本研究中类鼻疽的各种胃肠道表现。我们回顾性收集了2014年8月至2016年10月期间在海得拉巴亚洲胃肠病学研究所医院数据库中培养阳性的类鼻疽病例数据。共分析了9例培养阳性的类鼻疽病例（8例男性），中位年龄为40岁（范围23 - 66岁）。症状的中位持续时间为45天。2例患者曾被当作结核病治疗。3例患者出现肝脓肿，其中2例同时伴有脾脓肿，1例有前列腺脓肿。3例有急性胰腺炎病史的患者（43%）出现感染性胰腺积液，1例患者有左侧脓胸伴脾脓肿。1例患者有伤口感染伴左下肢蜂窝织炎，1例表现为慢性肝功能衰竭急性发作，另1例表现为自发性细菌性腹膜炎（SBP）。所有患者均患有糖尿病和/或酗酒。7例患者出现多器官播散性受累。7例患者接受了经皮介入脓肿引流治疗。给予头孢他啶（n = 4）或美罗培南（n = 5）进行诱导治疗，随后以口服复方新诺明（n = 6）和多西环素（n = 1）进行维持治疗。6例患者完成治疗，随访结束时无症状。2例患者在研究期间死亡。1例患者死于急性慢性肝功能衰竭（ACLF）合并急性肾损伤，另1例死于心力衰竭。1例患有SBP的患者失访。除了是肝/脾脓肿的不寻常病因外，类鼻疽还可表现为感染性胰腺积液、SBP以及代偿期肝硬化感染，后者可引发ACLF。早期识别和特异性治疗可改善预后。
