Khiangte Hannah L, Robinson Vimala Leena, Veeraraghavan Balaji, Yesudhason Binesh Lal, Karuppusami Reka
Department of Radiodiagnosis, Christian Medical College Vellore, Tamil Nadu, 632004, India.
Department of Microbiology, Christian Medical College Vellore, Tamil Nadu, 632004, India.
Insights Imaging. 2019 Feb 13;10(1):17. doi: 10.1186/s13244-019-0708-8.
Melioidosis being an important cause of community-acquired sepsis, caused by Burkholderia pseudomallei in the tropical and subtropical countries, is often underreported or misinterpreted on imaging investigations. We aim to describe the spectrum of imaging manifestations of melioidosis and to evaluate its role in prognosticating clinical outcome, and look for association of specific organ involvement with risk factors.
From January 2011 to October 2017, retrospective analysis of imaging investigations of 189 consecutive patients with culture-proven melioidosis was performed. Clinical and demographic records were collected from the hospital medical records.
Out of 67% with a localised disease musculoskeletal involvement was most common, whereas the common organs involved in disseminated infections were the lungs, spleen, liver and genitourinary tract in descending order. Twenty percent suffered unfavourable outcome with a mortality rate of 8.5%. The lung involvement was associated with unfavourable outcome (OR 3.2 [95%CI 1.54-6.63] p = 0.002). The lymph node involvement (OR 0.22 [95% CI 0.05-0.95] p = 0.04) predicted a favourable outcome. Those with diabetes were at a higher risk of splenic (OR 3.05 [95% CI 1.62-5.77]; p = 0.001) and musculoskeletal involvement (OR 2.14 [95% CI 1.09-4.17] p = 0.03) of melioidosis.
In this study, we have described the spectrum of imaging manifestation of melioidosis and evaluated its association with clinical outcome. Respiratory system involvement in melioidosis showed significant association with unfavourable outcome. Diabetes mellitus, a common risk factor for melioidosis, is more prone for infection of the spleen and musculoskeletal system. Thus awareness of imaging manifestations of melioidosis can complement microbiological diagnostic tests for accurate early diagnosis and management.
类鼻疽是热带和亚热带国家由伯克霍尔德菌引起的社区获得性败血症的重要病因，在影像学检查中常报告不足或被误诊。我们旨在描述类鼻疽的影像学表现谱，评估其在预测临床结局中的作用，并寻找特定器官受累与危险因素之间的关联。
对2011年1月至2017年10月期间189例经培养证实为类鼻疽的连续患者的影像学检查进行回顾性分析。从医院病历中收集临床和人口统计学记录。
在局限性疾病患者中，67%的患者骨骼肌肉受累最为常见，而播散性感染中受累的常见器官依次为肺、脾、肝和泌尿生殖道。20%的患者预后不良，死亡率为8.5%。肺部受累与不良结局相关（比值比3.2 [95%置信区间1.54 - 6.63]，p = 0.002）。淋巴结受累（比值比0.22 [95%置信区间0.05 - 0.95]，p = 0.04）预示预后良好。糖尿病患者发生类鼻疽脾受累（比值比3.05 [95%置信区间1.62 - 5.77]；p = 0.001）和骨骼肌肉受累（比值比2.14 [95%置信区间1.09 - 4.17]，p = 0.03）的风险更高。
在本研究中，我们描述了类鼻疽的影像学表现谱，并评估了其与临床结局的关联。类鼻疽累及呼吸系统与不良结局显著相关。糖尿病是类鼻疽的常见危险因素，更易发生脾脏和骨骼肌肉系统感染。因此，了解类鼻疽的影像学表现可辅助微生物诊断测试，以实现准确的早期诊断和管理。
