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A case report of Tubo-ovarian abscess caused by Burkholderia pseudomallei.
BMC Infect Dis. 2018 02 08; 18(1):73.BI

Abstract

BACKGROUND

Melioidosis, the disease caused by Burkholderia pseudomallei is endemic in the Northeastern part of Thailand, South-East Asia, and Northern Australia. The pelvic involvement of disease is rare even in an endemic area. Therefore, we describe in this report the clinical presentation, management, and outcome of the patient with primary tubo-ovarian abscess due to melioidosis.

CASE PRESENTATION

A 31-year-old Thai cassava farmer woman presented with fever and abdominal pain at left lower quadrant for one month. She also had pain, swelling, and redness of the genitalia without any ulcer. She had odorless whitish vaginal discharge. The pelvic examination revealed excitation pain on the left side of her cervix. Transvaginal ultrasonography revealed a large left tubo-ovarian abscess size 9.4 × 4.8 cm located at anterior of the uterus. Urgent exploratory laparotomy revealed left hydrosalpinx with a large amount of pus. The pus culture grew Burkholderia pseudomallei. The computer tomography of the abdomen revealed multiple hepatosplenic abscesses. The patient underwent left salpingo-oophorectomy and pus drainage. The pathological examination of excised left adnexa revealed chronic and acute suppurative inflammation with necrotic tissue. She was given intravenous ceftazidime for one month, and her clinical symptom improved. She was diagnosed with type 2 diabetes mellitus at this visit and treated with insulin injection. She continued to take oral co-trimoxazole for 20 weeks. The final diagnosis was disseminated melioidosis with left tubo-ovarian abscess and hepatosplenic abscesses in a newly diagnosed morbidly obese diabetic patient.

CONCLUSION

Burkholderia pseudomallei should be considered as the causative organism of gynecologic infection among patient with risk factor resided in an endemic area who do not respond to standard antibiotics. The pus culture from the site of infection is the only diagnostic method of pelvic melioidosis, appropriate antibiotics, and adequate surgical drainage were the components of the successful outcome.

Authors+Show Affiliations

Division of Infectious Disease, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi District, Bangkok, Thailand.Division of Infectious Disease, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand. mchitasombat@gmail.com.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29422033

Citation

Nernsai, Pattaranit, et al. "A Case Report of Tubo-ovarian Abscess Caused By Burkholderia Pseudomallei." BMC Infectious Diseases, vol. 18, no. 1, 2018, p. 73.
Nernsai P, Sophonsritsuk A, Lertvikool S, et al. A case report of Tubo-ovarian abscess caused by Burkholderia pseudomallei. BMC Infect Dis. 2018;18(1):73.
Nernsai, P., Sophonsritsuk, A., Lertvikool, S., Jinawath, A., & Chitasombat, M. N. (2018). A case report of Tubo-ovarian abscess caused by Burkholderia pseudomallei. BMC Infectious Diseases, 18(1), 73. https://doi.org/10.1186/s12879-018-2986-z
Nernsai P, et al. A Case Report of Tubo-ovarian Abscess Caused By Burkholderia Pseudomallei. BMC Infect Dis. 2018 02 8;18(1):73. PubMed PMID: 29422033.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A case report of Tubo-ovarian abscess caused by Burkholderia pseudomallei. AU - Nernsai,Pattaranit, AU - Sophonsritsuk,Areepan, AU - Lertvikool,Srithean, AU - Jinawath,Artit, AU - Chitasombat,Maria Nina, Y1 - 2018/02/08/ PY - 2017/08/11/received PY - 2018/01/31/accepted PY - 2018/2/10/entrez PY - 2018/2/10/pubmed PY - 2018/4/26/medline KW - Burkholderia pseudomallei KW - Melioidosis KW - Ovarian abscess KW - Pelvic inflammatory disease SP - 73 EP - 73 JF - BMC infectious diseases JO - BMC Infect Dis VL - 18 IS - 1 N2 - BACKGROUND: Melioidosis, the disease caused by Burkholderia pseudomallei is endemic in the Northeastern part of Thailand, South-East Asia, and Northern Australia. The pelvic involvement of disease is rare even in an endemic area. Therefore, we describe in this report the clinical presentation, management, and outcome of the patient with primary tubo-ovarian abscess due to melioidosis. CASE PRESENTATION: A 31-year-old Thai cassava farmer woman presented with fever and abdominal pain at left lower quadrant for one month. She also had pain, swelling, and redness of the genitalia without any ulcer. She had odorless whitish vaginal discharge. The pelvic examination revealed excitation pain on the left side of her cervix. Transvaginal ultrasonography revealed a large left tubo-ovarian abscess size 9.4 × 4.8 cm located at anterior of the uterus. Urgent exploratory laparotomy revealed left hydrosalpinx with a large amount of pus. The pus culture grew Burkholderia pseudomallei. The computer tomography of the abdomen revealed multiple hepatosplenic abscesses. The patient underwent left salpingo-oophorectomy and pus drainage. The pathological examination of excised left adnexa revealed chronic and acute suppurative inflammation with necrotic tissue. She was given intravenous ceftazidime for one month, and her clinical symptom improved. She was diagnosed with type 2 diabetes mellitus at this visit and treated with insulin injection. She continued to take oral co-trimoxazole for 20 weeks. The final diagnosis was disseminated melioidosis with left tubo-ovarian abscess and hepatosplenic abscesses in a newly diagnosed morbidly obese diabetic patient. CONCLUSION: Burkholderia pseudomallei should be considered as the causative organism of gynecologic infection among patient with risk factor resided in an endemic area who do not respond to standard antibiotics. The pus culture from the site of infection is the only diagnostic method of pelvic melioidosis, appropriate antibiotics, and adequate surgical drainage were the components of the successful outcome. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/29422033/A_case_report_of_Tubo_ovarian_abscess_caused_by_Burkholderia_pseudomallei_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-2986-z DB - PRIME DP - Unbound Medicine ER -