Surgical presentation of melioidosis in India

Background. Melioidosis, the disease caused by Burkholderia pseudomallei, i s common in Southeast Asia. It has also been reported from India, where som e investigators feel it is underdiagnosed and under-reported. We report our experience with melioidosis presenting as abscesses at unusual sites. Methods. All consecutive patients with culture proven B. pseudomallei who p resented to a single surgical unit between 1995 and 1998, were evaluated. Results. Three patients presented with splenic abscesses and one with a sof t tissue abscess in the neck. One patient developed septicaemia. All patien ts responded favourably to ceftazidime and/or co-trimoxazole which was star ted as soon as the diagnosis was confirmed. Conclusion. Melioidosis is under-diagnosed in India, probably due to a low index of suspicion of this disease among clinicians. It should be considere d as a possibility when abscesses are encountered at unusual sites. The pus must then be cultured to identify the causative agent.