Spectrum of imaging findings in melioidosis

Abstract

This pictorial review aims to highlight the clinical and imaging features of melioidosis in various organ systems. The patients were from two centres: one in Thailand and one in Singapore. The annual average incidence of melioidosis is estimated to be 4.4 in 100 000 in north-eastern Thailand and 1.7 in 100 000 in Singapore. Melioidosis affects many different organs and produces a spectrum of imaging features. The lung is the most frequently involved organ and, on radiographs and computed tomography, melioidosis may manifest as acute pulmonary consolidation, multiple nodules and abscesses. The finding of multiple small discrete abscesses in both the liver and the spleen is highly suggestive of visceral melioidosis and is best diagnosed on ultrasonography and computed tomography. Bone and soft tissue musculoskeletal involvement is usually part of disseminated melioidosis, with changes being seen on radiographs and MRI. Although imaging findings of melioidosis are not specific, this infection requires a high index of clinical suspicion, particularly in patients with pre-disposing comorbidities, such as diabetes mellitus, chronic renal failure, alcoholism or malignancy, those who are immunosuppressed as the result of either diseases or drug treatment, and those living in or with a history of travel to endemic areas.