Clinical Experience with Treatment of Splenic Abscess at Burirum Hospital (2004-2007)
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Abstract
Background: Splenic abscess are relatively uncommon, but patients who were untreated had a high mortality rate. The causative organisms, underlying disease, therapeutic methods and outcome of treatment were vary due to the difference of geographic area.
Objective: To study patients with splenic abscess in clinical presetations, underlying diseases, immediate outcomes and outcomes after 5 months of treatment.
Research Design: Descriptive, retrospective study.
Method: All Medical Record of the patients which a discharge diagnosis of splenic abscess admitted at Buriram Hospital during 1st January 2004 - 30th June 2007, were reviewed. The demographic data, clinical, underlying, microbiologic findings, treatment modalities and outcome of treatment were analyzed. The data were analyzed with descriptive analysis and demonstrated in mean, percentage.
Result: There were 49 cases, 37 cases (75.5%) were male. The average age was 44.52 ± 13.51 years. The common underlying disease were thalassemia 19 cases (38.8%), Diabetes mellitus 18 cases (36.7%). Six Cases (12.2%) had a concurrent liver abscess. High Fever was found in all cases. Twenty - patients (46.9%) complained of abdominal pain, while 18 cases (36.7%) had tenderness at LUQ and splenomegaly was found in 8 cases (16.3%). Leukocytosis (wbc > 10 X 10 VL ) was found in 28 patients (57.1%). Only 9 patients (18.4%) that Burkholderia pseudomallei were identified from the abscess (surgical cases) and hemoculture. Forty four patients (89.8%) were medical treatment with antimicrobials that cover B. pseudomallei, 5 cases (10.2%) were surgical treatment with splenectomy. There was one patient which underlying HIV death from hospital acquired ๒fection. Fourty eight patients (98%) were improved before discharged and neither readmitted or relapsed of the disease.
Conclusion: Abdominal ultrasound was necessary investigation ๒ patients with splenic abscess. The patients who live in endemic area of Meloidosis and present with multiple splenic abscess, especially who had low immunity conditions, should recive empirical antimicrobial treatment for Burkholderia pseudomallei.
Key words: Splenic Abscess, Meloidosis, Burkholderia pseudomallei.
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References
2. Chang KC, et al. Clinical characteristics and prognostic factors of splenic abscess : A review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006;12(3):460-4.
3. Sarr MG, Zuidema GD. Splenic abscess : presentation, diagnosis, and treatment. Surgery 1982;92:480-5.
4. Chulay JD, Lankerani MR. Splenic abscess : report of 10 cases and review of the literature. Am J Med 1976;61:513-22.
5. Lin CY, Chen TC, Lu PL, Lin WR, and Chen YH. Melioidosis Presenting with solated splenic abscesses : a case report. Kaohsiung J Med Sci 2007;23:417-21.
6. Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern taiwan. J Microbilo Immunol Infect 2004;37:39-44.
7. Sangchan A, Mootsikapun P, Mairiang P. Splenic abscess : clinical features, microbiologic finding, treatment and outcome. J Med Assoc Thai 2003;86:436-41.
8. Tung CC, Chen FC, Lo CJ. Splenic Abscess : An Easily Overlooked Disease?. Themerican Surgeon; Apr 2006;72,4;322-5.
9. Lee CH, Leu HS, Hu TH, et al. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect 2004 ; 37 : 39-44.
10. White NJ. Melioidosis. Lancet 2003;361:1715-22.
11. Cheng AC, Currie BJ. Melioidosis : epidemiology, pathophysiology, and management. Clin Microbiol Rev. 2005;18:383-416.
12. Johnson JD, Raff MJ, Barnwell PA, et al. Splenic abscess complicating infectious endocarditis. Arch Intern Med 1983;143:906-12.
13. Wibulpolprasert B, Dhiensiri T. Visceral organ abscess in melioidosis: Sonographic finding, J Clinical Ultrasound 1999;27:29-34.
14. Thummakul T, wilde H, Tantawichien T. Melioidosis, an environmental and occupational hazard in Thailand. Mil Med 1999;164:658-62.
15. Leerarasamee A, Trakulsomboon S, Kasum M, Dejsirilert S. Isolation rates of Burkholderia pseudomallei among the four regions in Thailand. Southeast Asian J Trop Med Public Health 1997;28:107-13.
16. Vuddhakul V, Tharavichitkul P, Na-Ngam N, et al. Epidemiology of Burkholderia pseudomallei in Thailand. Am J Trop Med Hyg 1999;60:458-60.
17. Dance DAB, Davis TME, Wattanagoon Y, et al Acute suppurative parotitis caused by Pseudomonas pseudomallei in children. J Infect Dis 1989,159:654-60.
18. Woods ML 2nd, Currie BJ, Howard DM, et al. Neurological meliodosis : seven cases from the Nothem Territory of Australia Clin Infect Dis 1992;15:163-69.
19. Ramsay SC, Labrooy J, Norton R, Webb B. Demonstration of different patterns of musculoskeletal, soft tissue and visceral involvement in melioidosis using 99 m Tc stannous colloid white cell scanning. Nucl Med Commun 2001;22:1193-99.
20. Chou YH, Tiu CM, Chiou HJ, et al. Ultrasound-guided interventional procedures in splenic abscesses. Eur J Radiol 1998;28:167-70.
21. Paris S, Weiss SM, Ayers WH, et al. Splenic abscess. Am Surg 1994;60:358-61.
