Primary melioidotic prostatic abscess: presentation, diagnosis and management.

Introduction:  In South-East Asia and Northern Australia, melioidosis (infection with Burkholderia pseudomallei) is a known cause of severe community-acquired sepsis. However, melioidosis presenting primarily as prostatic abscesses is very rare. Methods:  The presenting features, investigations and management outcome of five patients who developed melioidotic prostatic abscesses from 1997 to 2000 were reviewed in the present study. Results:  The mean age at presentation was 53 years (range: 29−69). Old age and diabetes mellitus were predisposing factors. All patients had a fever of at least 38.5°C and presented with obstructive urinary symptoms culminating in urinary retention. Presence of prostatic abscess was demonstrated by transrectal ultrasound in all cases. The abscesses were drained with transurethral resection of the prostate. One patient required re-resection while another patient developed severe septic shock requiring intensive care and ­inotropic support. There was no mortality in our series. Conclusions:  Elderly diabetic men presenting with fever and urinary tract obstruction in endemic areas may harbour an unusual but potentially life threatening melioidotic prostatic abscess. Transrectal ultrasound and bacteriological confirmation are mandatory. Prompt surgical drainage coupled with appropriate antibiotics are keys to a favourable outcome.