A rare and fatal case of tubo-ovarian abscess due to Burkholderia pseudomallei presenting as puerperal sepsis
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Introduction. Melioidosis is an emerging life-threatening infectious disease caused by the Gram-negative Burkholderia pseudomallei found in contaminated soil and surface ground water. It often presents with varied clinical manifestations and has a high mortality if left untreated due to lack of clinical suspicion. Here we report a rare and fatal case of tubo-ovarian abscess presenting as puerperal sepsis due to B. pseudomallei in a young woman.
Case report. A 25-year-old female presented for medical consultation at day 43 postpartum complaining of fever on and off for the past 40 days associated with vomiting. On per speculum examination, greenish discharge from the cervix was seen and a right adnexal mass was felt which was cystic in consistency, non-tender and pushing the cervix to the left side. An exploratory laparotomy was carried out and pus was drained from below the rectus sheath, and from the right tubo-ovarian mass. Peripheral blood and the pus samples collected intraoperatively grew B. pseudomallei . The patient died on the fifth post-operative day due to septic shock with disseminated intravascular coagulation secondary to puerperal sepsis.
Conclusion. Melioidosis is a fatal but treatable disease when it is promptly diagnosed. In countries such as India, where tuberculosis is highly endemic, underdiagnosis of melioidosis can be common. Clinicians and microbiologists should have a high index of suspicion of melioidosis especially in individuals with underlying illness.
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This is a study that would be of interest to the field and community. You have addressed the reviewers comments, and as such I am happy to accept this manuscript for Access Microbiology.
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The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
1. Description of the case(s) - The description of the case was clear and fairly well written although there are sections that need improvement. 2. Presentation of results - Results were complete and presented well. Investigations were performed in accordance as per standard. 3. How the style and organization of the paper communicates and represents key findings - The organization of the manuscript was easy to read with a good flow. 4. Literature analysis or discussion - The literature review and discussion could have been improved with added relevant and more recent citations; especially the fact that melioidosis not only "endemic in Thailand and Northern Australia" as presented in the manuscript. 5. Any other relevant comments Formatting and spelling errors - To avoid the use abbreviations …
Comments to Author
1. Description of the case(s) - The description of the case was clear and fairly well written although there are sections that need improvement. 2. Presentation of results - Results were complete and presented well. Investigations were performed in accordance as per standard. 3. How the style and organization of the paper communicates and represents key findings - The organization of the manuscript was easy to read with a good flow. 4. Literature analysis or discussion - The literature review and discussion could have been improved with added relevant and more recent citations; especially the fact that melioidosis not only "endemic in Thailand and Northern Australia" as presented in the manuscript. 5. Any other relevant comments Formatting and spelling errors - To avoid the use abbreviations unless notes/explanations are provided. Eg: Line 47: "A 25-year-old female Para-1, live-1, abortion-1 status" - While the status is acceptable in a case note, would be great to have it written clearer for non-medical readers - Formatting of spacing needs to looked into - Inconsistent spelling of certain words. Eg. "Post partum" and "postpartum", "Gram negative" vs "Gram-negative", "post operative" vs "post op" - Authors to have consistency in terminologies - Authors to have the manuscript proofread for improved language Suggestions of amendments - Line 114: "This organism has been isolated from endemic areas of Thailand and Northern Australia" - Melioidosis is not only endemic in these two countries/regions. To include other endemic regions/countries and provide relevant citation(s). - Authors to add on possible postulation as to how the infection manifested as described in the manuscript. - The authors missed out other reported cases of melioidosis during pregnancy including this article by Chang et al. [Chang, C.Y., Lau, N.L.J., Currie, B.J. et al. Disseminated melioidosis in early pregnancy - an unproven cause of foetal loss. BMC Infect Dis 20, 201 (2020)] - Errors in reference - No. 9 and 10 are the same.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
1. Description of the case(s)- in the case report, there is no mention of the imaging studies of the antenatal period except for oligohydramnios, there is no clarity of timing of development of tubo-ovarian abscess , was it during pregnancy and manifested by rupture in post-partum period. In any case a revision of title as B. pseudomallei tubo-ovarian abscess presenting as puerperal sepsis would be more appropriate 2. Presentation of results- more details about ante natal period findings would have brought more clarity 3. How the style and organization of the paper communicates and represents key findings- Satisfactory, More details about B pseudomallei in pregnancy in the introduction as well as discussion instead of the traditional risk factors and environmental factors would add more value to the …
Comments to Author
1. Description of the case(s)- in the case report, there is no mention of the imaging studies of the antenatal period except for oligohydramnios, there is no clarity of timing of development of tubo-ovarian abscess , was it during pregnancy and manifested by rupture in post-partum period. In any case a revision of title as B. pseudomallei tubo-ovarian abscess presenting as puerperal sepsis would be more appropriate 2. Presentation of results- more details about ante natal period findings would have brought more clarity 3. How the style and organization of the paper communicates and represents key findings- Satisfactory, More details about B pseudomallei in pregnancy in the introduction as well as discussion instead of the traditional risk factors and environmental factors would add more value to the manuscript 4. Literature analysis or discussion- More details about B pseudomallei in pregnancy and outcomes in the postpartum period and neonatal outcome is warranted in the discussion section 5. Any other relevant comments- Imaging findings could have been added
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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