Burkholderia infections in the head and neck: a new tenant in the block

Abstract

Introduction

Burkholderia is a less familiar family of gram-negative bacteria with potential to harm human, usually reported in immunocompromised patients. The aims of this study are to present a case report of Burkholderia infection in the head and neck area and to discuss the clinical and histopathological features of Burkholderia infections in general in the head and neck region including treatment options.

Methods

A comprehensive English literature analysis between years 1995 and 2022, which were included in the current review.

Results

A total of 29 patients, M:F ratio 1.07. The age ranged from 5 to 77 years with an average of 41.4 + 17.4 years. The most common infection site was the lower neck. Most of the patients developed an abscess. Systemic presentation mainly included fever. Overall, 55.17% of the patients had some form of immunosuppression. The most common specie was Burkholderia pseudomallei. Five of the patients had a combined infections. Patients received 1-12 types of antibiotics. A total of 26 patients required surgical treatment in addition to antibiotics. A total of 27 patients recovered, while 2 patients died from the infection. The histopathological spectrum included: Necrotizing granuloma, chronic or acute inflammation and necrotizing fasciitis.

Conclusion

This study consolidates for the first time all cases of Burkholderia infections, a relatively unknown type of bacterium in the head and neck area. This is a rare phenomenon, with patients that are usually immunosuppressed, and the treatment is usually a long-term combination of surgery and medication. The attending clinician should be familiar with the pathogen, the clinical signs of infection, and the patient’s treatment options. This bacterium can manifest as an abscess, acute and chronic inflammation, and necrotizing granulomas. The prognosis is excellent when an early diagnosis is made and appropriate treatment administered. Burkholderia infection should be considered in the differential diagnosis of abscesses and granulomas with necrosis in the head and neck area.