Choy, Oh Sung, Sun, David, Vedanayagam, Vimalin, and Velu, Ramesh (2025) Melioidosis Aortic Aneurysms, 2019–2025: Incidence, Management and Outcomes From a Regional Tertiary Centre in North Queensland. ANZ Journal of Surgery, 96 (4). pp. 862-866.

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Abstract

Introduction: Melioidosis (organism: Burkholderia pseudomallei) is an uncommon but serious cause of mycotic aortic aneurysms in endemic areas of North Queensland and Southeast Asia. This study describes the presentation, management, and outcomes of melioidosis-associated aortic aneurysms at a regional tertiary centre. Methods: A retrospective review of all open and endovascular aortic aneurysm repairs recorded in the Australasian Vascular Audit and in the institutional electronic database between 1 January 2019 and 15 May 2025 was performed. Patient demographics, comorbidities (including ischaemic heart disease, type 2 diabetes, hypertension, end-stage renal failure, and smoking status), aneurysm characteristics (location and maximum diameter), procedural details (repair type, American Society of Anesthesiologists (ASA) score and device selection) and outcomes at 30 days, 90 days and 12 months were collected. Results: Among 217 AAA repairs (17 open, 200 EVAR), six (2.8%) were mycotic and, of these, five (2.3%) yielded B. pseudomallei on culture. Four patients presented as emergency ruptures, while one with an ectatic aorta was referred electively by the infectious diseases team. Aneurysm diameters ranged from 30 mm to 60 mm, all involving the infrarenal aorta or aortoiliac segment. Two patients (40%) died—one from gastrointestinal complications within 30 days and another from an unrelated cardiac event at 12 months. The other three recovered without further aneurysm-related issues. Conclusion: Although rare, melioidosis aortic aneurysms in endemic regions almost invariably present as surgical emergencies and carry a high risk of both early and late mortality. These findings highlight the necessity of prompt imaging, targeted microbiological diagnosis, and rapid initiation of either endovascular or open repair together with appropriate antimicrobial therapy. Multicentre studies are needed to refine long-term management strategies and antibiotic protocols for this life-threatening infection.

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