Immunopathogenesis of melioidosis liver abscess and advance in precise diagnosis and treatment

Melioidosis liver abscess (MLA), caused by Burkholderia pseudomallei (Bp), is a severe infectious disease predominantly found in tropical regions such as Southeast Asia and Australia. MLA accounts for approximately 12% to 18% of melioidosis cases, most frequently affecting the male population aged between 30 and 50 years old; the cases are usually complicated with diabetes or immunosuppression. Bp facilitates the formation of hepatic abscess through immune evasion mechanisms mediated by type Ⅲ/Ⅳ secretion systems, which impair macrophage function, dysregulate T-cell immunity, and involve TLR4 genetic variants. The typical clinical manifestations include right upper quadrant pain, jaundice, and persistent high fever refractory to conventional antibiotic therapy. Imaging often reveals a distinctive 'honeycomb sign', and definitive diagnosis relies on Bp culture. Molecular diagnosis techniques such as clustered regularly interspaced short palindromic repeats (CRISPR)-BP34 can enhance the detection sensitivity. The treatment included two phases: intensification and eradication, and abscesses no less than 3cm require drainage. Emerging therapeutic strategies, including combination drug regimens and phage therapy, show promising potential. However, antimicrobial resistance and prolonged treatment remain significant challenges. Future efforts should be focused on advancing rapid diagnostics, personalized therapeutic approaches and multidisciplinary collaboration so as to improve clinical outcomes.