A case report of melioidosis in a diabetic patient in a union territory

Paul, Esther Jemima; Sudhagar, M; Swaminathan, Anandhalakshmi; Mathias, Shanthi

doi:10.4066/amj.2013.1751

Cited by 1 publication

(3 citation statements)

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“…It has previously been called as Pseudomonas pseudomallei . It is most predominant in South-East Asia, South Asia, Nothern Australia & China [ 5 , 6 , 8 – 10 ]. Sri Lanka lies in the melioidosis-endemic belt between 5°N and 10°N surrounded by countries known to be endemic to melioidosis [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The populations at risk are those who have occupational exposure to wet soil or surface water in the form of farming, agriculture, gardening, fishing, manual labour, land surveying, building construction and immunocompromised states such as diabetes, alcoholism, chronic renal failure, chronic lung disease and HIV/AIDS [ 3 , 4 , 7 , 8 , 10 – 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Melioidosis can have 2 major presentations; acute infection (symptoms lasting less than 2 months) and chronic infections (symptoms lasting more than 2 months) [ 8 , 12 , 16 ]. Melioidosis can present as septicemia, localized infection with/without septicemia, asymptomatic infections, ulcers, pneumonia,visceral abscesses, neurologic infection, musculoskeletal infections [ 6 , 8 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

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A case report of melioidosis complicated by infective sacroiliitis in Sri Lanka

Karunarathna

Mendis

Perera

et al. 2018

Trop Dis Travel Med Vaccines

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BackgroundMelioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei. It can present as septicemia, localized infection with/without septicemia, asymptomatic infections, ulcers, pneumonia, visceral abscesses, neurological infection, musculoskeletal infections and can involve any organ.Case presentationA 56 year old Sri Lankan diabetic female presented with fever, chills and rigors for 2 weeks. She also had malaise and loss of appetite, but no other features. On examination, she was febrile (temperature was 101.4 0 F) and rest of the examination was unremarkable. Her blood culture was positive for Burkholderia pseudomallei and she was started on IV antibiotics, on day 3. During her 2nd week of hospital stay, she developed right sided low back pain with buttock pain, right hip joint pain and restricted hip joint movements suggestive of right sacroiliitis. CE CT and MRI scans confirmed the diagnosis of right iliopsoas abscesses and right sacroiliitis.Incision and drainage was performed and a pigtail catheter was left in place for continuous drainage of abscesses. Her intensive phase was initiated with IV ceftazidime 2 g every 6 h for 12 days, then changed over to IV meropenem 2 g every 8 h together with oral co-trimoxazole. 2 weeks later, oral co-trimoxazole was replaced by oral doxycycline for another 6 weeks (due to transient pancytopaenia). She made a complete and uneventful recovery with oral co-trimoxazole for another 6 months, in her eradication phase.We report this case to show the importance in early diagnosis of melioidosis, and to consider it in the differential diagnosis of multiple abscesses and to emphasize the importance in suspecting melioidosis as a causative agent in infective sacroiliitis.DiscussionMelioidosis can have 2 major presentations; acute infection (symptoms lasting less than 2 months) and chronic infection (symptoms lasting more than 2 months). Musculoskeletal melioidosis is a well-recognized manifestation of the disease, which can manifest as soft tissue abscesses, septic arthritis, spondylitis, sacroiliitis and osteomyelitis.Management of melioidosis consists of 2 phases. The intensive phase and the eradication phase. These are aimed at the importance of rapidly treating the septicemia, the need of eradication of the persistent disease and the prevention of recurrent infections or relapses. The intensive phase consists of minimum 10–14 days of IV antibiotics: IV ceftazidime or IV carbapenem (meropenem/ imipenem). Eradication phase should be followed by 3–6 months of oral co-trimoxazole alone or in combination with oral doxycycline/ oral amoxiciliin-clavulanic acid.

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