Fatal Septicemic Melioidosis in a Young Military Person Possibly Co‐Infected With Leptospira Interrogans and Orientia Tsutsugamushi

Abstract

Concurrent melioidosis, leptospirosis, and scrub typhus after rural activities is rarely reported. A 19-year-old previously healthy man had fever onset after 2 weeks of military training. Pneumonia became evident on the fifth day of fever under intravenous penicillin and oral minocycline therapy. Acute respiratory failure developed the next day with shock and acute renal and liver function deterioration, which resulted in death. Blood cultures on the third and fifth days grew Burkholderia pseudomallei. Serology revealed leptospirosis and scrub typhus. The emergence of melioidosis in Taiwan and this death without antibiotic treatment for melioidosis alert us that B. pseudomallei should be included as a possible pathogen of pneumonia and sepsis, especially after rural activities.

Fatal Co-Infection–Melioidosis and Leptospirosis

“…The outbreak in Taiwan was following a typhoon and in Western Australia, it was caused by contaminated water supply. 6,7 Our outbreak was noted on July 8, 2010 when at least 20 patients presented with acute febrile illness after being involved in the search and rescue operation. Ten patients had blood culture confirmed melioidosis and four of them had concomitant leptospirosis based on blood PCR (the details of the outbreak will be reported separately).…”

“…Confirmed co-infection of melioidosis and leptospirosis was not previously reported except for a possible case in Taiwan in which the diagnosis of leptospirosis was based on serology. 6 On June 26, 2010, a young man was suspected to have drowned at Lubuk Yu, a natural recreational forest with river and waterfall in Pahang, Malaysia. A team composed of more than 150 members from the police, army, divers, firemen, and volunteers from a nearby village were involved in the search and rescue operation.…”

Acute Septicemic Melioidosis Presenting with Acute Cholangitis

“…It accounts for about 20% of community-acquired bacteremia in northeastern Thailand [13] and is the most common cause of fatal community-acquired bacteremic pneumonia in tropical Australia [14]. In this decade, increasing numbers of indigenous cases were described in Taiwan [3][4][5][6][7][8]. Chen et al [15] used antiflagellin antibody against B. pseudomallei to survey seroprevalence in Taiwan and revealed 2.8-5% seropositive rate of unapparent infection among Taiwanese.…”

“…This alerted us again that melioidosis should be kept in mind in endemic areas, especially after heavy rainfall or floods. We also collected paired sera for diagnosis of leptospirosis because it has a similar transmission route and clinical presentation, and the possibility of co-infection exists [6]. However, the result was negative.…”

“…The first case of melioidosis in Taiwan who caught the disease during a near drowning in the Philippines was reported in 1985 [2]. The numbers of melioidosis cases have been increasing for both imported and indigenous disease thereafter [3][4][5][6][7][8][9]. Accordingly, melioidosis is an emerging and endemic disease in Taiwan.…”