Meiliodosis - An Enigma With Varying Antibiotic Response

Abstract

Melioidosis or Whitmore's disease is an infection of humans and animals caused by aerobic gram negative bacillus Burkholderia pseudomallei. This infection with a wide clinical spectrum is predominantly present in tropical climates, mainly Southeast Asia and Northern Australia. The clinical manifestations include pneumonia, skin ulcers or abscesses, osteomyelitis, prostatitis, encephalomyelitis and fulminant septic shock. The denitive diagnosis is made by a positive culture of Burkholderia pseudomallei. The bacteria is innately resistant to 6 classes of commonly used antibiotics. CDC recommends an intensive phase of intravenous antibiotics for 10 to 14 days followed by eradication therapy with oral antibiotics for 3 – 6 months. The intravenous agents effective against the bacteria are meropenem and ceftazidime. Trimethoprim sulfamethoxazole and amoxicillin/clavulanic acid are the oral antimicrobial agents used. Here we present two cases of Melioidosis, at opposite ends of the spectrum with varying antibiotic response. One patient is a young non immunocompromised female and the second an elderly immunocompromised (T2DM) male, both presented with skeletal melioidosis.