Melioidosis in a patient with type 1 diabetes mellitus on an insulin pump

Abstract

SummaryDiabetes mellitus is a well-recognised risk factor for melioidosis, the disease caused by Burkholderia pseudomallei, which is endemic in northern Australia and Southeast Asia. We present the initial diagnostic dilemma of a febrile patient from northern Australia with type 1 diabetes mellitus and negative blood cultures. After a 6-week history of fevers and undifferentiated abdominal pain, MRI of her spine revealed a psoas abscess. She underwent drainage of the abscess which cultured B. pseudomallei. She completed 6 weeks of intravenous (IV) ceftazidime and oral trimethoprim/sulphamethoxazole (TMP/SMX) followed by a 12-week course of oral TMP/SMX. We postulate that the likely route of infection was inoculation via her skin, the integrity of which was compromised from her insulin pump insertion sites and an underlying dermatological condition.Learning points:Diabetes mellitus is the strongest risk factor for developing melioidosis.Atypical infections need to be considered in individuals with diabetes mellitus who are febrile, even if blood cultures are negative.There is heterogeneity in the clinical presentation of melioidosis due to variable organ involvement.Consider melioidosis in febrile patients who have travelled to northern Australia, Asia and other endemic areas.

Melioidosis complicating lepromatous leprosy with type 2 lepra reaction: A rare case report from India

“…2 Impaired neutrophil function with altered chemotaxis, phagocytosis, oxidative burst and killing activity has been observed in these cases. 8 Our patient had immunosuppression because of chronic systemic corticosteroid intake which would have provided suitable conditions for infection with B. pseudomallei.…”

Is Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency a Risk Factor for Melioidosis?

“…Our patient was a farmer with newly diagnosed T2DM. The association with DM may be secondary to impaired neutrophil function with studies demonstrating altered chemotaxis, phagocytosis, oxidative burst, and killing activity [7].…”

Isolated splenic abscess due to melioidosis in type 1 diabetes mellitus: laboratory diagnosis ofBurkholderia pseudomalleiin resource-restricted setting

“…It is important to note that, m-cresol (3-methylphenol), a preservative used in all injectable insulin preparations, was found to inhibit the growth of B. pseudomallei and might have confounded the results of the earlier studies 15 16. In addition, direct dermal inoculation through insulin injection sites or insulin pump tube insertion sites might also explain the higher risk in type 1 DM 17. Bathing in muddy pool and breached cutaneous integrity due to subcutaneous insulin injections probably led to acquisition of infection in this patient.…”