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DOI: 10.1055/s-0040-1721232
Melioidosis: A Fulminant Infection in a Patient with Uncontrolled Diabetes
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Abstract
Melioidosis is an endemic infection in Southeast Asia and Northern Australia commonly manifesting with pneumonia and localized skin infection. Though most exposures do not lead to severe illness, a fulminant infection can occur among patients with risk factors. A 59-year-old male presented with cough with expectoration and fever for 1 week. He had diabetes for 10 years with poorly controlled blood sugars. Contrast-enhanced computerized tomography (CECT) of thorax showed right upper lobe consolidation with diffuse ground-glass opacities in right upper lobe along with microabscesses in liver and spleen. Sputum culture and Xpert mycobacterium tuberculosis complex and resistance to rifampin (MTB/RIF) for tuberculosis were negative. Bronchoalveolar lavage culture grew Burkholderia pseudomallei. He was treated with initial intensive therapy with injection amoxicillin-clavulanic acid for 2 weeks and subsequently started on eradication therapy with tablet trimethoprim-sulfamethoxazole. Diagnosis of melioidosis should be considered in a patient of pneumonia with multiorgan involvement in an endemic area, especially with underlying risk factors.
Publication History
Article published online:
02 December 2020
© 2020. Nitte University (Deemed to be University). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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References
- 1 Abu-Ashour W, Twells LK, Valcour JE, Gamble J-M. Diabetes and the occurrence of infection in primary care: a matched cohort study. BMC Infect Dis 2018; 18 (01) 67
- 2 Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care 2018; 41 (03) 513-521
- 3 Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabet Med 1997; 14 (01) 29-34
- 4 Hostetter MK. Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes 1990; 39 (03) 271-275
- 5 Fishman JA, Roth RS, Zanzot E, Enos EJ, Ferraro MJ. Use of induced sputum specimens for microbiologic diagnosis of infections due to organisms other than Pneumocystis carinii . J Clin Microbiol 1994; 32 (01) 131-134
- 6 Brownback KR, Thomas LA, Simpson SQ. Role of bronchoalveolar lavage in the diagnosis of pulmonary infiltrates in immunocompromised patients. Curr Opin Infect Dis 2014; 27 (04) 322-328
- 7 Shannon VR, Andersson BS, Lei X, Champlin RE, Kontoyiannis DP. Utility of early versus late fiberoptic bronchoscopy in the evaluation of new pulmonary infiltrates following hematopoietic stem cell transplantation. Bone Marrow Transplant 2010; 45 (04) 647-655
- 8 Marr KA, Laverdiere M, Gugel A, Leisenring W. Antifungal therapy decreases sensitivity of the Aspergillus galactomannan enzyme immunoassay. Clin Infect Dis 2005; 40 (12) 1762-1769
- 9 White NJ. Melioidosis. Lancet 2003; 361 (9370) 1715-1722
- 10 Dance DA. Ecology of Burkholderia pseudomallei and the interactions between environmental Burkholderia spp. and human-animal hosts. Acta Trop 2000; 74 (2-3) 159-168
- 11 Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005; 18 (02) 383-416
- 12 Tipre M, Kingsley P, Smith T, Leader M, Sathiakumar N. Melioidosis in India and Bangladesh: a review of case reports. Asian Pac J Trop Med 2018; 11 (05) 320
- 13 Currie BJ, Fisher DA, Howard DM. et al. The epidemiology of melioidosis in Australia and Papua New Guinea. Acta Trop 2000; 74 (2-3) 121-127
- 14 Suputtamongkol Y, Chaowagul W, Chetchotisakd P. et al. Risk factors for melioidosis and bacteremic melioidosis. Clin Infect Dis 1999; 29 (02) 408-413
- 15 Currie BJ, Ward L, Cheng AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis 2010; 4 (11) e900
- 16 McLeod C, Morris PS, Bauert PA. et al. Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature. Clin Infect Dis 2015; 60 (01) 21-26
- 17 Birnie E, Virk HS, Savelkoel J. et al. Global burden of melioidosis in 2015: a systematic review and data synthesis. Lancet Infect Dis 2019; 19 (08) 892-902
- 18 Meumann EM, Cheng AC, Ward L, Currie BJ. Clinical features and epidemiology of melioidosis pneumonia: results from a 21-year study and review of the literature. Clin Infect Dis 2012; 54 (03) 362-369
- 19 Garg R, Shaw T, Vandana KE, Magazine R, Mukhopadhyay C. Melioidosis in suspected recurrent tuberculosis: a disease in disguise. J Infect Dev Ctries 2020; 14 (03) 312-316
- 20 Currie BJ, Fisher DA, Howard DM. et al. Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature. Clin Infect Dis 2000; 31 (04) 981-986
- 21 Hoffmaster AR, AuCoin D, Baccam P. et al. Melioidosis diagnostic workshop, 2013. Emerg Infect Dis 2015; 21 (02) e141045
- 22 Eickhoff TC, Bennett JV, Hayes PS, Feeley J. Pseudomonas pseudomallei: susceptibility to chemotherapeutic agents. J Infect Dis 1970; 121 (02) 95-102
- 23 Chaowagul W, Suputtamongkol Y, Dance DA, Rajchanuvong A, Pattara-arechachai J, White NJ. Relapse in melioidosis: incidence and risk factors. J Infect Dis 1993; 168 (05) 1181-1185
- 24 Dance D. Treatment and prophylaxis of melioidosis. Int J Antimicrob Agents 2014; 43 (04) 310-318