A case of systemic melioidosis: unravelling the etiology of chronic unexplained fever with multiple presentations.

Srujana Mohanty,Prasanta Raghab Mohapatra,Gourahari Pradhan,Baijayantimala Mishra,Manoj Kumar Panigrahi

doi:10.5603/piap.2016.0012

Srujana Mohanty, Prasanta Raghab Mohapatra

Open Access

https://doi.org/10.5603/piap.2016.0012

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Abstract

Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute. A strong clinical and microbiological suspicion for melioidosis should be considered in the differential diagnosis of acute pyrexia of unknown origin, acute respiratory distress syndrome and acute onset of sepsis, especially in the tropics.

Highlights

Melioidosis or “the remarkable imitator”, an acute infectious disease, caused by the environmental Gram-negative bacillus, Burkholderia pseudomallei, is endemic, widespread and an important public health problem in Southeast Asia and Northern Australia [1, 2]. It is being increasingly reported from other parts of the world, including India, China, Sri Lanka, and North and South America expanding the endemic zone of the disease [3, 4]
We report a case of melioidosis in a diabetic, occupationally unexposed male, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute
Melioidosis was first recognized as a clinical entity in 1911 when Indian Bacteriologist C.S

Summary

Introduction

Melioidosis or “the remarkable imitator”, an acute infectious disease, caused by the environmental Gram-negative bacillus, Burkholderia pseudomallei, is endemic, widespread and an important public health problem in Southeast Asia and Northern Australia [1, 2]. We report a case of melioidosis in a diabetic, occupationally unexposed male, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute. Drained pus along with blood, urine, sputum, and pleural fluid (1.5 ml, right side aspirate) were subjected to microbiological investigations, including culture.

Results

Conclusion