Abstract
Melioidosis is a bacterial infection caused by Burkholderia pseudomallei. The first cases of melioidosis were described in Burma just over a century ago. Since then, the endemic zone has expanded and includes Sri Lanka. The clinical presentation of melioidosis ranges from acute, subacute and chronic manifestations. Due to its protean clinical presentation, a high index of suspicion is necessary for the clinical diagnosis. Diagnosis is confirmed by isolation of B. pseudomallei from clinical specimens. A high or rising antibody titre to melioidin antigen is supportive, but not diagnostic. B. pseudomallei grows readily in commonly used laboratory media but may not be identified unless laboratory personnel have prior experience with this organism. Treatment is complex and includes a prolonged course of intravenous antibiotics followed by months of oral therapy to ensure eradication of the bacterium. Relapse is common in spite of adequate therapy. Acase report of a patient with acute onset pneumonia with a positive sputum culture of B.pseudomallei is presented. DOI: http://dx.doi.org/10.4038/gmj.v19i1.6955 Galle Medical Journal 2014 19(1): 23-26
Highlights
Melioidosis is a bacterial infection caused by B.pseudomallei, an aerobic, Gram-negative, motile bacillus, endemic in the tropical and subtropical regions of South East Asia and Northern Australia
Even though Sri Lanka has been considered as nonendemic for melioidosis in the past, it is recognised as an emerging infection in the country
Since several case reports of melioidosis acquired in Sri Lanka have been published [2,3,4]
Summary
Melioidosis is a bacterial infection caused by B.pseudomallei, an aerobic, Gram-negative, motile bacillus, endemic in the tropical and subtropical regions of South East Asia and Northern Australia. His full blood count revealed neutrophil leucocytosis and his ESR and CRP were high His initial chest radiograph showed apical shadowing on the left side (Figure 1). He was started on intravenous cefuroxime and discharged on oral antibiotics once the fever settled. Repeat chest radiograph revealed left upper zone opacity with cavitation (Figure 2) He was started on intravenous meropenem 1g 8 hourly after taking sputum and blood for culture and transferred to the National Hospital for Respiratory Diseases (NHRD), Welisara for further management. 2 weeks after discharge, he was clinically well with good glycaemic control His inflammatory markers were normal and a repeat chest radiograph showed resolution of the lung lesion (Figure 3). He is currently on oral cotrimoxazole and doxycycline for a total of three months
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