Abstract
BackgroundMelioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia.Case presentationHere, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole.ConclusionThe case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.
Highlights
Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei
Diabetic-farmers who present with fever and sepsis and do not respond to antibiotics may turn out to be yet another case of melioidosis
The microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species
Summary
In Nepal, most of the clinicians are unaware of the clinical presentation of melioidosis; they often misdiagnose the condition for tuberculosis. Clinicians should suspect melioidosis as a differential diagnosis when any febrile patient with multiple abscesses and predisposing factors like diabetes does not respond to antibiotics especially if the patient has a history of travelling to melioidosis prone area. The disease may manifest in the patient several years after their return back to home, much like our reported cases. Occupational history is important as one cannot rule out the possibility of local acquisition. Microbiologists and laboratory technicians should be sufficiently trained so that they do not confound the organism for other Burkholderia species. The disease has a high mortality rate; it should be diagnosed at its earliest possible stages
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