MELIOIDOSIS: THE "GREAT MIMICKER"

Abstract

SESSION TITLE: Pulmonary Manifestations of Infections SESSION TYPE: Case Reports PRESENTED ON: 10/17/2022 03:15 pm - 04:15 pm INTRODUCTION: Melioidosis, caused by Burkholderia pseudomallei, is often referred to as a "great mimicker” as it is often mis-diagnosed and under-reported due to its widely variable clinical presentation (1). Here we discuss a patient who presented with a constellation of symptoms that were mistaken for other disease processes prior to a melioidosis diagnosis. CASE PRESENTATION: A 71 year old male of Haitian descent with recent travel to Haiti presented with >1 month of persistent fevers and worsening diffuse weakness and arthralgias. The patient was first empirically treated for Q fever with doxycycline and hydroxychloroquine at a different hospital prior to presentation. Upon presentation to this facility, he underwent further work-up for a variety of infectious etiologies including chikungunya, malaria, and lyme disease due to his presentation with a multi-system process and recent travel. The patient's blood and joint aspirate cultures returned positive for Burkholderia pseudomallei and he was subsequently diagnosed with melioidosis. He was discharged on long-term antibiotic treatment with meropenem. The patient then re-presented to the ED approximately a week after discharge with signs of worsening disease including bilateral multifocal pneumonia. Imaging showed multiple pneumothoraces complicated by lung collapse and respiratory failure. The patient also had worsening neurological manifestations and further bone and joint involvement. CDC analysis of cultures identified resistance to meropenem. The patient was switched to ceftazidime and trimethoprim-sulfamethoxazole before escalation to imipenem. The patient expired six weeks from initial presentation due to worsening pulmonary and neurologic manifestations. DISCUSSION: As of 2020, only one confirmed case of melioidosis has been documented in the U.S. since 1945 (2). The incidence of this infection is reportedly increasing throughout the world and regions of endicimity are expanding. Its difficulty to diagnose contributes to a high mortality rate of 20-50% as of 2020 (2). 50% of patients will present with bacteremia and 20% of patients will progress to a fulminant septicemia (1). CONCLUSIONS: This case report identifies a case of melioidosis with both classic disease manifestations (pulmonary involvement), as well as less common manifestations (bone and joint involvement) and emphasizes the need for a broad differential when the patient presents with a non-specific, multi-organ clinical syndrome after travel. Although previously thought to be endemic only to Asian and Australian populations, more and more cases are being seen in South America, central America, and the Caribbean (2). With this being the case, the incidence of Melioidosis has the potential to increase in the U.S and further discussion of epidemiology, clinical presentation, and treatment is warranted for critical care, pulmonology, infectious disease, and primary care physicians. Reference #1: Chakravorty A, Heath CH. Melioidosis: An updated review. Australian Journal of General Practice. 2019;48(4):327-332. doi:10.31128/ajgp-04-18-4558 Reference #2: Gassiep I, Armstrong M, Norton R. Human melioidosis. Clinical Microbiology Reviews. 2020;33(2). doi:10.1128/cmr.00006-19 DISCLOSURES: No relevant relationships by Rose Puthumana No relevant relationships by Rachel Werne