Unusual Case of Surgical Site Infection with Uncommon Organism – Burkholderia pseudomallei

Abstract

Melioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei, previously termed as Pseudomonas pseudomallei. This case report is an unusual case of surgical site infection with uncommon organism-B. pseudomallei. We report a case of melioidosis. A 62-year-old patient complained of swelling, redness, discharge from the surgical site right hip, and on and off generalized temperature from the last 15 days. The patient was toxic. Erythrocyte sedimentation rate was 130, C-reactive protein – 92, and Hb – 9.2, and on further blood investigation, the patient was diagnosed with surgical site infection with an implant in situ and underwent implant removal and surgical debridement of right hip, by intraoperative pus culture shows Staphylococcus aureus growth, and the patient was started on intravenous cefoperazone-sulbactam 1.5 g for 1 week, following which symptoms reappear. Later, Gram-stain shows the growth of B. pseudomallei. He was started on injection ceftazidime 2 g thrice daily (TDS) (Q8 hourly) for 2 weeks followed by oral cotrimoxazole for the next 9 months, the patient is on regular follow-up. Diagnosis of melioidosis is missed in many parts of the world due to lack of awareness of this infection caused by B. pseudomallei. Delay in diagnosis or treatment against melioidosis can worsen the outcome. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.