Systemic Melioidosis Research Articles

A Rare Case of Permanent Complete Heart Block in a 61-year-old Female Presenting With Recurrent Syncope and Systemic Melioidosis From Rural Queensland

A Rare Case of Permanent Complete Heart Block in a 61-year-old Female Presenting With Recurrent Syncope and Systemic Melioidosis From Rural Queensland

Peritoneal dialysis-related peritonitis from Burkholderia pseudomallei infection (Melioidosis) of northeast Thailand

Objectives: Melioidosis is an uncommon cause of peritonitis in patients with end-stage renal disease who are receiving continuing peritoneal dialysis. This study aims to investigate the prevalence and outcome of peritoneal dialysis-related peritonitis due to Burkholderia pseudomallei infection. Materials and Methods: A retrospective cohort study of melioidosis infection between 2018 and 2022, peritoneal dialysis-related peritonitis in cases with end-stage renal failure was collected. The patients’ demographics, clinical characteristics, and treatments were described. Results: Of the 194 cases diagnosed with peritoneal dialysis-related peritonitis, there were 7 patients (3.6%) with melioidosis peritonitis. The patients’ mean age was 51.1 ± 9.44 years old, range of 40–65. Diabetes (5 cases, 71.4%) and hypertension (7 cases, 100%) were the most common co-morbidities. Six cases (85.7%) had fever, 5 (71.4%) had hazy dialysate, and everyone had abdominal pain as clinical signs. Associated septicemia was observed in 5 (71.4%) cases. As part of their antibiotic therapy, meropenem was given to 1 (14.3%) and ceftazidime to 6 (85.7%) cases. Six cases (85.7%) received intravenous antibiotics, whereas 1 (14.3%) case received both intravenous and intraperitoneal routes. The catheters were removed; then, hemodialysis sessions of 5 (71.4%) cases were initiated. Hemodialysis mode was switched permanently in 3 (42.9%) cases and temporarily in one case, thereafter, peritoneal dialysis was resumed. 3 (42.9%) cases died. No significant relations were found about risk factors between survivor and non-survivor group (P < 0.05). Conclusion: Peritoneal dialysis-related peritonitis due to melioidosis is uncommon. However, it may be accompanied by catheter loss and can be lethal if untreated as systemic melioidosis.

<i>Burkholderia pseudomallei</i> - an unusual cause of septic embolism

Melioidosis is an infection caused by the Gram-negative bacterium Burkholderia pseudomallei. It is endemic in many regions, including Southeast Asia, Northern Australia, South Asia (including India), and China. The presentation of melioidosis varies from localized infection to systemic sepsis. The most common causes of septic emboli are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and the Salmonella group, but here we reported a case of pulmonary septic emboli, necrotizing pneumonia, and septic arthritis in case of systemic melioidosis infection.

Systemic melioidosis with prostatic abscess

Melioidosis is an infectious disease caused by the Gram-negative bacteria Burkholderia pseudomallei. The organism is a soil saprophyte and humans acquire infection via percutaneous inoculation through a breach in the skin. Inhalation of the organism is also a probable route of transmission as evident by a high incidence during the rainy season. Outbreaks of melioidosis have also occurred due to ingestion of water contaminated with B. pseudomallei. Sri Lanka is an endemic country for melioidosis.A 60-year-old male patient with hypertension presented with fever, chills, dysuria, and urinary retention. His blood culture signaled positive, and the isolate was identified as Burkholderia pseudomallei. He was managed for melioidosis complicated with prostatic abscess. He was successfully treated with intravenous meropenem in the intensive phase and discharged with oral co-trimoxazole during the eradicative phase.Though the patient was initially treated for a prostatitis and urosepsis, correct identification through blood culture and appropriate investigations aided us to identify the prostatic abscess and treat the Burkholderia pseudomallei bacteraemia accordingly.

POS-716 BURKHOLDERIA PSEUDOMALLEI (MELIOIDOSIS) PERITONEAL DIALYSIS PERITONITIS

Melioidosis is known to be endemic in Southeast Asian countries, including Malaysia where it commonly presents as severe pneumonia or abscesses. In end stage renal disease (ESRD) patients on peritoneal dialysis (PD), melioidosis is rarely reported as the cause of peritonitis. These are retrospective case series of PD for the past 6bmonths secondary to Melioidosis. Clinical features and managements of these two patients are being described. Case series: We reported 2 cases of ESRD patients on continuous ambulatory peritoneal dialysis (CAPD). Both patients were diabetics and presented with typical symptoms of peritoneal dialysis peritonitis where the dialysate effluents grew Burkholderia pseudomallei. Patient 1 was hypotensive on presentation and started on broad spectrum antibiotics, intravenous (IV) ceftazidime. He responded well and completed 4 weeks of intensive IV ceftazidime and was switched to oral Bactrim as eradication therapy upon discharged. Patient 2 was hemodynamically stable and promptly started on intraperitoneal (IP) ceftazidime. Unfortunately, he did not respond despite escalation to intraperitoneal imipenem. His Tenckhoff catheter was removed subsequently and he was converted to haemodialysis (HD). Both patients completed the intensive phase of treatment and were discharged on oral eradication therapy for the treatment of melioidosis. Both are currently well with no relapse. Discussion: There have been few treatment options for melioidosis peritonitis. Treatment comprises of intensive phase, usually IV ceftazidime or meropenem, followed by a prolonged course of eradications phase. If IV antibiotics fail to treat the peritonitis, prompt Tenckhoff catheter removal will be the next appropriate course of action. In our cases, one patient had catheter loss due to melioidosis peritonitis while the other was able to continue on PD. PD peritonitis due to melioidosis is uncommon but it may be associated with catheter loss and possibly fatal if not treated early as systemic melioidosis is associated with high mortality. Early diagnosis, high awareness and prompt management are important in treating melioidosis PD peritonitis.

Endogenous endophthalmitis secondary to melioidosis in paediatric patients: Case series and review article

Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.

Systemic Melioidosis – uncommon cause of osteomyelitis in a non-endemic region

Melioidosis being tropical disease caused by soil saprophyte Burkholderia pseudomallei. We report a case in a farmer with cardiomyopathy and diabetes mellitus developed septic arthritis and osteomyelitis. Since south India is a non-endemic region for melioidosis, atypical presentation can lead to diagnostic delay and systemic sepsis. Awareness of melioidosis in recent times as anaetiology of isolated osteomyelitis in an immune-compromised individual.

A Case of Systemic Melioidosis: Unravelling the Etiology of Chronic Unexplained Fever with Multiple Presentations

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.

Multifocal Bone and Visceral Melioidosis in a Cirrhotic Patient Identified by 99mTc MDP Bone Scan

A 58-year-old diabetic male with hepatic cirrhosis presented with fever and vague bone pains. Technetium methylene diphosphonate (99mTc MDP) three phase bone scan (Figures 1 and ​and22) identified not only multiple sites of bone involvement but also extraskeletal renal involvement that was later proven by culture. Burkholderia pseudomallei was isolated from a blood culture, confirming a diagnosis of systemic melioidosis. Although lung abscess is the most common presentation disseminated disease often occurs, particularly in the presence of impaired host immunity, which was apparent in this patient. Pleural effusion, skin and soft tissue swellings, and liver and splenic abscesses may be encountered. Neurological involvement (brain stem encephalitis, cerebral abscess, cranial nerve palsies, and paraparesis), although less common, can be seen in 4% of cases. Figure 1. 99mTc MDP regional three-phase bone scan showed multifocal bone involvement. Vascular and soft tissue phase images showed symmetrically increased vascularity and soft tissue tracer uptake in both knee joints. Increased soft tissue tracer uptake was noted ... Figure 2. 99mTc MDP whole-body bone scan. Skeletal phase images depict diffusely intense tracer uptake in the left femoral shaft with interspersed small cold defects. A hot spot is seen in left eighth rib posteriorly with associated increased tracer uptake in the ... Melioidosis1 is a great masquerader, and it is often confused with staphylococcal abscesses in acute form, tuberculosis in chronic presentations, or a generalized sepsis. Aspirated pus may show caseating material similar to the material in tuberculosis, and tissue biopsy may show granuloma.

A Melioidosis Patient Presenting with Brainstem Signs in the Emergency Department

BackgroundNeurological abnormalities in melioidosis are rare but may manifest as an acute stroke, and in the emergency department (ED), an inappropriate stroke treatment may threaten a patient’s life. ObjectivesA case of cerebral melioidosis is reported in a patient presenting with brainstem signs to increase awareness of the uncommon presentations of melioidosis that may cause a delayed diagnosis in the ED. Case ReportA 45-year-old man who worked as a construction worker, with diabetes mellitus and alcoholic liver cirrhosis, presented to the ED after a 10-day period of fever and cough. He was initially diagnosed and treated as a case of community-acquired pneumonia. However, a sudden change in consciousness with 6th and 7th cranial nerve palsy and flaccid paralysis were noted while he was in the ED, and acute brainstem stroke was suspected. Brain magnetic resonance imaging disclosed brainstem lesions, slightly hypointense on T1-weighted images and hyperintense on T2-weighted images. Blood and urine cultures subsequently yielded Burkholderia pseudomallei. Abdominal computed tomography revealed multiple small consolidated patches, ground-glass opacities, small nodules in the lower lungs bilaterally, and a pancreatic tail abscess. Systemic melioidosis with lung, pancreas, urogenic tract, and brainstem involvement was diagnosed. Three weeks after admission, the patient died from a sudden onset of apnea and asystole. ConclusionsIn light of this case, patients with identifiable risk factors, especially underlying diabetes, a history of positive soil contact, and those who lived in an endemic area or ever traveled to an endemic area, and who present themselves with fever and neurologic deficit or multi-organ involvement, should have melioidosis considered in the differential diagnosis.

Systemic melioidosis presenting as suppurative parotitis

A 3 year old child was brought with fever, left parotid swelling and altered sensorium. Cultures from blood, pus and throat swab grew Burkholderia pseudomallei. A diagnosis of septicemic melioidosis with encephalopathy was made. She recovered following treatment with parenteral ceftazidime for 14 days, and 6 months of oral co trimoxazole and amoxycillin clavulanate. She is doing well on follow-up.

Neuromyelitis optica antibodies

Neuromyelitis optica (NMO) is a severe demyelinating disease that affects the optic nerve and spinal cord. It is considered a variant of multiple sclerosis; however, prognosis is worse and management approach differs from that of multiple sclerosis. Differentiating NMO from more common causes of transverse myelitis (TM), particularly secondary to systemic infection, is important for prognostic and therapeutic reasons. The diagnosis of NMO is dependent upon the identification of antibodies against aquaporin-4. Aquaporin-4 is the principal water channel in the central nervous system – controlling water movement between the brain, CSF and blood. It is a component of the dystroglycan protein complex located in the astrocyte foot processes at the blood brain barrier. The original method of detection of anti-NMO-IgG is indirect immunofluorescence (IIF) using a composite of frozen mouse sections including cerebellum, midbrain and kidney medulla. The typical staining pattern must include staining of the renal papilla, located in the medulla of the kidney; staining around the blood vessels, pial surfaces and the Virchow-Robin space in the cerebellum and midbrain. We observed atypical NMO-IgG-like IIF staining in a patient with TM secondary to systemic melioidosis. As atypical staining could be mistaken for NMO-IgG, we evaluated the presence of NMO-IgG-like IIF staining patterns in a range of patients with systemic infections. Sera from patients with serological evidence of acute infection caused by common bacterial/viral pathogens and other controls were tested using IIF. No patients fulfilled clinical or radiological criteria for NMO. IIF staining was interpreted according to the original description of NMO-IgG.1 Several NMO-IgG-like IIF patterns were detected and while different staining combinations of central nervous system microvessels, pia, subpia, Virchow-Robin space and renal papilla tubules were detected, overall patterns were atypical compared with that originally defined.1 This study demonstrates the importance of experience in interpretation of IIF and strict adherence to the original NMO-IgG description1 to ensure the correct interpretation in patients with systemic infections that may be complicated by TM. Given clinical implications of a diagnosis of NMO, standardisation in reporting NMO-IgG IIF to reduce the risk of reporting atypical NMO-IgG-like patterns as NMO-IgG is required. Neuromyelitis optica (NMO) is a severe demyelinating disease that affects the optic nerve and spinal cord. It is considered a variant of multiple sclerosis; however, prognosis is worse and management approach differs from that of multiple sclerosis. Differentiating NMO from more common causes of transverse myelitis (TM), particularly secondary to systemic infection, is important for prognostic and therapeutic reasons. The diagnosis of NMO is dependent upon the identification of antibodies against aquaporin-4. Aquaporin-4 is the principal water channel in the central nervous system – controlling water movement between the brain, CSF and blood. It is a component of the dystroglycan protein complex located in the astrocyte foot processes at the blood brain barrier. The original method of detection of anti-NMO-IgG is indirect immunofluorescence (IIF) using a composite of frozen mouse sections including cerebellum, midbrain and kidney medulla. The typical staining pattern must include staining of the renal papilla, located in the medulla of the kidney; staining around the blood vessels, pial surfaces and the Virchow-Robin space in the cerebellum and midbrain. We observed atypical NMO-IgG-like IIF staining in a patient with TM secondary to systemic melioidosis. As atypical staining could be mistaken for NMO-IgG, we evaluated the presence of NMO-IgG-like IIF staining patterns in a range of patients with systemic infections. Sera from patients with serological evidence of acute infection caused by common bacterial/viral pathogens and other controls were tested using IIF. No patients fulfilled clinical or radiological criteria for NMO. IIF staining was interpreted according to the original description of NMO-IgG.1 Several NMO-IgG-like IIF patterns were detected and while different staining combinations of central nervous system microvessels, pia, subpia, Virchow-Robin space and renal papilla tubules were detected, overall patterns were atypical compared with that originally defined.1 This study demonstrates the importance of experience in interpretation of IIF and strict adherence to the original NMO-IgG description1 to ensure the correct interpretation in patients with systemic infections that may be complicated by TM. Given clinical implications of a diagnosis of NMO, standardisation in reporting NMO-IgG IIF to reduce the risk of reporting atypical NMO-IgG-like patterns as NMO-IgG is required.

Role for theBurkholderia pseudomalleiCapsular Polysaccharide Encoded by thewcbOperon in Acute Disseminated Melioidosis

The capsular polysaccharide of Burkholderia pseudomallei is an essential virulence determinant that is required for protection from host serum cidal activity and opsonophagocytosis. In this study, the immune response directed against a B. pseudomallei capsule mutant (JW270) was investigated in an acute respiratory murine model. JW270 was significantly attenuated in this model ( approximately 2 logs) to levels resembling those of avirulent Burkholderia thailandensis. At lethal doses, JW270 colonized the lung, liver, and spleen at levels similar to the wild-type strain levels and was found to trigger reduced pathology in the liver and spleen. Several cytokine responses were altered in these tissues, and importantly, the levels of gamma interferon were reduced in the livers and spleens of JW270-infected mice but not in the lungs. These results suggest that the capsular polysaccharide of B. pseudomallei is a critical virulence determinant in respiratory tract infections and that it is an important antigen for generating the Th1 immune response commonly observed in systemic melioidosis. Furthermore, the data suggest that host recognition of B. pseudomallei capsular polysaccharide in the lungs may not be as important to the disease outcome as the innate immune response in the peripheral organs.

Cutaneous melioidosis

Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei. This disease is endemic in Southeast Asia and North Australia with sporadic occurrence in temperate countries, mostly imported from travellers. Any organ can be involved in melioidosis whereby Burkholderia pseudomallei causes an acute inflammatory reaction with rapid development of small abcesses which tend to coalesce to form larger abscesses. Cutaneous manifestations vary greatly. We report a man with systemic melioidosis who presented with cutaneous lesions.

Route of Infection in Melioidosis

Route of Infection in Melioidosis

Acute systemic melioidosis. Autopsy findings in four patients.

Melioidosis is a disease caused by the Gram-negative bacillus Pseudomonas pseudomallei . It is endemic in Southeast Asia, but is being seen with increasing frequency in the United States as more military personnel return from Vietnam. We have recently autopsied four patients with relatively minor burns who died with the acute systemic form of melioidosis. The clinical course was that of a fulminating septicemia. Grossly visible lesions were present in three patients, whereas microscopic lesions were present in all. The lungs, liver, spleen, and bone marrow were characteristically involved. The morphogenesis of a t3rpical pulmonary lesion was traced. The grossly visible lesions had a zonal architecture. Necrotic centers were surrounded by degenerative histiocytes. Peripherally, there was a mixed infiltrate of neutrophils and viable histiocytes. The entire lesion was surrounded by a hemorrhagic border. The causative organism was easily seen, using modified Giemsa or Gram stains. Early treatment in one case appeared to sterilize the lesion.

Systemic melioidosis presenting as myocardial infarct.

Case Studies1 October 1967Systemic Melioidosis Presenting as Myocardial InfarctBILLY B. BAUMANN, EUGENE T. MORITABILLY B. BAUMANNSearch for more papers by this author, EUGENE T. MORITASearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-67-4-836 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptMelioidosis (Greek: "resembling a distemper of asses") was originally described in 1912 by Whitmore and Krishnaswami (1) when they distinguished a "disease somewhat resembling, but really easily distinguishable from, glanders prevalent among the ill-nourished, neglected, wastrels of the town" (Rangoon). Since that time hundreds of cases have been reported in the world literature. Although the disease remains largely limited to an endemic area centering in Southeast Asia, at least two cases (2) have been acquired in the western hemisphere.Melioidosis results from infection by the bacillusPseudomonas pseudomallei. Most recognized cases are of the acute variety, but recently a chronic...

Chronic systemic melioidosis: Review of literature and report of a case, with a note on visual disturbance due to chloramphenicol

Chronic systemic melioidosis presents a diagnostic and therapeutic problem. A patient is reported in whom the disease was possibly contracted in the United States. The prolonged course in this patient is the longest on record. What was probably retrobulbar optic neuritis due to chloramphenicol appeared. A review of previously reported cases of chronic melioidosis reveals the varied clinical features of this illness. The disease may be more common in the United States than has been recognized but thus far there are only three reported cases from this country.