Reports of unusual microorganisms causing human infections are on the rise due to transitions in epidemiological trends. Commensal/normal flora which are otherwise termed as ‘good bacteria’ are now causing infections in different group of patients, mostly immunocompromised individuals. Various host and environmental factors play a pivotal role in microbial transmigration from their normal habitat into the blood and other body sites. We report one such ‘good bacterium’ associated with sepsis in a patient who was given the same bacterium in the form of probiotics.

Pulmonary infections are not uncommon in patients with an underlying immunocompromised condition. Unusual combination of microorganisms causing concomitant infections among these patients has also been reported. However, certain rare dual occurrences are usually unanticipated as in the case we present here. This case highlights the importance of being aware of the possible coexistence of infections in immunocompromised patients. To the best of our knowledge, this is the first report of coinfection with Nocardia otitidiscaviarum and Orientia tsutsugamushi in a critically ill immunocompromised patient from South India.

A bstract Key Points (1) Diabetes, hazardous alcohol use, and/or significant heart disease are more likely to develop a critical illness with melioidosis. (2) Pneumonia is the most common presentation. Those with pneumonia or bacteremia are most likely to require intensive care unit admissions. (3) Culture is the mainstay for the diagnosis. However, it is noted that Burkholderia pseudomallei is often wrongly identified as Pseudomonas or other Burkholderia species by commonly available commercial techniques. (4) Therapy consists of an intensive phase with intravenous antibiotics to prevent mortality followed by an eradication phase with oral antibiotics to prevent relapse. (5) Meropenem is the drug of choice for those with septic shock or neurological involvement. For patients with nonpulmonary organ focal sites of infection (neurologic, prostatic, bone, joint, cutaneous, and soft tissue melioidosis), the addition of trimethoprim-sulfamethoxazole (TMP-SMX) to ceftazidime/carbapenem during intensive therapy is recommended. TMP-SMX is the drug of choice for oral antibiotic therapy during the eradication phase. (6) Adequate source control is essential for successful treatment and to prevent relapse. (7) The use of granulocyte-colony stimulating factor (G-CSF) those with septic shock is controversial. How to cite this article Sridharan S, B Princess I, Ramakrishnan N. Melioidosis in Critical Care: A Review. Indian J Crit Care Med 2021; 25(Suppl 2):S161–S165.

According to the Centers for Disease Control and Prevention, from being nonendemic for melioidosis, India has now become endemic for the disease since 2012. Until then, melioidosis cases were being reported sporadically from India. There have been isolated case reports from few states across the country for the past few years. Most of the times, Burkholderia pseudomallei may be misreported as Pseudomonas species, especially in resource-poor laboratories. Due to its varied clinical presentation, the specific clinical diagnosis can be difficult, thereby making laboratory diagnosis mandatory. This could make a huge impact on patient care as this organism has a different treatment protocol as well as virulence determinants which influence the course of management. Although known for its endemicity in Australia, Thailand, and other Southeast Asian countries, B. pseudomallei has emerged in new areas such as India, Southern China, Brazil, and Malawi. We present a rare case of melioidosis with rapid disease progression to fatal outcome from Chennai, South India.

<p>The first theory which has established itself across the world is that COVID-19 is a “new virus”. It is rather wise to call it a “new strain” of a pre-existing coronavirus since history clearly denotes cases of coronavirus surfacing the world in past years beginning as early as mid-1960s.Including this novel strain of the virus, seven strains of coronaviruses have been commonly associated with human infections. Coronaviruses are primarily respiratory viruses causing infections ranging from mild to severe involvement of the respiratory tract. The common cold strains of coronavirus are 229E alpha coronavirus, NL63 alpha coronavirus, OC43 beta coronavirus and HKU1 beta coronavirus.The acute respiratory distress causing strains are severe acute respiratory syndrome (SARS) beta CoV causing SARS, MERS beta CoV causing Middle East respiratory syndrome (MERS) and the very novel COVID-19. Researchers and molecular biologists have confirmed phylogenetic relationship of COVID-19 with a 2015 Chinese bat strain of SARS CoV.Mutations to the surface protein as well as nucleocapsid proteins were demonstrated. These two mutations predicts the characteristics such as higher ability to infect as well as enhanced pathogenicity of COVID-19 as compared to older SARS strain. For this reason and with similarities in clinical presentation the novel strain has been named as SARS-CoV-2.</p>