Introduction: Legionella pneumophila can cause severe community acquired pneumonia which may be life threatening. This organism is found in aquatic environments and infection is acquired through inhalation of aerosols. Few studies conducted in Sri Lanka have confirmed the presence of this organism in cooling tower water in Sri Lanka. Published data regarding human cases of legionellosis in Sri Lanka is not available. Objective: To determine the prevalence of community acquired pneumonia due to L. pneumophila among patients who required hospital admission and assess the risk factors associated with this infection. Methods: The study was carried out from July 2014 to June 2015 at the Teaching Hospital, Peradeniya. Expectorated sputum or endotracheal secretions and urine specimen were collected within 24 hours of admission after obtaining consent from all adult patients admitted during the study period with community acquired pneumonia. Respiratory specimens, if obtained, were inoculated onto Buffered Charcoal Yeast Extract (BCYE) agar and were inoculated at 35 º C-37 º C for 7 days and observed for typical colonies. Urine specimens were stored at-20 º C and ELISA test was performed for the detection of L. pneumophila serogroup 1a antigen. Results: Eighty urine specimens and 27 respiratory specimens were obtained form 80 patients. None of the respiratory specimens grew suspected colonies of L. pneumophila and all urine specimens were negative for L. pneumophila serogroup 1a antigen. Conclusion: L. pneumophila serogroup 1a was not identified as the pathogen responsible for community acquired pneumonia in this study sample.

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IntroductionMelioidosis is an emerging infection in Sri Lanka, acquired by inoculation or inhalation of soil and water containing Burkholderiapseudomallei. The disease may be acute, chronic, localized or disseminated. Case reportA 55 year old male with poorly controlled diabetes mellitus presented with fever for 5 days and left sided abdominal pain in January 2017. Two years previously, just after returning from Malaysia, he developed recurrent episodes of a neck abscess. His CRP was 192 mg/L. Ultrasound abdomen revealed splenomegaly with multiple focal lesions. Blood culture grew B. pseudomallei with a positive antibody titre of >1280. He was treated with IV ceftazidime and oral cotrimoxazole for two weeks and discharged on oral cotrimoxazole for ten more weeks.Five months later he presented with fever, left sided abdominal pain and difficulty in breathing for 5 days and admitted discontinuation of the eradication phase cotrimoxazole after 4 weeks. The white cell count was 21.47 x 109/L and CRP was 185 mg/dl. Ultrasound abdomen showed a small subphrenic collection with splenic abscesses. On the CT scan, there were empyema of the left lung, a subphrenic collection and multiple abscesses in the spleen, liver and kidneys. Aspirated pus grew B. pseudomallei after 4 attempts and prolonged incubation of the sample. The melioidosis antibody titre was >10240. On admission, he was started with IV ceftazidime, oral doxycycline and cotrimoxazole in high doses. The patient improved clinically and was discharged after counselling on completing the eradication phase of treatment. Discussion and ConclusionRecurrent melioidosis may be caused by relapse or reinfection. Inadequate intravenous antibiotics, multifocal infection, bacteraemia, disseminated melioidosis during the primary episode and inadequate duration and poor compliance of eradication therapy are associated with recurrences. The second episode is a probable relapse which was not confirmed due to unavailability of genotyping facilities. Knowledge on the nature of the disease with its propensity to relapse, prompt aspiration of abscesses and repeated attempts at culture were important in confirming the relapse in this case. It is the responsibility of the clinicians to counsel the patient on discharge about the importance of compliance with the eradication treatment to prevent life threatening relapses.

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