A first report of pulmonary melioidosis in Cambodia

Abstract

Melioidosis has never been officially reported from Cambodia. Here we report two cases, a 58-year-old male (case 1) and a 49-year-old female (case 2) who presented with respiratory illnesses featuring multiple lung abscesses. The sputum culture of both patients, taken in the framework of a laboratory-based study on aetiologies of (sub-)acute respiratory infections among hospitalized patients in southern Cambodia, grew Burkholderia pseudomallei. The most striking aspect of these case stories was the extent of the delays in diagnosis. Presenting with a 1-month history of respiratory symptoms, case 1 was first suspected of tuberculosis (TB) infection, and then misdiagnosed as 'metastatic lung cancer' in Phnom Penh, Cambodia. Case 2 suffered from pulmonary infections for >10 years, during which time she was treated for TB four times. Neither patient ever produced acid-fast-bacilli (AFB)-positive sputum. Following our laboratory confirmation, the patients were traced for re-admission. Under the 'classical' trimethoprim sulphamethoxazole, chloramphenicol and doxycycline treatment, their clinical status improved considerably within 2 weeks. The two study cases illustrate issues relating to the misdiagnosis of melioidosis in Cambodia; an unfamiliarity of clinicians with the disease, which is associated with a high prevalence of TB. Therefore, a heightened awareness of melioidosis among clinicians would have a substantial impact on public health as the non-septicaemic form of the disease is potentially treatable with antibiotics that are available in Cambodian public hospitals.

Etiologies and Resistance Profiles of Bacterial Community-Acquired Pneumonia in Cambodian and Neighboring Countries’ Health Care Settings: A Systematic Review (1995 to 2012)

“…B. pseudomallei was the only pathogen causing CAP in the region which does not widely circulate in developed countries [39], [41], [52], [57], [58]. Melioidosis has recently been described as a frequent, endemic pathogen in Cambodia, but its true incidence in the community remains unknown [30], [47], [51], [59].…”

Emergence of Pediatric Melioidosis in Siem Reap, Cambodia

“…Melioidosis was first reported from Laos in 2001 after the development of a diagnostic microbiology laboratory at Mahosot Hospital, Vientiane,10 and B. pseudomallei was subsequently isolated from the surrounding environment 11 . B. pseudomallei has also been isolated from rice paddies in Siem Reap province in northwest Cambodia,12 and a recent report of two cases of melioidosis in adults from southern Cambodia has confirmed the presence of melioidosis in the indigenous population 13. A seroprevalence study of children presenting to a hospital in Siem Reap detected antibodies to B. pseudomallei in 16% of cases,12 but melioidosis has not been detected previously in this pediatric population.…”

Melioidosis: Clinical impact and public health threat in the tropics

“…The first case of pulmonary melioidosis was reported in southern Cambodia. For example, a 58-year-old male patient and a 49-year-old female patient presented with respiratory illness and severe lung abscesses [54]. Subsequently, another 2 melioidosis cases were documented in Cambodian residents in Canada, as well as the United States.…”