Acute Melioidosis in a Soldier Home From South Vietnam

Abstract

A fatal case of acute melioidosis occurred in a soldier who had recently returned from Vietnam. Pseudomonas pseudomallei was identified by culture of blood specimens taken before and after death, animal inoculation, and fluorescent antibody tests. Chloramphenicol is the drug of choice in this disease.It is imperative that military and civilian physi¬ cians be aware of the exotic infections which may confront our servicemen in Southeast Asia. The rapid transportation of military personnel to our shores literally brings the exotic diseases of the East to our doorstep. Melioidosis is one such disease. This paper reports this infection in a soldier who recently returned home from South Vietnam. Report of a CaseThis 22-year-old white man (Register No. 106 349) had a transient febrile illness of obscure etiology four months before his death but otherwise had been in good health. He had been stationed in South Vietnam since January 1966 (with the exception of temporary leave to the United States in June 1966), but was sent home on Oct 6, 1966, for emer¬ gency leave. Soon after he arrived, severe bilateral frontal headache, anorexia, nausea, prominent sore throat, dysphagia, and generalized myalgia developed. He was seen in the emergency room of a civilian hospital and given what was probably penicillin, orally and intramuscularly, with¬ out relief.On Oct 12, 1966, he was admitted to a civilian hospital. Physical examination revealed a temperature of 105 F (40.6 C), flushed skin, a striking pharyngitis with tonsillar exúdate, marked anterior cervical lymphadenopathy, clear lungs on auscultation, right and left upper abdominal ten¬ derness, and a staggering gait thought to be due to weak¬ ness.The hemoglobin level was 13 gm/100 ml and the white blood cell count (WBC) was 8,800/cu mm, with a normal differential. Prothrombin time was 75% of normal. Re¬ peated smears for malaria were negative, throat culture grew /3-hemolytic streptococcus, and results of urinalysis were normal. An antistreptolysin O titer was 250 Todd units. Febrile agglutinin titers were 1:40 to 1:80 to the typhoid and paratyphoid antigens. Skin test with purified protein derivative tuberculin was negative. Tularemia ag¬ glutination titer was 1:20. Stool cultures were negative. Sulfobromophthalein (BSP) retention was 22%. Numerous blood cultures were negative. A chest film revealed accen¬ tuated hilar markings with perihilar streaking, suggesting to the radiologist a viral pneumonia.The patient was treated with 6 million units procaine penicillin daily for six days, 5 gm chloramphenicol (Chloromycetin) daily for three days (discontinued after WBC decreased to 5,000/cu mm), and 2 gm sodium methicillin daily for four days. His hospital course was characterized by spiking temperature to 105 F and rapidly progressing weakness. The patient's hematocrit value dropped to 34% during his admission.See also page 452.On Oct 22, 1966, he was transferred to US Air Force Hos¬ pital Wright-Patterson for evaluation of fever of obscure etiology. On admission to this hospit...

Development and Characterization of a Caprine Aerosol Infection Model of Melioidosis

“…It has been reported in goats in association with central nervous system lesions [44]. There are a limited number of papers with detailed histopathologic descriptions of human disease [12]–[15], [47], [48], none of which report vasculitis. The majority of these reports are based on acute fatal cases with lesions that are more suppurative in nature.…”

“…The majority of these reports are based on acute fatal cases with lesions that are more suppurative in nature. Zones of hemorrhage, particularly surrounding pulmonary lesions are frequently reported in acute human cases [12], [13], [15], [47], [48], but have not been reported to be associated with vasculitis. A more recent paper, which also included a number of surgical biopsy samples from chronic cases in addition to acute fatal cases, specifically noted that vasculitis was not found, and only reported hemorrhage being variably present in biopsy samples [14].…”

Particle-size dependent effects in the Balb/c murine model of inhalational melioidosis

“…This is similar to other pathogens infective via the URT, including Yersinia pestis and Bacillus anthracis (Thomas et al, 2009, 2010). URT pathology resulting from B. pseudomallei infection has been observed in US soldiers returning from Vietnam and patients in South-East Asia presenting amongst other symptoms with severe pharyngitis with tonsillar exudates, suppurative cervical lymphadenopathy, and acute pansinusitis (Patterson et al, 1967; Lim et al, 2001). This pathology is consistent with the murine infection produced after the inhalation of 12 μm aerosol particles.…”

Melioidosis: Clinical impact and public health threat in the tropics

“…Military personnel serving in Vietnam have been reported with acute and fatal melioidosis [43,44] (for example, they were diagnosed with septicemic melioidosis following acute influenza [45]). About 100 melioidosis cases were reported during the war of Vietnamese independence, during or after 1948–1954 [43,46].…”