Melioidosis after a long silence in Sri Lanka: an environmental hazard and dilemma in diagnosis, with recovery and longitudinal follow-up for 13 years: a case report

Abstract

Background: Melioidosis is a potentially fatal bacterial infection caused by Burkholderia pseudomallei. The existence of melioidosis in Sri Lanka was once unheard of, and entertaining it as a diagnosis in clinical practice was extremely rare. Case presentation: In this case report, we describe the clinical, epidemiological, and longitudinal follow-up data of a 58-year-old previously healthy Sinhalese woman who presented to our hospital with protracted febrile illness of 5 weeks' duration, later developing multiple abscesses at different sites of the body. There was a significant delay in confirming the diagnosis of melioidosis by isolating B. pseudomallei from blood and pus cultures. The patient recovered fully with a prolonged course of antibiotics and has remained in good health over the last 13 years without recurrence. Despite being immunocompetent, she had contracted the infection by a brief contact with mud soil in a footpath. Conclusions: A high index of clinical suspicion along with laboratory support is needed to confirm the diagnosis of melioidosis. Treatment with sensitive antibiotics over a long duration is needed, and longitudinal follow-up is essential to detect recurrences. This case raised awareness and created renewed interest in studies of melioidosis in Sri Lanka.

Melioidosis presenting as pneumonia and left parietal lobe focal meningitis with a subdural collection: a case report

“…Neurological melioidosis is rare (seen in about 5%), and may present with brain or epidural abscesses, encephalomyelitis, aseptic meningitis, dural venous sinus thrombosis or transverse myelitis. Isolated subdural collections associated with melioidosis are rarely reported [13].…”

Severe Sepsis with Multiorgan Failure due to Melioidosis: A Lesson to Learn

“…Definitive diagnosis requires identification of Burkholderia pseudomallei in clinical specimens ideally by using Ashdown broth [ 14 , 15 ]. Bacterial culture has 100% specificity in diagnosing melioidosis; however, sensitivity has been estimated as low as 60% in one Bayesian model [ 16 ].…”

“…Burkholderia pseudomallei shows resistance to many antibiotics [ 14 ]. It is sensitive to tetracycline, trimethoprim-sulfamethoxazole, chlorampenicol, 3 rd generation cephalosporin (ceftazidime), amoxicillin-clavulanic acid, ureidopenicillin, cefoperozone/sulbactam, azithromycin, and carbapenem [ 14 ]. This patient's isolate was resistant to ceftazidime but sensitive to meropenem and trimethoprim-sulfamethoxazole.…”

Melioidosis : The Great Mimicker: A Case Report

“…It is commonly seen among agricultural workers. The disease was first described by the pathologist Captain Alfred Whitmore and his assistant C.S.Krishnaswami [2]. Melioidosis emerged as a major public health concern in Thailand in the latter half of the 21st century, accounting for 20% of all community acquired bacteraemias in Ubon Ratchathani, Thailand [3].…”

“…The first case of melioidosis in Sri Lanka was reported in 1927 in a European tea broker. Sri Lanka was the third country to report melioidosis in the literature and the first country to detect melioidosis in South Asia [2]. Sri Lanka lies in the endemic belt of the disease.…”