Melioidosis as a Cause of Acute Abdomen in Immuno-Competent Male from Eastern India

Abstract

Though melioidosis is rare in India, it has gained importance as one of the most potent emerging infections. In India, the cases have been under-reported because of the lack of awareness. The majority of cases present with multifocal pyogenic infections with septicemia. We present an unusual case of melioidosis presenting as acute intestinal perforation. The organism was ceftazidime resistant, and we successfully treated the case with imipenem and doxycyclin. This case highlights ruling out the possibility of melioidosis in acute abdomen and existence of ceftazidime resistant cases in India.

Acute Pneumonia Like Illness and Sepsis in India: Is it Time to Suspect Pulmonary Melioidosis?

“…The presentations included chronic osteomyelitis [ 15 ], relapsing pneumonia [ 16 ] and melioidosis masquerading as a brain abscess with meningitis [ 9 ]. A thorough literature from various other medical databases revealed other presentations of melioidosis across the world with large case series conducted in Australia and Western India, most cases occurred in immunocompromised conditions or with underlying comorbid conditions or risk factors such as diabetes mellitus, renal failure, farmers or recent travel history to highly endemic areas as shown by literature but this case was unique to not have any of the above [ 8 ] and occurred in an immunocompetent host, similar to Karuna et al [ 7 ].…”

“…Burkholderia pseudomallei is an organism of growing concern in the recent few years in India, where an increased number of cases have been reported in the last decade, including our institute [ 2 , 6 - 7 , 11 ]. A saprophytic bacteria hosts a wide array of virulence factors such as the polysaccharide capsule, lipopolysaccharides, toxins, enzymes such as hemolysin, lipases and proteases, type III secretory systems, quorum sensing, type IV pilli and siderophores for iron stealing [ 12 ].…”

“…Burkholderia pseudomallei, a previously rare Gram-negative bacteria, presents with a wide variety of clinical conditions congregated as melioidosis, a severe and potentially fatal disease caused [1]. The disease is earlier endemic majorly in Southeast Asia [2][3], and Northern Australia [4], now has a rising trend of detection in India and has also been reported in India in a few situations [5][6][7].…”

“…The source of B. pseudomallei in India is thought to be soil and water [ 2 , 7 ]. The organism can survive in a variety of environmental conditions and can infect humans through multiple routes, including inhalation, skin contact, and ingestion.…”

A case of fatal septicaemic melioidosis from Odisha

“…6 There are recent reports of ceftazidime resistance in Indian B. pseudomallei also and requires active monitoring. 7,8…”