Melioidosis presenting as sepsis syndrome: a case report

Abstract

Melioidosis is an important disease in Asia and Australia. It is very rare in Venezuela. We describe the case of a 50-year-old diabetic patient with several episodes of right tibial osteomyelitis, left shoulder arthritis, sternal osteomyelitis, right parietal osteomyelitis, and subperiosteal abscess, followed by septic arthritis of the right knee. In all cases Gram stain smear showed Gram-negative bacilli. Culture yielded Burkholderia pseudomallei, susceptible to third- and fourth-generation cephalosporins, ciprofloxacin and aztreonam, and resistant to aminoglycosides. He developed sepsis syndrome. Blood cultures and culture of abscess and joint fluids also revealed B. pseudomallei. The patient was treated with ceftazidime and ciprofloxacin, then cefepime and trimethoprim-sulfamethoxazole. He was discharged with suppressive therapy consisting of oral doxycycline and trimethoprim-sulfamethoxazole, and follow-up has continued to date. At this time he remains asymptomatic. Melioidosis is an extremely rare disease in our country. To our knowledge, this is only the second case reported in Venezuela.

Presence of B. thailandensis and B. thailandensis expressing B. pseudomallei-like capsular polysaccharide in Thailand, and their associations with serological response to B. pseudomallei

“…Humans acquire the disease following skin inoculation, inhalation or ingestion of the bacterium from the environment. The disease is highly endemic in Southeast Asia and Northern Australia [ 1 ], and is increasingly being reported in South Asia, Africa and Central and South America [ 2 , 3 ]. A recent modeling study estimated that there are about 165,000 human melioidosis cases per year worldwide, of whom 89,000 (54%) die [ 4 ].…”

Melioidosis in South America

“…Three cases of human melioidosis have been described in Venezuela from 1995 to 2003 [ 4 , 6 ]. In Colombia, after the first report in 1998 [ 27 ], a total of 11 further cases have been described up to 2015 ( Table 1 ) [ 1 , 2 , 3 , 4 , 5 , 6 , 13 , 14 , 19 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 ]. Initially, the reports were clustered in the region of Antioquia, where there is a university referral hospital, although two cases were reported from other regions.…”

Septicaemic Melioidosis in a Diabetic Patient From a Tertiary Care Centre in Kerala

“…4 Pneumonia is the most frequent presentation of melioidosis and is involved in approximately half of all cases. 1 But when presenting as acute septicaemic melioidosis, the mortality is high, at least 34% despite treatment with ceftazidime, the current treatment of choice. 5 Isolation of B. pseudomallei from the body fluids of patients still remains the gold standard in the diagnosis.…”