Melioidosis: the great mimicker presenting as spondylodiscitis

Garg, Rahul; Shaw, Tushar; Bhat, Shyamasunder N; Mukhopadhyay, Chiranjay

doi:10.1136/bcr-2017-223223

Cited by 11 publications

(9 citation statements)

References 15 publications

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“…[1] It often presents with life threatening sepsis, pneumonia or abscesses in the internal organs, [2,3] but the presentation can also be uncharacteristic making it very difficult to differentiate from other diseases clinically, hence its nickname "the remarkable imitator". [4][5][6][7][8][9][10] In addition, laboratory diagnosis is not straightforward and the organism is often dismissed as a contaminant or misidentified. [11,12] B. pseudomallei is intrinsically resistant to a wide range of antibiotics (penicillin, ampicillin, first-and second-generation cephalosporins, aminoglycosides, macrolides and polymyxins) and routine treatment protocols for sepsis and pneumonia frequently do not cover B. pseudomallei.…”

Section: Introductionmentioning

confidence: 99%

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

et al. 2021

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Background Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. Methodology/Principal findings We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70–7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19–2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21–6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant. Conclusion/Significance This study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar.

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Section: Introductionmentioning

confidence: 99%

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

et al. 2021

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“…Several case reports in previous literature mention predominant bony involvement with abscess formation as the spinal manifestation of melioidosis. 5 6 Our case report for the first time documents isolated disc involvement without adjacent bony disease or abscess formation in melioidosis thus mimicking degenerative disc disease. Melioidosis should be thought of as an important differential diagnosis when discitis is being suspected in patients presenting with back pain.…”

Section: Discussionmentioning

confidence: 71%

“…Unlike our case, they presented with fever and constitutional symptoms such as loss of weight and appetite and had multiple abscesses which were aspirated thus confirming the diagnosis. Garg et al 6 reported a case of melioidosis and emphasized on additional tests before labeling it as “smear-negative tuberculosis.”…”

Section: Discussionmentioning

confidence: 99%

Isolated Discitis in Melioidosis: An Unknown Presentation and a Microbiological Challenge

Varma

Mathew

Gopalakrishnan

et al. 2021

JNRP

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Burkholderia pseudomallei causes Whitmore’s disease or melioidosis which is endemic in many South Asian countries including India. This gram-negative bacterium is frequently found in the moist soil and agricultural workers get infected most commonly. Most of the infections are asymptomatic and have a wide spectrum of manifestations as in tuberculosis. Melioidosis of the spine manifests as spondylodiscitis with paravertebral and prevertebral abscess and presentation as discitis alone is not reported. We report the first case of melioidosis causing isolated discitis without any obvious bony involvement. It also highlights the need for preoperative suspicion of these rare manifestations even in seemingly innocuous disc disease presenting as back pain and radiculopathy.

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“…Infection occurs by inoculation or inhala-tion, especially in patients with sickle cell disease (SCD). The disease has been called the "Great Mimicker" because it produces a wide range of clinical features such as would be found in patients with SCD [3] . In fact, in patients living with a SCD, infection is a major determinant of the outcome, particularly in Africa.…”

Section: Introductionmentioning

confidence: 99%

Melioidosis and sickle cell disease: Description of a rare association

Shongo

Yav

Mukuku³

et al. 2020

Theory Clin Pract Pediatr

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Melioidosis and its germ are increasingly reported on the African continent and particularly in Central Africa, probably due to the increased awareness of clinicians and microbiologists and the growing recognition of the organism. It is called "Great Mimicker" because it produces a wide range of clinical characteristics such as would be found in patients living with sickle cell disease (SCD) in particular. However, to date, no publication presents this association between melioidosis and SCD. The authors describe here 3 clinical cases presenting this very rare association between melioidosis and SCD. These are 3 children with SCD (homozygous SS) residing in Lubumbashi in Haut-Katanga province in the Democratic Republic of Congo. One patient presented with sepsis as a clinical form of the disease. All 3 had presented a pulmonary form. Only one patient was treated specifically after the diagnosis of melioidosis; for the other two, this diagnosis was confirmed after their death. Thus the death rate is 66.67%. This article describes, through these 3 clinical cases, a very rare first association between melioidosis and SCD. This association requires research to establish whether, like Thalassemia, SCD can be considered a risk factor for melioidosis. A screening of cases of melioidosis in the general population should allow us to focus on this.

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Melioidosis: the great mimicker presenting as spondylodiscitis

Cited by 11 publications

References 15 publications

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

Isolated Discitis in Melioidosis: An Unknown Presentation and a Microbiological Challenge

Melioidosis and sickle cell disease: Description of a rare association

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