Title : Case series on melioidosis
Abstract:
Melioidosis is caused by the bacteria Burkholderia pseudomallei. It has a wide range of signs and symptoms often mimicking other infections leading to its misdiagnosis or underdiagnosis. We hereby aim to highlight on some of the atypical presentations which might cause delay in diagnosis and pose a challenge for the treating physician as well as the patient. With this we hope to widen the doctor’s perspective regarding these possible unusual findings, ultimately helping them to initiate empirical antibiotics, send cultures, diagnose, treat faster and better. This would contribute to improve the quality of patient care and reduce unwanted poor outcomes. We would also like to emphasize on the role of the infectious disease (ID) team and the importance of multi-disciplinary approach – the reason being some of the cases were diagnosed incidentally as a routine referral to the ID team. This is a case series of ten patients each with a different set of complaints. Four patients had pulmonary involvement – first patient presented with unresponsiveness. Incidentally, ground glass densities and consolidation in bilateral lungs found on imaging. Blood cultures showed Burkholderia pseudomallei. The second patient presented pleural effusion for which aspiration and lung biopsy was done which showed Burkholderia pseudomallei. The third patient had symptoms mimicking tuberculosis – fever, cough and weight loss. Imaging showed a calcified granuloma and he was empirically started on antitubercular drugs [ ATT]. Pus culture results later showed Burkholderia. ATT drugs were hence discontinued and he was given antibiotics. The last patient came with breathing difficulty and cough. Blood cultures sent as a part of sepsis protocol grew Burkholderia. Two patients presented with gastro intestinal symptoms – one with liver involvement and the other with splenic abscess. Respective blood and pus cultures showed Burkholderia. Two patients presented with neurological manifestations as their presenting feature, first patient had a focal seizure and brain abscess seen on MRI. Tissue culture of the abscess showed Burkholderia. The second patient had worsening of headache, facial deviation and language disturbance. MRI showed a subdural hematoma, he was operated for the same and had a seizure in post operative period. A repeat MRI brain showed a left temporal abscess. Culture sent from the evacuated collection showed Burkholderia. Another interesting presentation was with complaints of fever, backpain, a soft and pulsatile mass at the epigastric region and blisters in lower limb. CT abdomen showed a saccular aneurysm with rupture and retroperitoneal hematoma. An open surgical graft repair was done. Incident pus culture sent from leg (blister) showed burkholderia pseudomallei. The tissue and blood cultures were also positive for Melioid. Yet another unique presentation was with complaints of hip pain and difficulty in walking. Imaging of the lumbar spine showed a hyperintense infective lesion. Hemilaminectomy and evacuation of epidural abscess was done and was sent for which culture showed Burkholderia. All the 10 cases were treated successfully with intravenous antibiotics (ceftazidime and cotrimoxazole) and were discharged.
