Indian Journal of Medical Research

CLINICAL IMAGE
Year
: 2019  |  Volume : 149  |  Issue : 4  |  Page : 561--562

Melioidosis


Anand K Annamalai1, Kothandaramaraju Padmini2,  
1 Department of Endocrinology, Ashwin Speciality Hospital; Department of Endocrinology, Vadamalayan Multispeciality Hospital, Madurai 625 020, Tamil Nadu, India
2 Department of Microbiology, Vadamalayan Multispeciality Hospital, Madurai 625 020, Tamil Nadu, India

Correspondence Address:
Anand K Annamalai
Department of Endocrinology, Ashwin Speciality Hospital; Department of Endocrinology, Vadamalayan Multispeciality Hospital, Madurai 625 020, Tamil Nadu
India




How to cite this article:
Annamalai AK, Padmini K. Melioidosis.Indian J Med Res 2019;149:561-562


How to cite this URL:
Annamalai AK, Padmini K. Melioidosis. Indian J Med Res [serial online] 2019 [cited 2020 Jan 21 ];149:561-562
Available from: http://www.ijmr.org.in/text.asp?2019/149/4/561/262879


Full Text

A 21 yr old woman † from an urban locality with no travel history presented to the Emergency department at Vadamalayan Hospital, Madurai, India, in August 2015, with intermittent fever for two months. She had type 2 diabetes mellitus (body mass index 28 kg/m2, presence of acanthosis) for six months with a poor preceding glycaemic control (glycated haemoglobin, HbA1c - 10.6%). She was delirious, icteric, tachycardic and hypotensive. Investigations revealed anaemia, leucocytosis, hyperbilirubinaemia and hyperglycaemia. Infectious screens for malaria, leptospirosis, hepatitis and dengue were negative. Half-Fourier Acquisition Single-Shot Turbo Spin-Echo coronal and axial abdomen magnetic resonance imaging revealed hepatic and splenic bright signals suggestive of abscesses [Figure 1]A and [Figure 1]B. Although uncommon, the history of visceral abscesses in a young individual with diabetes is suggestive of melioidosis. This was confirmed on splenic pus aspirate Gram stain [Figure 1]C and [Figure 1]D, culture and blood culture. The patient recovered completely with intravenous ceftazidime (2 g thrice daily) for two weeks followed by oral co-trimoxazole and sulphamethoxazole for 12 wk. The patient recovered completely with complete regression of the visceral abscesses on further follow up after three months.{Figure 1}

Disseminated melioidosis has a high fatality rate and could be caused by inhalation, ingestion or percutaneous inoculation of a Gram-negative bacterium Burkholderia pseudomallei present in the soil. Diabetes has been described as a major risk factor of melioidosis in up to 60 per cent of cases. It is important to highlight that a clinical suspicion of melioidosis is necessary in an individual with fever, multiple visceral abscesses and predisposing risk factors like diabetes even in a non-endemic area.

Conflicts of Interest: None.