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| CLINICAL IMAGE |
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| Year : 2019 | Volume
: 149
| Issue : 4 | Page : 561-562 |
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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
| Date of Submission | 21-Dec-2017 |
| Date of Web Publication | 16-Jul-2019 |
Correspondence Address:
Anand K Annamalai
Department of Endocrinology, Ashwin Speciality Hospital; Department of Endocrinology, Vadamalayan Multispeciality Hospital, Madurai 625 020, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijmr.IJMR_2018_17
How to cite this article:
Annamalai AK, Padmini K. Melioidosis. Indian J Med Res 2019;149:561-2 |
†Patient's consent obtained to publish clinical information and images.
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: (A) Half-Fourier Acquisition Single-Shot Turbo Spin-Echo coronal abdomen magnetic resonance imaging showing hepatic and splenic bright signal intensities suggestive of abscesses (black and white arrows). (B) Half-Fourier Acquisition Single-Shot Turbo Spin-Echo axial abdomen magnetic resonance imaging showing hepatic and splenic bright signal intensities suggestive of abscesses (arrow). (C) Gram stain of splenic pus aspirate (×40) showing Gram-negative bacilli, bipolar stained with a safety pin appearance (circle). (D) Splenic aspirate pus Gram stain (×100) oil immersion field shows many bipolar-stained (pink-coloured) Gram-negative bacilli giving a safety pin appearance.
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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.
[Figure 1]
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