Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is an important cause of sepsis in tropical areas in Eastern Asia, affecting mainly immunocompromised people in their 4th to 6th decade of life. Diabetes mellitus is the most important host risk factor accounting 60.9% of the cases. In Thailand, Meliodosis represents the most common cause of fatal community acquired pneumonia and the third most common cause of death from infectious disease following HIV & tuberculosis. The disease mimics cancer, tuberculosis & fungal infections.
Case:
A 54 years old Saudi male with uncontrolled Diabetes Mellitus for 10 years presented to our hospital with 6 weeks history of fever, cough, night sweats and weight loss. No other symptoms were reported. He had frequent travels to the Philippines for the past 5 years with his last visit being 2 weeks before his symptom. The patient had no improvements despite seeking medical advice from multiple private dispensaries & receiving multiple antibiotics. Physical examination showed decrease air entry in right upper and middle zone with minimal fine inspiratory crepitation. Lab results were normal except for WBC of 13.2 with normal differential. Full bacteriology and virology screen were negative. CT scan revealed multiple bilateral pleural based nodules and multiple splenic hypodensities representing likely abscesses. Lung biopsy showed non-caseating granuloma with negative malignant cells. AFB and Fungal cultures were negative.
Definite diagnosis of melioidosis was not made due to insufficient facility to culture the organism in our lab, but due to the cumulative clinical scenario, the diagnosis was made. Patient was discharged on Trimethoprim-sulfamethoxazole and doxycycline for 3 months with dramatic improvement upon follow up.
Conclusion:
High index of suspicion for melioidosis should be raised in febrile patients with history of traveling to endemic areas especially diabetic patients for prompt diagnosis & treatment.
