Septicemic melioidosis and meningitis: A case report.

Melioidosis predominantly affects the rice-farming community of north-eastern Thailand, and occurs mainly in patients with underlying diseases such as diabetes mellitus or chronic renal impairment. It may be asymptomatic or may present as acute septicaemic or chronic suppurative infection. Neurological involvement in melioidosis is uncommon. We report here on a patient with septicaemic melioidosis and meningitis. A 48-year-old man presented with a three-month history of fever, chillis and weight loss. He came from Udon Thani and was a known diabetic who had been on regular treatment for three years. Both Widal and Weil-Felix reactions were negative with normal X-ray of the chest. On the next day, the patient had severe headache with a stiff neck. The CSF contained elevated glucose and protein concentrations, polymorphonuclear cells and lymphocytes but revealed no growth on culture. Two days later, the patient developed a cough, dyspnoea with difficulty in swallowing. Culture frpm the blood and sputum yielded pure Burkholderia pseudomallei. The patient was treated with a combination of ceftriaxone and trimethoprim-sulphamethoxazle which was found to be sensitive in vitro. However, the patient died on day 7 of hospitalization. This case illustrate an urgent need for early diagnosis and identification of sensitive drugs for the treatment the melioidosis which is still quite common in north. Eastern Thailand.

Increased circulating levels of transcobalamin II in typhoid fever.

Many previous studies have shown that serum transcobalamin II (TCII) is usually elevated in patients with a stimulated and proliferative reticuloendothelial system resulting from such diseases as multiple myeloma, systemic lupus erythrematosus, dermatomyositis, rheumatoid arthritis and Gaucher’s disease. As reactive macrophage hyperplasia with monocytosis also occurs in patients with typhoid fever, we therefore studied TCII in these patients. The mean value of serum TCII was significantly higher in the typhoid patients’ group, and 15 out of 35 patients had serum TCII values over 2,000 pg/ml. There was no relationship between serum TCII and white blood count, haemoglobin or haematocrit values. The increased serum TCII level in typhoid patients was possibly due to increased synthesis by the proliferative mononuclear cells derived from reticuloendothelial tissue in various organs such as the spleen, liver and mesenteric lymph nodes. This supposition is supported by a previous report that TCII is synthesized in part by mouse peritoneal macrophages, as well as by human monocytes and macrophages which produced and secreted considerable amounts of TCII into the medium. Findings of increased serum TCII in typhoid patients therefore add a new area of information which has never been studied before.

Salmonella choleraesuis bacteremia associated with The Acquired Immunodeficiency Syndrome (AIDS).

Multiple opportunistic infections are characteristic of the acquired immunodeficiency syndrome (AIDS). An emerging problem with salmonella infection among patients with AIDS is increasing. We report here 3 patients with AIDS who presented with fever and were found to be bacteremia due to serotypes of Salmonella choleraesuis. As this serotype rarely occurs in normal hosts in Thialand, finding the infection in patients with AIDS indicate that these patients are at high risk. It suggests that AIDS patients with prolonged febrile illness should be investigated for salmonella infection.