Melioidosis con endocarditis de válvula protésica / Prosthetic valve endocarditis in melioidosis: case report

Resumen La melioidosis es endémica en varias regiones, con predominio en el Sudeste Asiático, norte de Australia, sur de Asia, China y Taiwán. En Sudamérica, Colombia ocupa el segundo lugar de casos de melioidosis, después de Brasil. Su manifestación clínica es variable, desde una infección asintomática hasta un compromiso multiorgánico con formación de abscesos múltiples y choque séptico. El compromiso cardiaco es inusual, con una incidencia menor del 1%. Se presenta el caso de un varón de 51 años, colombiano, con antecedente de una valvula aórtica mecánica, quien presentó un absceso en la pierna derecha y en la válvula cardiaca protésica, aislándose Burkholderia pseudomallei en hemocultivos y en el cultivo de secreción de la pierna. Fue tratado con meropenem y cotrimoxazol, con una adecuada respuesta clínica, requiriendo un reemplazo valvular aórtico.

Abstract Melioidosis is an endemic disease to several regions and occurs predominantly in Southern Asia, Northern Australia, China and Taiwan. In South America, Colombia is second after Brazil in number of melioidosis cases reported. Clinical manifestation varies from asymptomatic infection to multiorgan compromise involving multiple abscesses and septic shock. Cardiac compromise is infrequent, with an incidence of <1%. We report the case of a 51-year-old patient from Colombia with a mechanical aortic valve who had an abscess in right leg and in the prosthetic valve. Burkholderia pseudomallei was isolated in blood cultures and drained pus from the leg cultures. Patient was treated with meropenem and cotrimoxazole and required aortic valve replacement, resulting in adequate improvement in clinical symptoms.

Severe coinfection of melioidosis and dengue fever in northeastern Brazil: first case report / Coinfecção grave de melioidose e dengue no nordeste do Brasil: primeiro caso

This report focuses on a fatality involving severe dengue fever and melioidosis in a 28-year-old truck driver residing in Pacoti in northeastern Brazil. He exhibited long-term respiratory symptoms (48 days) and went through a wide-ranging clinical investigation at three hospitals, after initial clinical diagnoses of pneumonia, visceral leishmaniasis, tuberculosis, and fungal sepsis. After death, Burkholderia pseudomallei was isolated in a culture of ascitic fluid. Dengue virus type 1 was detected by polymerase chain reaction in cerebrospinal fluid (CSF); this infection was the cause of death. This description reinforces the need to consider melioidosis among the reported differential diagnoses of community-acquired infections where both melioidosis and dengue fever are endemic.

Estudo de caso fatal de coinfecção de melioidose e dengue grave em um motorista de 28 anos, residente no município de Pacoti, nordeste do Brasil. O paciente apresentou inicialmente sintomas respiratórios com evolução por 48 dias. Foi internado em três diferentes unidades de saúde com suspeitas de pneumonia, leishmaniose visceral, tuberculose e sepse fúngica. Após o óbito, a cultura de líquido ascítico identificou a bactéria Burkholderia pseudomallei. O vírus da dengue tipo 1 foi detectado por PCR no líquor do paciente. Esta descrição reforça a necessidade de considerar a melioidose entre os diagnósticos diferenciais de infecções comunitárias onde as duas doenças são endêmicas.

Reduced interleukin-17 expression of Burkholderia pseudomallei-infected peripheral blood mononuclear cells of diabetic patients.

Burkholderia pseudomallei is the causative agent of melioidosis. One of the main risk factors for B. pseudomallei infection in endemic areas is diabetes mellitus. The present study investigated IL-17 mRNA and protein expression by peripheral blood mononuclear cells in response to B. pseudomallei infection in 10 diabetic patients in comparison to 10 healthy blood donors. The IL-17 expression in diabetic patients was significantly lower (p < 0.05) than in the controls. However, IL-23 mRNA expression of the 2 groups was comparable. The present findings suggest that melioidosis affects T cell IL-17 production and that patients with diabetes mellitus have a defective IL-17 production in response to this type of infection.

Melioidosis presenting as genitourinary infection in two men with diabetes.

Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It occurs predominantly in tropical regions. The manifestations are protean which include pneumonia, visceral abscesses, septic arthritis, osteomyelitis, acute suppurative and chronic granulomatous lesions with involvement of almost all organ systems. Fulminant sepsis is much more common and is associated with high mortality. Hence prompt recognition and early treatment is warranted. We report unusual presentations of urinary tract melioidosis in two diabetic men.

Mycobacterium avium and Burkholderia pseudomallei (Melioidosis) coinfection in an HIV-positive patient.

A 29 year old HIV positive Thai female with CD4 count of 10 cells/mm3 presented with chronic diffuse abdominal pain, fever, weight loss, anemia and leucopenia. Ultrasonography demonstrated diffuse upper abdominal lymphadenopathy with ascites. Microbiological and molecular work up of the specimen obtained by ultrasound-guided lymph node aspiration revealed co-infection with Burkholderia pseudomallei and Mycobacterium avium. Indirect hemagglutination, IgM-indirect fluorescent antibody, and IgG-indirect fluorescent antibody to Burkholderia pseudomallei were < 1:20, < 1:50 and < 1:50, respectively, at nine months, four months before the culture diagnosis and two months, eight months after the culture diagnosis of Burkholderia pseudomallei infection. The patient was treated initially with two weeks of intravenous ceftazidime, followed by oral cotrimoxazole, doxycycline and chloramphenicol. Clarithromycin and ofloxacin were added after the identification of Mycobacterium avium and its susceptibility test. The patients demonstrated clinical improvement with decreasing abdominal pain and resolution of fever.

Dural sinus thrombosis in melioidosis: the first case report.

Melioidosis which is infection with Burkholderia pseudomallei, is an important cause of sepsis in India, southeast Asia and northern Australia. Mortality is high and treatment is problematic. Neurological melioidosis is unusual but meningoencephalitis, encephalomyelitis and brain microabscess can occur Dural sinus thrombosis is not an uncommon cerebrovascular disorder with various etiologies. Hypercoagulable state, pregnancy, dehydration, certain blood dyscrasia and contraceptive pills are common causes however meningitis and local head & neck infections may lead to this condition. Dural sinus thrombosis complicating septicemic melioidosis has never been reported. The authors report a 42-year-old Thai man suffering from septicemic melioidosis with dural sinus thrombosis. He had high fever, headache, left hemiparesis, focal seizure and increased intracranial pressure. Diabetes and mild alcoholic cirrhosis were diagnosed in this admission. CT scan, MRI brain and MRV revealed superior saggital sinus thrombosis with complicating venous infarction over right posterior parietal lobe. Hemoculture demonstrated Burkholderia pseudomallei and CSF was acellular Investigations for causes of dural sinus thrombosis were all negative. This patient gradually improved after treatment with ceftazidime, antiepileptic drug and heparin without clinical recurrence. Neuromelioidosis is a rare syndrome that may present as brain abscess, encephalitis or meningoencephalitis. The authors report dural sinus thrombosis associated with septicemic melioidosis. The authors' hypothesis of venous thrombosis in the presented case is sepsis induced hypercoagulable state. Physicians should be aware of cerebral venous thrombosis in case of suspicious melioidosis with neurological involvement. Prompt treatment with intravenous heparin and antibiotic is potentially effective.

Fatal septicemic melioidosis in young adult

Melioidosis caused by B. pseudomallei remains dormant for months, years and even decades but becomes active when host is immunocompromised by drugs or disease including diabetes mellitus. Patients with diabetes mellitus shows a severe serious presentation of melioidosis. This is a case report of a 26 year old man with diabetes mellitus presented with fever, shortness of breath, left loin pain, dysuria and haematuria. The outcome of this melioidosis case and differential diagnosis are discussed

Imipenem therapy for septicemic melioidosis in a child with penicillin and cephalosporin adverse reaction.

The recommended treatment for severe melioidosis is ceftazidime or a combination of ceftazidime and trimethoprim-sulfamethoxazole (TMP/SMX). Amoxicillin-clavulanate has been shown to be an effective alternative therapy. In patient who is allergic to penicillin and cephalosporin, imipenem an alternative drug may be used. We described a 10 year-old boy who was diagnosed as septicemic melioidosis and type 1 diabetes mellitus. He developed fever and rash while being given ceftazidime and TMP/SMX. The fever recurred when amoxicillin-clavulanate was administered orally. He was successfully treated with imipenem.

Transient asceptic arthritis of knees in a patient with melioidosis.

Osteomyelitis and septic arthritis are known manifestations of melioidosis. Whether reactive arthritis can occur as a sequele to B. pseudomallei infection, is yet to be seen. As more and more cases of melioidosis will be reported in future, this aspect has to be kept in mind.

Diabetic ketoacidosis and melioidosis in a child.

A case of 5 year old diabetic girl with melioidosis was reported. She presented with the symptoms and signs of intraabdominal infection, septicemia and diabetic ketoacidosis. Abdominal ultrasonography showed multiple splenic and liver abscesses, melioidosis was suspected. Hemoculture and pus culture yielded Burkholderia pseudomallei which was susceptible to ceftazidime and cotrimoxazole. Correction of fluid and electrolyte combined with insulin therapy and proper antibiotics resulted in a good outcome in this patient.

Pseudomonas pseudomallei (melioidosis): acute septicemia and meningitis in patient with systemic lupus erythematous

Se presenta un caso de meningitis secundario a melioidosis (Pseudomonas pseudomallei) con septicemia en una mujer puertorriqueña con lupus eritematoso sistémico. Este es el primer caso de melioidosis autóctono de Puerto Rico que se presenta en la literatura. La susceptibilidad "in vitro" sugiere que las cefalosporinas de tercera generación pueden ser efectivas en el tratamiento de septicemia por melioidosis