Septicemic melioidosis and meningitis: A case report.

ABSTRACT

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.