ABSTRACT
BACKGROUND: In regions endemic for tuberculosis (TB) such as India, presumptive anti-tuberculosis treatment is often prescribed. Melioidosis, caused by Burkholderia pseudomallei, is underdiagnosed in India, due to lack of awareness and a low index of suspicion. SETTING: A tertiary care hospital in south India. OBJECTIVE: To present our analysis of a series of 22 cases of suspected TB that was later confirmed as melioidosis. DESIGN: Twenty-two patients with culture-proven melioidosis, who were initially given empirical anti-tuberculosis treatment, were retrospectively analysed regarding clinical presentation, laboratory findings and epidemiological features, with a view to determining any significant discriminatory parameter/s that would help distinguish the two diseases. RESULTS: Eight cases mimicked pulmonary TB, five tubercular arthritis, three tubercular spondylitis, two tubercular lymphadenitis, two splenic abscess, and one each mimicked tubercular pericarditis and parotid abscess. Fever was the chief presenting complaint; all had high erythrocyte sedimentation rate (ESR) values (mean 111 mm +/- 23.7 SD); 15 (68.2%) had neutrophilic leuco-cytosis, 20 (90.9%) had diabetes mellitus. Subsequent to laboratory culture reports confirming melioidosis, appropriate treatment was instituted. CONCLUSION: Fever in a diabetic patient with high ESR and neutrophilic leucocytosis should raise suspicion of melioidosis while instituting presumptive anti-tuberculosis treatment in areas where both diseases are prevalent.
Subject(s)
Melioidosis/diagnosis , Tuberculosis, Pulmonary/diagnosis , Adolescent , Adult , Aged , Antitubercular Agents/administration & dosage , Burkholderia pseudomallei/isolation & purification , Chi-Square Distribution , Diagnosis, Differential , Female , Humans , India/epidemiology , Male , Melioidosis/drug therapy , Melioidosis/epidemiology , Melioidosis/microbiology , Middle Aged , Retrospective Studies , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Pulmonary/epidemiologyABSTRACT
Between January 2005 and December 2006, a higher incidence of paratyphoid fever (53.8%) compared to typhoid fever (44.9%) has been observed at a tertiary hospital in South India. A definite seasonal pattern of incidence is seen in paratyphoid fever (peak incidence during October-December, i.e., post monsoon period) but not in typhoid fever. Decreased fluoroquinolone susceptibility is much higher in S. Paratyphi A (98.8%) as compared to S. Typhi (46.5%). These findings are of importance in therapeutic decision making, development of vaccination strategies and implementing public health measures for disease control.
Subject(s)
Anti-Bacterial Agents/pharmacology , Salmonella paratyphi A/drug effects , Salmonella typhi/drug effects , Seasons , Typhoid Fever/epidemiology , Adolescent , Adult , Aged , Blood/microbiology , Child , Child, Preschool , Culture Media , Female , Humans , Incidence , India/epidemiology , Infant , Male , Microbial Sensitivity Tests , Middle Aged , Salmonella paratyphi A/classification , Salmonella paratyphi A/isolation & purification , Salmonella typhi/classification , Salmonella typhi/isolation & purification , Typhoid Fever/microbiologyABSTRACT
Clinico-microbiological analysis of a series of 25 patients with culture proven melioidosis was done. All patients came from the coastal regions of Kerala and Karnataka and presented between June 2005 to July 2006. They were analysed with respect to clinical presentation, occupation, epidemiology and microbiological features. No single presenting clinical feature was found to be typical of melioidosis. The disease was found to mimic a variety of conditions, including tuberculosis and malignancy. Burkholderia pseudomallei was isolated from blood, sputum, pus, urine, synovial, peritoneal and pericardial fluids. Diabetes mellitus was the most common predisposing factor and 80% of the cases presented during the Southwest monsoon (June to September). It is probable that melioidosis is highly prevalent in western coastal India and yet, greatly underestimated. Better awareness, both among clinicians and microbiologists, coupled with improved diagnostic methods to allow early diagnosis and hence early treatment, will significantly reduce the morbidity and mortality associated with this disease.
