A case of disseminated melioidosis: clinical insights and management

Abstract

Melioidosis is an infectious disease of humans and animals resulting from infection with the gram-negative organism Burkholderia pseudomallei. Known as the “great mimicker”, melioidosis presents with a wide spectrum of disease including isolated cutaneous/pulmonary disease, primary bacteremia, visceral abscesses or fulminant fatal septicaemia. The mean incubation period is nine days (1-21 days) but symptoms can evolve more quickly (<24 h) following inhalational and/or presumed aspiration events. In acute disease, sepsis syndrome is common; >50% of patients are bacteremic at presentation and 20% develop septic shock. Pulmonary involvement is the most common acute infection in adults responsible for >50% of presentations, while pneumonia is seen in approximately 20% of paediatric cases. Presentations in children more frequently have skin involvement (60%), compared with 13% in adults. In our case report, patient was a 41year-old male, resident of Ratnagiri district, farmer by occupation, presented with fever for 1 month, cough and breathlessness for same period. He was successfully treated with meropenem and doxycycline and put on maintenance therapy for duration of 12 weeks.