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Case:
40sh
male,
diabetic,
non-complaint
with
medication
brought
to
the
ED
with
two
weeks
H/O
fever
+
cough
and
shoulder
pain.
N&V
+
Exam:
Icteric
+
VS:
120/min
BP:
100/70
RR:
38/min
SpO2:
88%
RA
RS:
Creps
B/L,
bronchial
breath
sounds
+
Other
systems:
NAD
What
is
Melioidosis?
Organism
Pathogenesis
Transmission
Percutaneous
inoculation
Inhalation
Ingestion
Fever
Varied
clinical
spectrum
ranging
from
acute
or
chronic,
local
or
systemic,
sub-clinical
or
clinical
disease
(the
remarkable
imitator)
1.
2.
3.
4.
Diagnosis
May
be
misidentified
Isolation
from
blood,
sputum,
urine
or
a
swab
from
an
abscess
or
non-healing
ulcer
PCR
Peculiar
Antibiotic
Resistance
Pattern
(Resistant
to
Gentamycin/Colistin
but
sensitive
to
Amoxicillin-Clavulanic
acid)
How
do
we
treat
Melioidosis?
Two
staged
treatmentan
intravenous
high
intensity
stage
and
an
oral
maintenance
stage
to
prevent
recurrence.
Initiation
Phase
(2
weeks):
Ceftazidime/
Carbepenems
with
or
without
Cotrimoxazole
Eradication
Phase
(3-5
Months):
Cotrimoxazole/
Doxycycline
Supportive
Care
Surgical
Drainage
of
large
abscesses
Key Points:
References:
1. Wiersinga,
W.
Joost,
et
al.
"Melioidosis:
insights
into
the
pathogenicity
of
Burkholderia
pseudomallei."
Nature
Reviews
Microbiology
4.4
(2006):
272-282.
2. Cheng
AC,
Currie
BJ.
Melioidosis:
epidemiology,
pathophysiology,
and
management.
Clin
Microbiol
Rev
2005;18:383-416.
3. Poe
RH,
Vassallo
CL,
Domm
BM.
Melioidosis:
the
remarkable
imitator.
Am
Rev
Respir
Dis
1971;104:427-31.
4. Vidyalakshmi
K,
Shrikala
B,
Bharathi
B,
Suchitra
U.
Melioidosis:
an
under-diagnosed
entity
in
western
coastal
India:
a
clinico-microbiological
analysis.
Indian
J
Med
Microbiol
2007;25:245-8.
5. Saravu
K,
Mukhopadhyay
C,
Vishwanath
S,
Valsalan
R,
Docherla
M,
Vandana
KE,
et
al.
Melioidosis
in
southern
India:
epidemiological
and
clinical
profile.
Southeast
Asian
J
Trop
Med
Public
Health
2010;41:401-9.
Questions/Comments/Feedback
Lakshay
Chanana
drlakshay_em@yahoo.com
Twitter:
@EMDidactic
EM
Academy
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