ABSTRACT

Melioidosis is an infectious disease caused by the Gram negative rod Burkholderia pseudomallei. It is a major cause of sepsis in southeastern Asia and northern Australia and represents the third cause of death from infectious diseases in those regions. It is characterized by the presence of pneumonia and multiple abscesses, with mortality around 40%. We report the case of a 29 year old man, with an acute illness characterized by fever, malaise, and dyspnea, the physical exam found tachypnea, tachycardia an fever of 38.8 oC. The CT showed irregular hyperdense images with bilateral ground glass areas, the bronchoscopy obtained samples that were stained with Grocott, Ziehl-Neelsen and KOH with negative results. Sputum cultures, two blood cultures and pleural fluid were positive for B. pseudomallei. He received treatment with trimethoprim/sulfamethoxazole, imipenem/cilastatin and amikacin with adequate evolution and cure. This is one of the few case reports of melioidosis in Mexico with others being reported in central and south America and, because of it great public health importance, we describe the case and present a review about the mode of transmission, methods of diagnosis and treatments of choice.

KEYWORDS

Burkholderia pseudomallei, neumonía, sepsis.

REFERENCES

1. White NJ. Melioidosis. Lancet 2003;361:1715-1722.

2. Katangwe T, Purcell J, Bar-Zeev N, et al. Human melioidosis, Malawi, 2011. Emerg Infect Dis 2013;19:981-984.

3. Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med 2012;367:1035-1044.

4. Currie BJ, Fisher DA, Howard DM, et al. The epidemiology of melioidosis in Australia and Papua New Guinea. Acta Trop 2000;74:121-127.

5. Wiersinga WJ, van der Poll T, White NJ, Day NP, Peacock SJ. Melioidosis: insights into the pathogenicity of Burkholderia pseudomallei. Nat Rev Microbiol 2006;4:272-282.

6. Leelarasamee A. Recent development in melioidosis. Curr Opin Infect Dis 2004;17:131-136.

7. Stanton AT, Fletcher W, Kanagarayer K. Two cases of melioidosis. J Hyg 1924;23:268-276.

8. How SH, Liam CK. Melioidosis: a potentially life threatening infection. Med J Malaysia 2006;61:386-394: quiz 95.

9. Meumann EM, Cheng AC, Ward L, Currie BJ. Clinical features and epidemiology of melioidosis pneumonia: results from a 21-year study and review of the literature. Clin Infect Dis 2012;54:362-369.

10. Dance DA. Ecology of Burkholderia pseudomallei and the interactions between environmental Burkholderia spp. and human-animal hosts. Acta Trop 2000;74:159-168.

11. Stewart T, Engelthaler DM, Blaney DD, et al. Epidemiology and investigation of melioidosis, Southern Arizona. Emerg Infec Dis 2011;17:1286-1288.

12. Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005;18:383-416.

13. Dance DA. Melioidosis as an emerging global problem. Acta Trop 2000;74:115-119.

14. Ketterer PJ, Webster WR, Shield J, Arthur RJ, Blackall PJ, Thomas AD. Melioidosis in intensive piggeries in south eastern Queensland. Aust Vet J 1986;63:146-149.

15. McCormick JB, Sexton DJ, McMurray JG, Carey E, Hayes P, Feldman RA. Human-to-human transmission of pseudomonas pseudomallei. Ann Intern Med 1975;83:512-513.

16. Currie BJ, Jacups SP. Intensity of rainfall and severity of melioidosis, Australia. Emerg Infect Dis 2003;9:1538-1542.

17. Leelarasamee A. Melioidosis in southeast Asia. Acta Trop 2000;74:129-132.

18. Egan AM, Gordon DL. Burkholderia pseudomallei activates complement and is ingested but not killed by polymorphonuclear leukocytes. Infect Immune 1996;64:4952-4959.

19. Pruksachartvuthi S, Aswapokee N, Thankerngpol K. Survival of pseudomonas pseudomallei in human phagocytes. J Med Microbiol 1990;31:109-114.

20. Chierakul W, Wuthiekanun V, Chaowagul W, et al. Short report: disease severity and outcome of melioidosis in HIV coinfected individuals. Am J Trop Med Hyg 2005;73:1165-1166.

21. Puthucheary SD, Lin HP, Yap PK. Acute septicaemic melioidosis: a report of seven cases. Trop Geogr Med 1981;33:19-22.

22. Chan KW, Jayaratnam FJ, Teo SK. Acute septicaemic melioidosis. A report of three fatal cases. Singapore Med J 1985;26:382-385.

23. Puthucheary SD, Parasakthi N, Lee MK. Septicaemic melioidosis: a review of 50 cases from Malaysia. Trans R Soc Trop Med Hyg 1992;86:683-685.

24. Leelarasamee A, Bovornkitti S. Melioidosis: review and update. Rev Infect Dis 1989;11:413-425.

25. Ip M, Osterberg LG, Chau PY, Raffin TA. Pulmonary melioidosis. Chest 1995;108:1420-1424.

26. Currie BJ, Ward L, Cheng AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis 2010;4:e900.

27. Dance DA, Wuthiekanun V, Naigowit P, White NJ. Identification of Pseudomonas pseudomallei in clinical practice: use of simple screening tests and API 20NE. J Clin Pathol 1989;42:645-648.

28. Appassakij H, Silpapojakul KR, Wansit R, Pornpatkul M. Diagnostic value of the indirect hemagglutination test for melioidosis in an endemic area. Am J Trop Med Hyg 1990;42:248-253.

29. O’Brien M, Freeman K, Lum G, Cheng AC, Jacups SP, Currie BJ. Further evaluation of a rapid diagnostic test for melioidosis in an area of endemicity. J Clin Microbiol 2004;42:2239-2240.

30. Zysk G, Splettstösser WD, Neubauer H. A review on melioidosis with special respect on molecular and immunological diagnostic techniques. Clin Lab 2000;46:119-130.

31. Lowe P, Engler C, Norton R. Comparison of automated and nonautomated systems for identification of Burkholderia pseudomallei. J Clin Microbial 2002;40:4625-4627.

32. Burivong W, Wu X, Saenkote W, Stern EJ. Thoracic radiologic manifestations of melioidosis. Curr Probl Diagn Radiol 2012;41:199-209.

33. Wong KT, Puthucheary SD, Vadivelu J. The histopathology of human melioidosis. Histopathology 1995;26:51-55.

34. Chierakul W, Anunnatsiri S, Short JM, et al. Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis. Clin Infect Dis 2005;41:1105-1113.

35. Cheng AC, Stephens DP, Anstey NM, Currie BJ. Adjunctive granulocyte colony-stimulating factor for treatment of septic shock due to melioidosis. Clin Infect Dis 2004;38:32-37.

36. Nandi T, Tan P. Less is more: Burkholderia pseudomallei and chronic melioidosis. MBio 2013;4.e00709-13.