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  Table of Contents    
CASE REPORT  
Year : 2012  |  Volume : 55  |  Issue : 4  |  Page : 578-579
Burkholderia pseudomallei infection in a healthy adult from a rural area of South India


1 Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipeth, Puducherry, India
2 Department of Microbiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipeth, Puducherry, India

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Date of Web Publication4-Mar-2013
 

   Abstract 

Melioidosis is an emerging disease producing protean manifestations, and is more common in alcoholics and diabetics. The disease can be a trivial localized lesion or a fatal septicemia. Early diagnosis and appropriate antimicrobial treatment greatly reduces the mortality rate. We report a case of localized form of the disease in an elderly male with no known predisposing medical disease who responded well to oral amoxycillin-clavulanic acid and cotrimoxazole treatment.

Keywords: Burkholderia pseudomallei , localized trauma, melioidosis

How to cite this article:
Anandraj VK, Priyadharshini A, Sunil SS, Ambedkar RK. Burkholderia pseudomallei infection in a healthy adult from a rural area of South India. Indian J Pathol Microbiol 2012;55:578-9

How to cite this URL:
Anandraj VK, Priyadharshini A, Sunil SS, Ambedkar RK. Burkholderia pseudomallei infection in a healthy adult from a rural area of South India. Indian J Pathol Microbiol [serial online] 2012 [cited 2020 Sep 22];55:578-9. Available from: http://www.ijpmonline.org/text.asp?2012/55/4/578/107829



   Introduction Top


Burkholderia pseudomallei is a non-fermenting Gram-negative bacillus producing a clinical condition called melioidosis in man and animals. It is endemic in southeast Asia and tropical northern Australia, and is being increasingly reported in the Indian subcontinent. [1],[2] B. pseudomallei can be found in the wet soil and surface water, and large number of cases are being reported during rainy season. [3] The clinical manifestations vary from a short febrile illness, localized abscess, to fatal septicemia. [4] It is more common in alcoholics and diabetics. [5] A high index of suspicion on the part of clinician is necessary in view of its protean manifestations and also on the part of the microbiologist as it is often reported as Pseudomonas or non-fermenting Gram-negative bacillus.


   Case Report Top


A 58-year-old male presented to the out-patient department (OPD) with complaints of gradually increasing swelling over the left side of neck for about 6 weeks duration [Figure 1]a. Fever for 4 days duration preceded the swelling, for which he was put on oral amoxyclav 625 mg bid by his family physician before referral. The swelling was soft to firm in consistency, measuring 4 × 5 cm. No abnormality was detected on general physical examination. Local pathology in the ear, nose, throat, and oral cavity was excluded. The attending General Surgeon advised a fine-needle aspiration cytology (FNAC) procedure and culture of the aspirate, and to continue amoxyclav. FNAC showed necrotizing granulomatous lesion with neutrophilic infiltration [Figure 1]b. Gram stain showed plenty of pus cells and few Gram-negative bacilli [Figure 2]a. No acid-fast bacilli were seen by Ziehl Neelsen staining. Culture yielded a pure growth of B. pseudomallei. The swelling decreased in size markedly during each of the biweekly review consultations, and there was decrease in growth of B. pseudomallei from the aspirates. The patient was on oral amoxyclav 625 mg bid throughout the course of follow-up. He was put on oral cotrimoxazole after 6 weeks of treatment with amoxyclav as he developed diarrhea. During the subsequent review, the swelling had completely subsided [Figure 2]b. The patient was advised to continue cotrimoxazole for another 10 weeks. On the last review visit, the patient was totally asymptomatic with complete recovery from the lesion.
Figure 1: (a) Clinical picture showing the swelling before treatment. (b) FNAC showing necrotizing granulomatous picture (May Grunwald Giemsa, ×40)

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Figure 2: (a) Gram's stain - bipolar picture (Gram's, ×1000). (b) clinical picture after treatment

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   Discussion Top


Melioidosis is an emerging infection in India. Trauma, often trivial, is known to herald the onset of the infection. [6] B. pseudomallei infections are known for their protean manifestations with septicemia, pneumonia, etc. [7] Majority of the patients have an underlying risk factor like uncontrolled diabetes [8] or tuberculosis, which was absent in our patient. Most of the cases have been reported following a heavy rainfall and contact with stagnant water. In this present case, the patient developed symptoms starting with a short febrile illness followed by swelling, with a history of trauma due to the relief operations following a cyclonic storm.

The unusual feature of this case is that he was neither a known case of diabetic nor an alcoholic, and he had no immunosuppression, except for the trivial trauma presenting with only a localized abscess. Unlike most of the patients with systemic involvement who require parenteral administration of ceftazidime, our patient had responded well to oral treatment of amoxycillin-clavulanic acid 625 mg and cotrimoxoazole therapy. Melioidosis should be excluded in patients with isolated cutaneous lesions as in our case with a localized abscess formation; hence, any non-fermenting Gram-negative bacilli isolated from it should be analyzed for further identification and categorization, particularly with a history of trauma, however trivial. Oral antimicrobial therapy with drugs like cotrimoxazole and amoxycillin-clavulanic acid could be tried in patients without systemic symptoms and other risk factors, as in our case who responded very well to these drugs. A high index of suspicion and diligent search helps in early diagnosis of these cases, thus helping in the initiation of appropriate treatment with a good prognosis.

 
   References Top

1.White NJ. Melioidosis. Lancet 2003;361:1715-22.  Back to cited text no. 1
[PUBMED]    
2.John TJ, Jesudason MV, Lalitha MK, Ganesh A, Mohandas V, Cherian T, et al. Melioidosis in India; the tip of the iceberg?. Indian J Med Res 1996;103:62-5.  Back to cited text no. 2
    
3.Mandell GL, Bennett JE, Dolin RD, Mandell Douglas and Bennet's principles and practice of infectious diseases 6 th ed Philedelphiaprintarticle.asp?issn=0377-4929;year=2012;volume=55;issue=4;spage=578;epage=579;aulast=Anandraj: Elsevier Churchill Livingstone publisher; 2005.  Back to cited text no. 3
    
4.Jesudasan MV, Kumar RS, John Tj. Burkholderia pseudomalleii- An emerging pathogen in India. Indian J Med Microbiol 1997;15:1-2.  Back to cited text no. 4
    
5.Merianos A, Patel M, Lane JM, Noonan CN, Shanock D, Mock PA, et al. The 1990-1991 outbreak of Meiloidosis in the northern territory of Australia: Epidemiology and Environmental studies. Southeast Asian J Trop Med Public Health 1993;24:425-35.  Back to cited text no. 5
    
6.Penet JL. Melioidosis: A tropical time bomb that is spreading. Med Trop (Mars) 1997;57:195-201.  Back to cited text no. 6
    
7.Dhodapkar R, Sujatha S, Sivasangeetha K, Prasanth G, Parija SC. Burkholderia pseudumalleii infection in a patient with diabetes presenting with multiple splenic abscesses and abscesses in the foot: A case report. Cases J 2008;1:224.  Back to cited text no. 7
[PUBMED]    
8.Anuradha K, Meena AK, Lakshmi V. Isolation of B. pseudomalleii from a case of septicemia. A case report. Indian J Med Microbiol 2003;21:129-32.  Back to cited text no. 8
    

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Correspondence Address:
Vaithy K Anandraj
Department of Pathology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipeth, Puducherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.107829

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