Pathirage MMK, Kularatne SAM, Weerakoon KG. Melioidosis after a long silence in Sri Lanka: an environmental hazard and dilemma in diagnosis, with recovery and longitudinal follow-up for 13 years: a case report.
J Med Case Rep 2020;
14:50. [PMID:
32303247 PMCID:
PMC7165379 DOI:
10.1186/s13256-020-02372-2]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 03/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background
Melioidosis is a potentially fatal bacterial infection caused by Burkholderia pseudomallei. The existence of melioidosis in Sri Lanka was once unheard of, and entertaining it as a diagnosis in clinical practice was extremely rare.
Case presentation
In this case report, we describe the clinical, epidemiological, and longitudinal follow-up data of a 58-year-old previously healthy Sinhalese woman who presented to our hospital with protracted febrile illness of 5 weeks’ duration, later developing multiple abscesses at different sites of the body. There was a significant delay in confirming the diagnosis of melioidosis by isolating B. pseudomallei from blood and pus cultures. The patient recovered fully with a prolonged course of antibiotics and has remained in good health over the last 13 years without recurrence. Despite being immunocompetent, she had contracted the infection by a brief contact with mud soil in a footpath.
Conclusions
A high index of clinical suspicion along with laboratory support is needed to confirm the diagnosis of melioidosis. Treatment with sensitive antibiotics over a long duration is needed, and longitudinal follow-up is essential to detect recurrences. This case raised awareness and created renewed interest in studies of melioidosis in Sri Lanka.
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