Clinically lesser known entity in India: A Report of two cases of Melioidosis
A 58-year-old male presented with fever (on and off from last 1 to 11/2 years), cough, pain and swelling of left knee for last 2 weeks. He had taken treatment from various local practitioners without success. He was a known diabetic for last few years.\nOn presentation, his temperature was 100 °F, pulse 90/minute; blood pressure 94/50 mmHg, respiratory rate 38/minute. Left knee was hot and tender; however, anX-ray of the knee was normal. Bilateral scattered crepitations were heard on chest examination. Oxygen saturation was 80% for which he was started on non-invasive ventilator support. A chest X-ray showed fluffy nodular opacities in both lung fields. He was empirically started on piperacillin/tazobactum.\nInvestigations showed –a TLC of 10,900/cubic mm, the liver enzymes were raised with values of SGOT- 117 IU/L, SGPT- 175 IU/L, ALP- 69 IU/L, GGT – 81 IU/L, LDH- 289 IU/L. HsCRP level was 166.7 mg/dl, procalcitonin level was 0.9 ng/ml. Hb A1 c level was 10.0%. Sputum for AFB (stain and culture), Malaria antigen test and Widal test were all negative. Blood cultures were sent from two different peripheral sites on the day of admission. On day 3 of admission, he had spikes of fever. Another set of blood culture was sent. Burkholderia pseudomallei was isolated from all these blood samples.\nBoth the strains were resistant to ceftazidime (MIC>32 mg/l) and sensitive to imipenem (MIC < 2 mg/l), co-trimoxazole (MIC <1/19 mg/l)and tetracycline (MIC <2 mg/l). Antibiotics were escalated to imipenem (50 mg/kg/day) in both cases. Both cases responded well and were discharged on maintenance therapy with co-trimoxazole and doxycycline for 20 weeks. Blood cultures repeated 1 month afterwards came out to be sterile. Both these strains were handled in Biosafety level-2 in laboratory.