Dr.N. Kawiraj, Postgraduate-Unit -II Department of General Medicine

Abstract

Melioidosis is an infectious disease caused by gram negative bacterium Burkholderia pseudomallei. It is a soll and water pathogen and transmitted to humans through inoculation or inhalation. This dlsease is considered endemic in India and largely remains under reported due to is variability of presentations and as it can be easily mistaken for other infectious conditions.Disease manifestations can range from acute septicemia to chronic infection, as the facultative intracellular lifestyle and virulence factors of B. pseudomallei promote survival and persistence of the pathogen within a broad range of cells, and the bacteria can manipulate the host’s immune responses and signaling pathways to escape surveillance.Delays in treatment due to difficulties in clinical recognition and laboratory diagnosis often lead to poor outcomes and mortality can exceed 40% in some regions.As such the specific clinical diagnosis is difficult, thereby making laboratory diagnosis mandatory. The organism has a different treatment protocol as well as virulence determinants which influence the course of management.

Here,we are presenting a series of three laboratory proven cases of melioidosis and their varied outcomes.First is a case of 36-year-old male who presented with complaints of fever associated with multiple joint pain. He had evidence of Burkolderia in his blood and synovial fluid aspirate- suggestive of septic arthi itis.
Patient was managed with IV antibiotics, however he succumbed to illness.

Second is a 48-year-old male who presented with complaints of fever and unilateral lowerlimb swelling. Here patient had melioidosis in form of septic arthritis and septic pulmonary embolism. Patient responded well to antibiotic therapy and he recovered from the infection.

Third 1s a 65-year-old male who also presented with fever and he also had multiple subcutaneous abscess. He had burkolderia pseudomallei growth in blood, sputum and abscesses did not respond to the antibiotic therapy and died in view of ARDS.

The common aspects related to all the three cases include male sex, occupation and risk factors including diabetes and alcohol.The main cllnical aspect o1 the case series is,it is wise to consider Melioidosisin the initial differential diagnosis inpatients presenting with bone and joint infections. It is mandatory to differentiate Burkolderia pseudomallei mom the other non-lactose fermenting gram negativebacilli, as early identification serves to be a crucial factor in deciding the mortality in these patients.