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Dambly JM, Hunter ER, Giakas AM, Glowacki JB. Hypermucoviscous Klebsiella pneumoniae presenting as sternocleidomastoid pyomyositis with subsequent lower extremity necrotising fasciitis. BMJ Case Rep 2024; 17:e262362. [PMID: 39694652 DOI: 10.1136/bcr-2024-262362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2024] Open
Abstract
Necrotising fasciitis (NF) is a severe, rapidly progressing infection of the muscular fascia and subcutaneous tissue. Monomicrobial NF from hypermucoviscous Klebsiella pneumoniae (hvKP-NF) is rare but highly virulent, most common in East Asia. This report reviews a unique case of hvKP-NF in a US male in his 40s with undiagnosed diabetes mellitus, presenting with severe sepsis, neck swelling and calf pain. Imaging revealed pyomyositis in the sternocleidomastoid, and debridement cultures confirmed hvKP. Despite unremarkable examination findings, persistent pain led to a diagnosis of necrotising fasciitis after initial imaging misinterpretations. The patient was treated with multiple surgical debridements and tailored antibiotics. This case underscores the importance of maintaining a high index of suspicion for necrotising fasciitis despite atypical risk factors and symptomatology, awareness of hvKP in the Western Hemisphere, prompt consideration of advanced imaging modalities when initial evaluations are inconclusive and the critical role of multidisciplinary care in managing severe infections.
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Affiliation(s)
- Julia Margaret Dambly
- Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emily R Hunter
- Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alec M Giakas
- Thomas Jefferson University Hospital, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Joseph B Glowacki
- Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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2
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Ni HY, Zhang Y, Huang DH, Zhou F. Multi-systemic melioidosis in a patient with type 2 diabetes in non-endemic areas: A case report and review of literature. World J Clin Cases 2024; 12:1669-1676. [PMID: 38576731 PMCID: PMC10989420 DOI: 10.12998/wjcc.v12.i9.1669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/05/2024] [Accepted: 02/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Melioidosis, an infectious disease caused by Burkholderia pseudomallei (B. pseudomallei), occurs endemically in Southeast Asia and Northern Australia and is a serious opportunistic infection associated with a high mortality rate. CASE SUMMARY A 58-year-old woman presented with scattered erythema on the skin of her limbs, followed by fever and seizures. B. pseudomallei was isolated successively from the patient's urine, blood, and pus. Magnetic resonance imaging showed abscess formation involving the right forehead and the right frontal region. Subsequently, abscess resection and drainage were performed. The patient showed no signs of relapse after 4 months of follow-up visits post-treatment. CONCLUSION We present here a unique case of multi-systemic melioidosis that occurs in non-endemic regions in a patient who had no recent travel history. Hence, it is critical to enhance awareness of melioidosis in non-endemic regions.
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Affiliation(s)
- Huan-Yu Ni
- Department of Endocrinology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Ying Zhang
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China
| | - Dong-Hai Huang
- Department of Rheumatology and Immunology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
| | - Feng Zhou
- Department of Endocrinology, Puren Hospital, Wuhan University of Science and Technology, Wuhan 430080, Hubei Province, China
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Schwartzman G, Reddy SA, Berg SH, Currie BJ, Saavedra AP. Cutaneous melioidosis: An updated review and primer for the dermatologist. J Am Acad Dermatol 2023; 89:1201-1208. [PMID: 37582471 DOI: 10.1016/j.jaad.2023.07.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023]
Abstract
Melioidosis is an emerging infection with increasing endemic foci and global distribution. It is underrecognized and underdiagnosed because of factors including limited awareness of the disease, nonspecific clinical presentation, lack of diagnostic facilities in some locations, misidentification in laboratories inexperienced with culture, and identification of Burkholderia pseudomallei. Cutaneous findings are reported in approximately 10% to 20% of melioidosis cases and dermatologists may play a significant role in its recognition and management. The most dynamic situation of melioidosis recognition and/or expansion currently is in the United States. Global modeling had predicted that B. pseudomallei were potentially endemic in the southern United States and endemicity with local cases of melioidosis was confirmed in 2022. With the distribution and prevalence of melioidosis increasing globally and with this recent recognition that melioidosis is now endemic in the southern United States, it is important for dermatologists to maintain high clinical suspicion in appropriate patients and be familiar with its diagnosis and treatment. Here we review the available literature on cutaneous melioidosis to evaluate its epidemiology, etiology, pathophysiology and clinical presentation and provide guidance for diagnosis and management in dermatology practice.
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Affiliation(s)
| | - Soumya A Reddy
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Scott H Berg
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Arturo P Saavedra
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
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Jayawardena N, Ralapanawa U, Kumarihamy P, Jayalath T, Abeygunawardana SP, Dissanayake N, Dissanayake P, Udupihille J, Ratnatunga N, Dalugama C. Infective myositis, an uncommon presentation of melioidosis: a case report and review of the literature. J Med Case Rep 2019; 13:388. [PMID: 31888746 PMCID: PMC6937802 DOI: 10.1186/s13256-019-2321-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/20/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Melioidosis is considered endemic in certain areas of the world. Musculoskeletal and soft tissue involvement are relatively uncommon presentations in melioidosis. We present a case of infective myositis in a patient with melioidosis in Sri Lanka, which is not considered an endemic country. Even though multiple cases of melioidosis have been reported with an increasing number in Sri Lanka, infective myositis secondary to melioidosis was not reported previously. CASE PRESENTATION A 60-year-old Sinhalese man with diabetes presented with fever of 4 months' duration and a limp with a painful lump on the right side of the upper thigh of 2 months' duration. He had been treated in a local hospital for community-acquired pneumonia 3 weeks prior to this admission, for which he had received intravenous meropenem and teicoplanin with intensive care unit admission. He had a 0.5-cm × 0.5-cm tender lump over the right vastus lateralis muscle, and contrast-enhanced computed tomography of the area showed an ill-defined, heterogeneously enhancing, hypodense area involving the vastus lateralis, vastus intermedius, and quadratus femoris, suggestive of infective myositis but without abscess formation. Histopathology of the muscle biopsied from the vastus lateralis showed suppurative inflammation of subcutaneous fat with connective tissue necrosis and muscle infiltrated by lymphocytes. These features are suggestive of infective myositis possibly due to melioidosis. Although the result of a culture taken from the muscle biopsy was negative, the patient's antibody titer was strongly positive for melioidosis. He did not show any other areas with infected foci. He was treated with intravenous meropenem for 2 weeks and responded well. He was discharged with trimethoprim-sulfamethoxazole for 6 months as a maintenance therapy. CONCLUSION Melioidosis is commonly an undiagnosed disease that has a wide variety of clinical presentations. Myositis in melioidosis is uncommon, and careful evaluation is mandatory to avoid misdiagnosis of this treatable but fatal disease. The clinician should have a high index of clinical suspicion, and further clinical and epidemiological studies are needed to determine the true burden of the disease.
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Affiliation(s)
| | - Udaya Ralapanawa
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Thilak Jayalath
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | - Jeevani Udupihille
- Department of Radiology, University of Peradeniya, Peradeniya, Sri Lanka
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5
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Ţenţ PA, Juncar M, Mureșan O, Arghir OC, Iliescu DM, Onișor F. Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review. J Int Med Res 2018; 46:3480-3486. [PMID: 30058420 PMCID: PMC6134640 DOI: 10.1177/0300060518788490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Necrotizing fasciitis (NF) is a severe infection involving the superficial fascial layers, subcutaneous cellular tissue, and possibly skin. It usually has a fulminant evolution, rapidly leading to death in the absence of early diagnosis and aggressive surgical treatment. We herein report a rare case of NF secondary to a traumatized occipital psoriatic plaque in an alcoholic 47-year-old woman and compare this case with the published literature. The NF extended to the entire scalp, right face, and posterior and lateral cervical region. Despite the initially guarded prognosis, the patient’s survival emphasizes the importance of aggressive surgical treatment with wide excision of all necrotic structures without any aesthetic compromise.
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Affiliation(s)
- Paul Andrei Ţenţ
- 1 Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Mihai Juncar
- 1 Department of Oral and Maxillofacial Surgery, University of Oradea, Oradea, Romania
| | - Ovidiu Mureșan
- 2 Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Oradea, Romania
| | - Oana Cristina Arghir
- 3 Pulmonology Department, Faculty of Medicine, Ovidius University of Constanţa, Constanta, Romania
| | - Dan Marcel Iliescu
- 4 Anatomy Department, Faculty of Medicine, Ovidius University of Constanţa, Constanta, Romania
| | - Florin Onișor
- 2 Department of Oral and Maxillofacial Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Oradea, Romania
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6
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Kundangar RS, Bhat SN, Mohanty SP. Melioidosis mimicking tubercular cold abscess. BMJ Case Rep 2017; 2017:bcr-2017-221787. [PMID: 28928256 DOI: 10.1136/bcr-2017-221787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Burkholderia pseudomallei is a Gram-negative bacillus found in soil. The infection is thought to occur by inoculation or inhalation. It usually affects people with predisposing factors like diabetes mellitus and chronic alcoholism. A 36-year-old man, on the treatment of diabetes in the past 4 years, on oral hypoglycaemic drugs, presented to us with pain and insidious onset of swelling over left loin like a lumbar cold abscess. He underwent incision and drainage of the abscess. As per the culture report, we used ceftazidime for 2 weeks, followed by cotrimoxazole for 6 months. Surgical drainage of large abscesses is indicated. A dedicated team of microbiologist and physicians is required to identify and treat the disease. Orthopaedic manifestations are uncommon.
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Affiliation(s)
| | - Shyamasunder N Bhat
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Simanchal P Mohanty
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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7
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Achappa B, Madi D, Vidyalakshmi K. Cutaneous Melioidosis. J Clin Diagn Res 2016; 10:WD01-WD02. [PMID: 27790560 DOI: 10.7860/jcdr/2016/18823.8463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
Melioidosis is an emerging infection in India. It usually presents as pneumonia. Melioidosis presenting as cutaneous lesions is uncommon. We present a case of cutaneous melioidosis from Southern India. Cutaneous melioidosis can present as an ulcer, pustule or as crusted erythematous lesions. A 22-year-old gentleman known case of diabetes mellitus was admitted in our hospital with an ulcer over the left thigh. Discharge from the ulcer grew Burkholderia pseudomallei. He was successfully treated with ceftazidime. Melioidosis must be considered in the differential diagnosis of nodular or ulcerative cutaneous lesion in a diabetic patient.
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Affiliation(s)
- Basavaprabhu Achappa
- Associate Professor, Department of Medicine, Kasturba Medical College, Manipal University , Mangaluru, Karnataka, India
| | - Deepak Madi
- Associate Professor, Department of Medicine, Kasturba Medical College, Manipal University , Mangaluru, Karnataka, India
| | - K Vidyalakshmi
- Professor, Department of Microbiology, Kasturba Medical College, Manipal University , Mangaluru, Karnataka, India
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8
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Yeo B, Lee J, Alagappan U, Pan JY. Cutaneous melioidosis with unusual histological features. Clin Exp Dermatol 2015; 41:272-4. [DOI: 10.1111/ced.12726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/29/2022]
Affiliation(s)
- B. Yeo
- National Skin Centre; Singapore
| | - J. Lee
- National Skin Centre; Singapore
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10
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Foong YW, Tan NWH, Chong CY, Thoon KC, Tee NWS, Koh MJA. Melioidosis in children: a retrospective study. Int J Dermatol 2015; 54:929-38. [PMID: 25771733 DOI: 10.1111/ijd.12837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 07/29/2014] [Accepted: 08/11/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Melioidosis, caused by Burkholderia pseudomallei, is endemic in Singapore and can present as localized or disseminated disease. METHODS Demographic data, clinical features, investigation results, treatments, and outcomes in patients aged <16 years diagnosed with melioidosis at KK Women's and Children's Hospital between January 2002 and January 2014 were retrospectively reviewed. Data for patients with primary skin disease and those with other organ involvement were compared. RESULTS Seventeen children were diagnosed with melioidosis. Their median age was 12.5 years (range: 2-15 years). Nine (53%) patients presented with localized cutaneous melioidosis and five (29%) with localized lymphadenitis, pneumonia, or septic arthritis. The remaining three (18%) patients had melioidosis sepsis; two of these patients died from septic shock. Treatment included an initial 1-2 weeks of IV antibiotics followed by 3-6 months of oral combination antibiotics. All cases of localized cutaneous disease resolved completely with no recurrences. Three (60%) of the five patients with localized involvement of other organ systems achieved complete resolution of disease, and the remaining two were lost from follow-up. CONCLUSIONS Although uncommon, melioidosis can occur in children living in endemic regions. Patients with localized skin disease have good outcomes with no recurrences. Systemic disease can be fatal, especially in the presence of underlying immunodeficiency. Diagnosis requires a high index of suspicion, and treatment requires prolonged combination antibiotic therapy.
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Affiliation(s)
- Yee-Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Natalie Woon-Hui Tan
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Duke-NUS Graduate Medical School , Singapore
| | - Chia-Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Duke-NUS Graduate Medical School , Singapore
| | - Koh-Cheng Thoon
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore.,Duke-NUS Graduate Medical School , Singapore
| | - Nancy Wen-Sim Tee
- Duke-NUS Graduate Medical School , Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
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11
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Bodilsen J, Langgaard H, Nielsen HL. Cutaneous melioidosis in a healthy Danish man after travelling to South-East Asia. BMJ Case Rep 2015; 2015:bcr-2014-207340. [PMID: 25596295 DOI: 10.1136/bcr-2014-207340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A healthy Danish man presented with infected prepatellar bursitis 8 months after being involved in a car accident in Malaysia resulting in exposure of a laceration of his knee to stagnant water. Tissue samples grew Burkholderia pseudomallei and diagnostic work up revealed no secondary foci. The patient was successfully treated with surgical debridement and 3 months of oral trimethoprim-sulfamethoxazole. At 6 months follow-up the patient was without relapse.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | | | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
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Svensson E, Welinder-Olsson C, Claesson BA, Studahl M. Cutaneous melioidosis in a Swedish tourist after the tsunami in 2004. ACTA ACUST UNITED AC 2009; 38:71-4. [PMID: 16338844 DOI: 10.1080/00365540500264738] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A tourist from Sweden developed cutaneous melioidosis after the tsunami in Thailand on 26 December 2004. Melioidosis is a severe, chronic infection which is endemic in Thailand and is caused by Burkholderia pseudomallei. Persons with traumatic injuries inflicted by the tsunami have increased risks of being infected by B. pseudomallei and melioidosis should be suspected if abscesses of the skin or inner organs develop in the months or years after the trauma.
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Affiliation(s)
- Erik Svensson
- Department of Clinical Bacteriology, Sahlgrenska University Hospital, Göteborg, Sweden
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13
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Gibney KB, Cheng AC, Currie BJ. Cutaneous melioidosis in the tropical top end of Australia: a prospective study and review of the literature. Clin Infect Dis 2009; 47:603-9. [PMID: 18643756 DOI: 10.1086/590931] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Burkholderia pseudomallei is endemic in northern Australia, and melioidosis is a common cause of sepsis in the region. METHODS We summarized the cutaneous manifestations of melioidosis from a prospective cohort of 486 patients with culture-confirmed melioidosis in northern Australia, and we compared those who had primary skin melioidosis with those who had other forms of melioidosis. RESULTS Primary skin melioidosis occurred in 58 patients (12%). Secondary skin melioidosis--multiple pustules from hematogenous spread--was present in 10 patients (2%). Patients with primary skin melioidosis were more likely to have chronic presentations (duration, >or=2 months). On multivariate analysis, patients with primary cutaneous melioidosis were more likely to be children aged <or=15 years (adjusted odds ratio, 8.50; 95% confidence interval [CI], 3.24-22.28) and to have a history of occupational exposure to B. pseudomallei (adjusted odds ratio, 3.12; 95% CI, 1.56-6.25) but were less likely to have typical risk factors--including diabetes (adjusted odds ratio, 0.26; 95% CI, 0.12-0.56), excessive alcohol intake (adjusted odds ratio, 0.45; 95% CI, 0.22-0.90), and chronic lung disease (adjusted odds ratio, 0.26; 95% CI, 0.10-0.67). Of those patients with primary skin melioidosis, 1 patient was bacteremic and none had severe sepsis or died from melioidosis. Four (7%) of the 58 patients presenting with primary skin melioidosis had disseminated melioidosis, and 1 (2%) experienced a relapse of melioidosis. Nine patients (16%) were cured with a regimen of oral antibiotics alone, and 1 recovered with no therapy. CONCLUSION In our cohort, patients with primary skin melioidosis were younger, had fewer underlying medical conditions, and had better outcomes than did those with other forms of melioidosis. There may be a role for exclusive oral antibiotic therapy for some cases of primary skin melioidosis.
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Affiliation(s)
- Katherine B Gibney
- Infectious Diseases Unit and Northern Territory Clinical School, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Lim IWM, Stride PJ, Horvath RL, Hamilton-Craig CR, Chau PP. Chromobacterium violaceum endocarditis and hepatic abscesses treated successfully with meropenem and ciprofloxacin. Med J Aust 2009; 190:386-7. [PMID: 19351314 DOI: 10.5694/j.1326-5377.2009.tb02454.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 11/17/2008] [Indexed: 11/17/2022]
Abstract
Chromobacterium violaceum infection is uncommon but potentially fatal, with a clinical picture similar to melioidosis but with different antibiotic sensitivities and treatment. This infection can involve any organ, but we believe this is the first reported case of C. violaceum endocarditis.
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Burkholderia pseudomallei infection in a patient with diabetes presenting with multiple splenic abscesses and abscess in the foot: a case report. CASES JOURNAL 2008; 1:224. [PMID: 18840270 PMCID: PMC2567297 DOI: 10.1186/1757-1626-1-224] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 10/07/2008] [Indexed: 11/30/2022]
Abstract
Introduction Melioidosis or infection with Burkholderia pseudomallei presents with protean manifestations. We present a case of melioidosis in a diabetic patient from India. The case is presented to highlight the importance of early microbiologic diagnosis and subsequent institution of appropriate therapy to achieve a better prognosis Case presentation A male bachelor around 50 years of age from India presented with low grade fever, bilateral ankle swelling and hypochondrial pain. On examination patient had diabetes and had multiple abscesses in bilateral ankle, knee and splenic region. Microbiologic diagnosis revealed the etiologic agent to be Burkholderia pseudomallei. Patient was managed with iv ceftazidime and surgical excision. Conclusion The case report highlights the importance of early identification of etiologic agent. B. pseudomallei identification requires a great deal of clinical suspicion as well as alertness on the part of the medical microbiologist as these isolates are often reported as Pseudomonas spp. Correct identification of the etiologic agent is essential as B pseudomallei requires prolonged antimicrobial therapy for a better clinical outcome.
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Miksić NG, Alikadić N, Lejko TZ, Andlovic A, Knific J, Tomazic J. Osteomyelitis of parietal bone in melioidosis. Emerg Infect Dis 2007; 13:1257-9. [PMID: 17953108 PMCID: PMC2828097 DOI: 10.3201/eid1308.070479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei. This disease is endemic in Southeast Asia and North Australia with sporadic occurrence in temperate countries, mostly imported from travellers. Any organ can be involved in melioidosis whereby Burkholderia pseudomallei causes an acute inflammatory reaction with rapid development of small abcesses which tend to coalesce to form larger abscesses. Cutaneous manifestations vary greatly. We report a man with systemic melioidosis who presented with cutaneous lesions.
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Affiliation(s)
- Lynn Teo
- Division of Dermatology, Changi General Hospital, Singapore.
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Maegele M, Gregor S, Yuecel N, Simanski C, Paffrath T, Rixen D, Heiss MM, Rudroff C, Saad S, Perbix W, Wappler F, Harzheim A, Schwarz R, Bouillon B. One year ago not business as usual: wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R50. [PMID: 16584527 PMCID: PMC1550895 DOI: 10.1186/cc4868] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 02/20/2006] [Accepted: 02/26/2006] [Indexed: 12/03/2022]
Abstract
Introduction Following the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients. Methods This study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities). Results Multiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response. Conclusion Individuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.
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Affiliation(s)
- Marc Maegele
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
- Intensive Care Unit of the Department of Traumatology and Orthopedic Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Sven Gregor
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Nedim Yuecel
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Christian Simanski
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Thomas Paffrath
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Dieter Rixen
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Markus M Heiss
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Claudia Rudroff
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Stefan Saad
- Department of Visceral Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Walter Perbix
- Department of Plastic and Reconstructive Surgery, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Andreas Harzheim
- Department of Radiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Rosemarie Schwarz
- Department of Microbiology, CMMC, University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
| | - Bertil Bouillon
- Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstrasse, 51109 Cologne, Germany
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19
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Ivers LC, Ryan ET. Infectious diseases of severe weather-related and flood-related natural disasters. Curr Opin Infect Dis 2006; 19:408-14. [PMID: 16940862 DOI: 10.1097/01.qco.0000244044.85393.9e] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review will focus on some of the possible infectious disease consequences of disastrous natural phenomena and severe weather, with a particular emphasis on infections associated with floods and the destruction of infrastructure. RECENT FINDINGS The risk of infectious diseases after weather or flood-related natural disasters is often specific to the event itself and is dependent on a number of factors, including the endemicity of specific pathogens in the affected region before the disaster, the type of disaster itself, the impact of the disaster on water and sanitation systems, the availability of shelter, the congregating of displaced persons, the functionality of the surviving public health infrastructure, the availability of healthcare services, and the rapidity, extent, and sustainability of the response after the disaster. Weather events and floods may also impact disease vectors and animal hosts in a complex system. SUMMARY Weather or flood-related natural disasters may be associated with an increased risk of soft tissue, respiratory, diarrheal, and vector-borne infectious diseases among survivors and responders.
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Affiliation(s)
- Louise C Ivers
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts, USA
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20
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Abstract
Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease.
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Affiliation(s)
- Allen C Cheng
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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21
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Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005. [PMID: 15831829 DOI: 10.1128/cmr.18.2.383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease.
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Affiliation(s)
- Allen C Cheng
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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22
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Demar M, Ferroni A, Dupont B, Eliaszewicz M, Bourée P. Suppurative epididymo-orchitis and chronic prostatitis caused by Burkholderia pseudomallei: a case report and review. J Travel Med 2005; 12:108-12. [PMID: 15996456 DOI: 10.2310/7060.2005.12208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Magalie Demar
- Parasitology-Mycology Unit, Cayenne Hospital/University of West Indies and French Guiana University
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