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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.

Dhodapkar R, Sujatha S, Sivasangeetha K, Prasanth G, Parija SC - Cases J (2008)

Bottom Line: Patient was managed with iv ceftazidime and surgical excision.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, PIN 605006, India. sujathasistla@gmail.com.

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.

No MeSH data available.


Related in: MedlinePlus

Bilateral ankle swelling.
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Figure 1: Bilateral ankle swelling.

Mentions: On examination bilateral swelling in ankle region with tenderness, with restriction in movement of affected joint was observed(Figure 1); per abdomen examination revealed a spleen of 4 cm below the costal margin which was tender on palpation. USG abdomen confirmed the physical finding of an enlarged spleen with multiple hypo echoic lesions, largest being 3 cm in diameter. X ray of ankles was normal with no joint involvement. Ultrasonographic examination revealed a collection of fluid in subcutaneous plane in bilateral ankle region(Figure 2). Investigations revealed neutrophilia, raised ESR and a markedly elevated ALP- 750 U/L. The patient was diagnosed to be a diabetic on the basis of oral glucose tolerance test. Further during the course of his stay in the hospital, the patient developed a swelling in his right knee. At this point a differential diagnosis of tuberculosis, AIDS with multiple site infections, and infective endocarditis were considered. However these were ruled out as specific tests for tuberculosis and HIV were negative, blood culture was negative and there were no cardiac abnormalities detected in the echocardiogram. A diagnostic aspirate from the left ankle revealed frank pus which on gram staining revealed the presence of gram negative bacilli with a typical safety pin appearance. Culture from the pus grew dry wrinkled colonies on blood agar and pinkish rugose colonies on MacConkey's agar(Figure 3). The peculiar appearance on gram staining and colony characters on culture raised the suspicion of B. pseudomallei. The isolate was identified as B. pseudomallei by standard biochemical methods [3] and was found to be sensitive to ciprofloxacin and ceftazidime. The patient was started on Ceftazidime 2 grams iv given 8 hourly, abscesses were drained surgically, repeat cultures were positive for two weeks but were sterile thereafter; iv antibiotics were continued for one month. Control of the patient's blood sugar was achieved simultaneously and he was discharged after a month. One of the surprising features was that the patient remained afebrile throughout the course of hospitalization.


Burkholderia pseudomallei infection in a patient with diabetes presenting with multiple splenic abscesses and abscess in the foot: a case report.

Dhodapkar R, Sujatha S, Sivasangeetha K, Prasanth G, Parija SC - Cases J (2008)

Bilateral ankle swelling.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567297&req=5

Figure 1: Bilateral ankle swelling.
Mentions: On examination bilateral swelling in ankle region with tenderness, with restriction in movement of affected joint was observed(Figure 1); per abdomen examination revealed a spleen of 4 cm below the costal margin which was tender on palpation. USG abdomen confirmed the physical finding of an enlarged spleen with multiple hypo echoic lesions, largest being 3 cm in diameter. X ray of ankles was normal with no joint involvement. Ultrasonographic examination revealed a collection of fluid in subcutaneous plane in bilateral ankle region(Figure 2). Investigations revealed neutrophilia, raised ESR and a markedly elevated ALP- 750 U/L. The patient was diagnosed to be a diabetic on the basis of oral glucose tolerance test. Further during the course of his stay in the hospital, the patient developed a swelling in his right knee. At this point a differential diagnosis of tuberculosis, AIDS with multiple site infections, and infective endocarditis were considered. However these were ruled out as specific tests for tuberculosis and HIV were negative, blood culture was negative and there were no cardiac abnormalities detected in the echocardiogram. A diagnostic aspirate from the left ankle revealed frank pus which on gram staining revealed the presence of gram negative bacilli with a typical safety pin appearance. Culture from the pus grew dry wrinkled colonies on blood agar and pinkish rugose colonies on MacConkey's agar(Figure 3). The peculiar appearance on gram staining and colony characters on culture raised the suspicion of B. pseudomallei. The isolate was identified as B. pseudomallei by standard biochemical methods [3] and was found to be sensitive to ciprofloxacin and ceftazidime. The patient was started on Ceftazidime 2 grams iv given 8 hourly, abscesses were drained surgically, repeat cultures were positive for two weeks but were sterile thereafter; iv antibiotics were continued for one month. Control of the patient's blood sugar was achieved simultaneously and he was discharged after a month. One of the surprising features was that the patient remained afebrile throughout the course of hospitalization.

Bottom Line: Patient was managed with iv ceftazidime and surgical excision.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, PIN 605006, India. sujathasistla@gmail.com.

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.

No MeSH data available.


Related in: MedlinePlus