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Melioidosis: misdiagnosed in Nepal.
BMC Infect Dis. 2019 Feb 19; 19(1):176.BI

Abstract

BACKGROUND

Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia.

CASE PRESENTATION

Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole.

CONCLUSION

The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Authors+Show Affiliations

Department of Microbiology, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal. dr.neha.shrestha@gmail.com.Department of Microbiology, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.Department of Biochemistry, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.Department of Medicine, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.Department of Pathology, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.The Oxford University Clinical Research Unit, Kathmandu, Nepal.Department of Microbiology, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.Department of Microbiology, Tribhuvan University Teaching Hospital (TUTH), Institute of Medicine, Kathmandu, Nepal.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30782129

Citation

Shrestha, Neha, et al. "Melioidosis: Misdiagnosed in Nepal." BMC Infectious Diseases, vol. 19, no. 1, 2019, p. 176.
Shrestha N, Adhikari M, Pant V, et al. Melioidosis: misdiagnosed in Nepal. BMC Infect Dis. 2019;19(1):176.
Shrestha, N., Adhikari, M., Pant, V., Baral, S., Shrestha, A., Basnyat, B., Sharma, S., & Sherchand, J. B. (2019). Melioidosis: misdiagnosed in Nepal. BMC Infectious Diseases, 19(1), 176. https://doi.org/10.1186/s12879-019-3793-x
Shrestha N, et al. Melioidosis: Misdiagnosed in Nepal. BMC Infect Dis. 2019 Feb 19;19(1):176. PubMed PMID: 30782129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Melioidosis: misdiagnosed in Nepal. AU - Shrestha,Neha, AU - Adhikari,Mahesh, AU - Pant,Vivek, AU - Baral,Suman, AU - Shrestha,Anjan, AU - Basnyat,Buddha, AU - Sharma,Sangita, AU - Sherchand,Jeevan Bahadur, Y1 - 2019/02/19/ PY - 2018/05/28/received PY - 2019/02/08/accepted PY - 2019/2/21/entrez PY - 2019/2/21/pubmed PY - 2019/4/9/medline KW - Abscess KW - Burkholderia pseudomallei KW - Diabetes KW - Melioidosis KW - Nepal SP - 176 EP - 176 JF - BMC infectious diseases JO - BMC Infect Dis VL - 19 IS - 1 N2 - BACKGROUND: Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia. CASE PRESENTATION: Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole. CONCLUSION: The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes. SN - 1471-2334 UR - https://www.unboundmedicine.com/medline/citation/30782129/Melioidosis:_misdiagnosed_in_Nepal_ L2 - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-3793-x DB - PRIME DP - Unbound Medicine ER -