Pulmonary melioidosis. Observations in thirty-nine cases

Area of Science:

• Infectious Diseases
• Pulmonary Medicine
• Microbiology

Background:

• Melioidosis is a serious infectious disease caused by Pseudomonas pseudomallei, primarily found in endemic areas.
• Cases in non-endemic regions like the United States may arise from acute infections acquired abroad or reactivation of latent disease.
• Pulmonary melioidosis presents with symptoms such as fever, productive cough, and weight loss, often mimicking granulomatous conditions.

Purpose of the Study:

• To highlight the continued importance of recognizing pulmonary melioidosis in the United States.
• To describe the clinical presentation, diagnostic methods, and treatment outcomes for patients with pulmonary melioidosis.
• To emphasize the need for medical professional awareness of this potentially endemic disease.

Main Methods:

• Retrospective review of 39 pulmonary melioidosis cases treated between 1965 and 1970.
• Analysis of patient symptoms, medical history, chest radiographic findings, sputum culture results, and antibody titers.
• Evaluation of treatment responses to various antibiotic regimens and surgical interventions.

Main Results:

• Pseudomonas pseudomallei was identified as the causative agent, with isolates susceptible to tetracycline, chloramphenicol, sulfonamides, and kanamycin.
• Typical radiographic findings included upper lobe infiltrates and cavitation.
• Indirect hemagglutinating antibody titers were consistently elevated (greater than 1:40).
• Most patients responded well to tetracycline, often in combination with chloramphenicol.

Conclusions:

• Pulmonary melioidosis requires ongoing medical awareness in the US due to potential for imported or reactivated cases.
• Prompt bacteriologic examination and appropriate antibiotic therapy are key to successful management.
• Surgical intervention may be necessary in select cases, with lobectomy preferred when sputum cultures are negative.