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A traveller presenting with severe melioidosis complicated by a pericardial effusion: a case report

Detlev Schultze1, Brigitt Müller, Thomas Bruderer

  • 1Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St, Gallen, Switzerland. detlev.schultze@zlmsg.ch

BMC Infectious Diseases
|October 6, 2012
PubMed
Abstract

Insights

Melioidosis, a bacterial infection, can manifest as pericardial effusion in travelers returning from endemic areas. This case highlights the importance of considering melioidosis in non-endemic regions, even without typical risk factors.

Area of Science:

  • Infectious Diseases
  • Tropical Medicine
  • Cardiology

Background:

  • Melioidosis, caused by Burkholderia pseudomallei, is prevalent in Southeast Asia and Australia.
  • It typically affects individuals with compromised immune systems and can present with pericardial effusion in 1-3% of cases.
  • Pericardial effusion in melioidosis is usually confined to endemic regions.

Observation:

  • A traveler returning from Thailand to Switzerland developed pneumonia with pleural effusions and significant pericardial effusion.
  • Standard blood and specimen cultures were negative, delaying diagnosis.
  • Burkholderia pseudomallei was ultimately identified in the pericardial fluid aspirate.

Findings:

  • This is the first reported case of melioidosis in a traveler presenting with hemodynamically significant pericardial effusion without underlying risk factors.
  • The diagnosis was confirmed solely through pericardial fluid culture.
  • Prompt antibiotic treatment was initiated upon diagnosis.

Implications:

  • Melioidosis is a "great mimicker" with diverse clinical presentations.
  • Physicians in non-endemic countries must consider melioidosis in the differential diagnosis of pericardial effusion in travelers.
  • Awareness is crucial, even in patients without predisposing conditions for severe disease.

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