Splenic granuloma: Melioidosis or Tuberculosis?
Fibi Ninan1, Ajay Kumar Mishra1, Ajoy Oommen John1
1Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Abstract:
Melioidosis well known as a 'great mimicker' is caused by Burkholderia pseudomallei. Even though majority of the patients present with acute infection, around 18 % can present as chronic infection. These latent foci of infection may reactivate to cause fulminant infection at a later date. Due to lack of clinical suspicion and good laboratory facility latent infections are often misdiagnosed and treated as tuberculosis. Chronic splenic granuloma is a rare manifestation of Melioidosis . Deep seated abscess requires atleast 4 weeks of intensive treatment with intravenous antibiotics. Ceftazidime , the drug of choice for melioidosis can cause drug induced thrombocytopenia. Simultaneous use of diclofenac may potentiate this phenomenon. Treatment with meropenem may be life saving in such situitations.
Insights
Melioidosis, caused by Burkholderia pseudomallei, can present as chronic infection and rare splenic granulomas. Early diagnosis and appropriate antibiotics like meropenem are crucial for managing this great mimicker.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a significant infectious disease known for its diverse clinical presentations.
- While acute infections are common, approximately 18% of cases manifest as chronic infections, posing diagnostic challenges.
Observation:
- Chronic splenic granuloma is an uncommon but recognized manifestation of Melioidosis.
- Latent infections can reactivate, leading to severe, fulminant disease, often misdiagnosed as tuberculosis due to limited clinical suspicion and laboratory resources.
Findings:
- Deep-seated abscesses necessitate prolonged intravenous antibiotic therapy (at least 4 weeks).
- Ceftazidime, a primary treatment, can induce thrombocytopenia, a risk potentially amplified by concurrent diclofenac use.
Implications:
- Recognizing rare presentations like splenic granulomas is vital for accurate Melioidosis diagnosis.
- Alternative antibiotic choices, such as meropenem, may be life-saving in complicated cases or when drug-induced complications arise.
More Related Videos
Related Concept Videos
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:28Pulmonary Tuberculosis II
Here is a detailed explanation of its pathophysiology:
Transmission: The process begins when a person inhales droplet nuclei containing M. tuberculosis. These are typically released into the air when an individual with pulmonary or...
01:28Pulmonary Tuberculosis V
Latent tuberculosis infection occurs when TB bacteria are present in a person's body, but are not causing illness or symptoms. It is not contagious, and preventive treatment is crucial to avoid the...
01:31Pulmonary Tuberculosis III
The first classification is based on the development of the disease, and it includes the following categories:
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...