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Severe Sepsis with Multiorgan Failure due to Melioidosis: A Lesson to Learn
Dinuka S Warapitiya1, Shyama Subasinghe2, Rukshanie Frances de Silva1
1Post Graduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka.
Introduction:
Melioidosis is a bacterial infection caused by a Gram-negative bacillus Burkholderia pseudomallei, prevalent in Southeast Asia and Northern Australia. Sri Lanka is situated in the endemic belt of melioidosis. Melioidosis has a wide spectrum of clinical presentations and results in high mortality rates in severe infection. Case Report. We report a 54-year-old previously healthy Sri Lankan farmer who presented with septicemia following a cut injury to the right leg while working in a paddy field. Initially, he had mild wound sepsis, and later, his condition deteriorated rapidly. The patient required organ support later for cardiovascular instability, acute liver failure, acute kidney injury, acute respiratory distress syndrome, and coagulopathy. The patient's blood culture was negative on the admission day, and the repeated blood culture taken at the ICU was contaminated with a commensal flora initially and later isolated Burkholderia pseudomallei. Although wound swab culture taken on the first day isolated an organism, it took six days to identify it as Burkholderia pseudomallei. The patient succumbed to severe melioidosis leading to a severe sepsis and multiorgan failure in spite of treatment with meropenem.
Conclusion:
This case report highlights the importance of considering melioidosis as a differential diagnosis when a patient comes with risk factors for melioidosis.
Insights
Melioidosis, a serious bacterial infection caused by Burkholderia pseudomallei, is endemic in Sri Lanka. This case report details a fatal outcome despite treatment, underscoring the need for early diagnosis.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Melioidosis is a severe bacterial infection caused by Burkholderia pseudomallei, endemic in Southeast Asia and Northern Australia.
- Sri Lanka is located within the melioidosis endemic belt, posing a significant public health concern.
- The infection presents with diverse clinical manifestations and is associated with high mortality rates in severe cases.
Observation:
- A previously healthy 54-year-old Sri Lankan farmer presented with septicemia after a leg injury sustained in a paddy field.
- The patient experienced rapid deterioration, requiring extensive organ support for cardiovascular instability, liver and kidney failure, ARDS, and coagulopathy.
- Initial blood cultures were negative, with Burkholderia pseudomallei eventually isolated from a repeated blood culture and a wound swab after a delay in identification.
Findings:
- Despite prompt treatment with meropenem, the patient succumbed to severe melioidosis, sepsis, and multiorgan failure.
- Delayed identification of Burkholderia pseudomallei from clinical samples complicated the management of this severe case.
- The case highlights the challenges in diagnosing and managing melioidosis, particularly in resource-limited settings.
Implications:
- Early consideration of melioidosis in patients with relevant risk factors and compatible symptoms is crucial for timely diagnosis and treatment.
- This case underscores the need for improved diagnostic strategies and awareness of melioidosis in endemic regions like Sri Lanka.
- Healthcare providers should maintain a high index of suspicion for melioidosis in patients presenting with severe sepsis and multiorgan failure, especially after potential exposure.
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