Subacute pulmonary melioidosis in a temperate climate

Previous reports of cases of melioidosis that were seen in nonendemic areas of Australia describe recrudescences of latent infection. We describe the case of a patient who presented in the cooler climate of Melbourne with a probable primary, subacute pulmonary infection with Pseudomonas pseudomallei. This case illustrates several points that bear consideration in the management of atypical pneumonia and, more specifically, pulmonary melioidosis. Historical and occupational clues are easily missed or unrecognized, while a persistent growth of gentamicin-resistant Pseudomonas species should arouse suspicion. Septicaemic melioidosis carries a poor prognosis, and treatment should be early and aggressive; use of the newer, third-generation cephalosporin agents should be considered. Given active support in a well-equipped intensive care unit, together with appropriate antibiotic therapy, patients may eventually be cured of this infection, but a high mortality rate is still encountered.