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Published on: February 24, 2023
A case series of melioidosis: An underdiagnosed infection
Dilip Kumar Dubey1, Noor Bano1, Madhulika Dubey2
1Institute of Critical Care and Pulmonary Medicine, Medanta Hospital, Lucknow, Uttar Pradesh 226030, India.
Abstract:
Melioidosis is an infection caused by Burkholderia pseudomallei. It is a non notifiable disease and is not included in Integrated Disease Surveillance Program by National Center of Disease Control. India is predicted to have highest burden of disease with an estimated mortality of 32,000 per year. Melioidosis presents with a wide range of clinical manifestations like pneumonia, liver and splenic abscess, septicemia etc. This wide spectrum of presentation and mimicry with other infections leads to its misdiagnosis or underdiagnosis. The only source of disease burden in India is few case reports and the true burden and distribution of disease still needs to be assessed. We, hereby, report a case series of four cases aged 28 years, 53 years, 33 years and 22 years. All cases had different clinical presentation ranging from abdominal wall abscess to septicemia and neurological manifestations making the diagnosis challenging. Three of the four cases were discharged after complete recovery while one case went leave against medical advice. To our knowledge this is the first series describing complete recovery of three out of four cases. This case series will help the physicians to raise their index of clinical suspicion of melioidosis in high risk patients presenting with various findings thus improving the chances of correct diagnosis and treatment.
Insights
Melioidosis, a severe infection caused by Burkholderia pseudomallei, is underdiagnosed in India. This case series highlights varied presentations and successful treatment outcomes, emphasizing increased clinical suspicion for better diagnosis.
Area of Science:
- Infectious Diseases
- Clinical Medicine
- Microbiology
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a significant yet underreported public health concern in India, with an estimated 32,000 annual deaths.
- The disease is not notifiable and not part of national surveillance programs, contributing to its underdiagnosis.
- Its diverse clinical manifestations mimic other infections, complicating accurate and timely diagnosis.
Observation:
- A case series of four patients (aged 22-53 years) with melioidosis is presented.
- Clinical presentations varied widely, including abdominal wall abscess, septicemia, and neurological symptoms.
- Diagnosis was challenging due to the broad spectrum of symptoms and mimicry of other diseases.
Findings:
- Three out of four patients achieved complete recovery.
- This series represents the first documented cases of multiple melioidosis recoveries in India.
- The study underscores the potential for successful treatment outcomes with appropriate medical intervention.
Implications:
- Increased clinical suspicion for melioidosis is crucial in high-risk patients presenting with diverse symptoms.
- Improved diagnostic awareness can lead to earlier detection and more effective treatment strategies.
- Further research is needed to assess the true burden and distribution of melioidosis in India.
