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Chronic melioidosis: a report of the first case in Japan
1Second Department of Internal Medicine, Gifu University School of Medicine.
Abstract:
A 41-year-old Japanese male with uncontrolled diabetes mellitus and alcoholic liver dysfunction developed melioidosis after his business trip to Indonesia and Singapore in 1988. His disease started with spiked fever on the following day after extraction of a tooth, and a liver abscess developed, followed by abscesses in the spleen and in the subphrenic space. In spite of splenectomy and intensive antimicrobial treatments for three months, he developed parotitis, prostatitis, and abscess of the right submandibular gland at 5 to 16-month interval. Pseudomonas pseudomallei was isolated from the blood and pus from each abscess. The lung was not involved. At present, he has returned to work, with continued intravenous instillation of imipenem/cilastatin.
Insights
This case study details a severe melioidosis infection in a diabetic patient returning from Southeast Asia. Despite aggressive treatment, the patient experienced recurrent abscesses, highlighting the challenges of managing this bacterial disease.
Area of Science:
- Infectious Diseases
- Tropical Medicine
- Microbiology
Background:
- Melioidosis is a serious infectious disease caused by Burkholderia pseudomallei.
- Risk factors include diabetes mellitus and exposure to endemic areas like Southeast Asia.
- Alcoholic liver dysfunction can exacerbate infectious disease outcomes.
Observation:
- A 41-year-old Japanese male with diabetes and liver dysfunction developed melioidosis post-travel to Indonesia and Singapore.
- Initial symptoms included fever and abscesses in the liver, spleen, and subphrenic space.
- Recurrent infections, including parotitis, prostatitis, and submandibular abscess, occurred despite splenectomy and 3 months of antibiotics.
Findings:
- Pseudomonas pseudomallei was identified in blood and pus from multiple abscesses.
- The patient experienced a prolonged and relapsing course of melioidosis.
- Pulmonary involvement was notably absent in this case.
Implications:
- This case underscores the importance of considering melioidosis in patients with relevant travel history and risk factors presenting with abscesses.
- Aggressive and prolonged antimicrobial therapy, such as imipenem/cilastatin, may be necessary for severe or recurrent melioidosis.
- Early diagnosis and management are crucial to prevent severe morbidity and mortality associated with Burkholderia pseudomallei infections.