| dc.description.abstract | Melioidosis is endemic in Sri Lanka. We present a case of melioidosis which led to diagnostic
confusion and an unfavourable outcome. A 53-year-old paddy farmer from Kurunegala was
admitted to the University Hospital, KDU with fever, myalgia, arthralgia, headache, and loss of
appetite for 1 week. He was a diabetic with poor glycaemic control and had engaged in farming
during the preceding month. On examination, he was febrile, dyspnoeic and had multiple
abrasions on both feet. His temperature was 101° F, blood pressure 180/110mm Hg, respiratory
rate 40/min, heart rate 118/min, SpO2 78%, blood lactate 2.4mm/L and creatinine 2.1mg/dL
with acute kidney injury on admission. Clinical suspicion of sepsis following leptospirosis was
made, ceftriaxone 2g daily was started after taking blood for cultures and leptospira studies and
was transferred to the ICU. The patient rapidly desaturated and went into septic shock requiring
maximum inotrope and ventilatory support. On the following day blood cultures flagged positive
for a Gram-negative bacillus and ceftriaxone was changed to meropenem. Patient deteriorated
rapidly with refractory shock and persistent hypoxemia and died within 48 hours. A non-lactose
fermenting bacterium, resistant to aminoglycosides and colistin was isolated and a probable
diagnosis of melioidosis was made. Isolate was confirmed as Burkholderia pseudomallei using a
specific latex agglutination test and lpxO Real-Time PCR assay. Genotyping revealed isolate
belongs to Yersinia-like fimbrial(YLF) group which carry bimABp allele variant. Leptospirosis
micro agglutination test was negative. Melioidosis may mimic leptospirosis. However, the
antibiotics prescribed for leptospirosis are ineffective in the treatment of melioidosis. Therefore,
melioidosis should be a differential diagnosis in patients with acute sepsis from highly endemic
areas. | en_US |
