Melioidosis; Mimicker of Tuberculosis- A Diagnostic Challenge

Kundoly Velayudhan Suseela

Amala Institute of Medical Sciences, India

Biography :

Dr. K V Suseela graduated from Gov. Medical College, Thrissur, Kerala, India and received MD degree in Microbiology from Govt. Medical College, Kozhikode, Kerala, India. Currently, she is working as Professor and Head of Microbiology department, Amala Institute of Medical Sciences, Thrissur, Kerala, India. She had published more than 20 research articles in peer reviewed national and International journals. Prof. Dr. Suseela has keen interest in bacteriology research.

Abstract :

Aim:

To evaluate two cases of melioidosis which were diagnosed as tuberculosis by histopathological examinations and treatment failed with antituberculous drugs

To discuss major underlying co-morbidities

Introduction: Melioidosis is an infectious disease caused by Burkholderiapseudomalleii and endemic in some geographical areas. It can present as acute, sub acute or chronic diseases as septicemia, abscesses in any organ, tuberculosis like lesions in lungs and lymphnodes. Chronic lung lesions and lymphadenitis on histopathological examination show granuloma suggestive of tuberculosis. Patients receive antituberculous treatment and they do not respond; may end in septicemia and mortality.

Cases:

• –yr- old man with type 2 diabetes developed fever, cough and weight loss. Findings of radiological examina tion of chest were suggestive of tuberculosis and patient received antituberculous treatment for one month. Later patient developed lung abscess and microbiological examination of broncho alveolar lavage proved it as meli oidosis. The patient was treated accordingly.
• yr- old lady who was suffering from psoriasis developed left inguinal lymphadenitis. Following histopatho logical examination patient received antituberculous treatment. As the lesion progressed to abscess patient was re-evaluated and B.pseudomallei was grown from the lesion. Patient was treated with antibiotics successfully.

Discussion: pseudomalleii is a saprophyte, inhabiting the soil in tropical countries. On reaching humans it persists intracel lularly in phagocytic and non phagocytic cells and produce lesions especially in people with co-morbid con­ditions. As it is a good mimicker it is a challenge to diagnose the disease and administer optimum treatment. Diabetes mellitus is the major co morbidity, seen in studies, associated with this disease. Right diagnosis and timely treatment can save the patient. The awareness among treating physicians about the varying clinical pre­sentations of melioidosis is essential, especially in non endemic areas, to reduce the mortality.