https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/78 Tue, 02 Aug 2016 12:22:10 +0000 Melioidosis is an infectious disease that can cause serious morbidity and may result in death if not treated early. Its causative organism, Burkholderia pseudomallei is present in soil and water. Here, we report a case of disseminated melioidosis involving skin and joint in a farmer residing in an area where the organism has been found in the soil. Ibrahim Med. Coll. J. 2015; 9(2): 55-57     Melioidosis, a potentially life threatening infectious disease, is caused by the Gram-negative bacillus, Burkholderia pseudomallei, a soil and fresh water saprophyte in tropical and subtropical regions. Although it is regarded as a public health problem in tropical Australia and in Southeast Asian countries, particularly Malaysia, Thailandand Singapore, the increasing number of reported cases in Bangladeshand India are alarming.1,2 In Bangladesh, this organism has already been isolated from the soil of Kapasia of Gazipur district in 2013 rendering this country as a definite country for melioidosis.3 Here, we report a case of disseminated melioidosis involving skin and joint from the same region. Case summery The patient was treated with intravenous imipenem (dose was adjusted according to renal function) and subcutaneous insulin. His general condition improved, joint swelling reduced and a repeat blood culture after 3 days showed no growth of the organism. The patient was discharged on request after two weeks with oral doxycycline (100mg bid) and amoxicillin-clavulanate (500/125mg bid) for 5 months. A follow up visit after 2 weeks showed disappearance of his neck swellings but his joint was mildly tender and swollen. However, no fluid could be aspirated. He was advised to continue his medications and start physiotherapy once his joint pain subsides. Unfortunately, the patient died of acute myocardial infarction 4 weeks after the follow-up visit.   Discussion On the other hand in Southeast Asia, primary skin melioidosis has been reported to be associated with necrotizing fasciitis, sepsis and internal organ abscesses.4,7,8 Blisters, superficial erythematous pustules, clusters of violaceous skin abscesses, cellulites and subcutaneous abscesses have commonly been reported.l,4 Treatment for melioidosis is effective and life saving provided the diagnosis is timely made and the   Melioidosis mimics tuberculosis in clinical, radiological and histo-pathological aspects. Considering the rising numbers of reported cases in our country and a high mortality rate in bacteraemic cases, it is important to suspect melioidosis in appropriate clinical settings where infection does not respond to conventional antibiotics or anti-tubercular medications. Awareness about the extent of this disease in our country needs to be developed among both clinicians and microbiologists. Acknowledgements References 2.    Barai L, Jilani SA, Haq JA. Melioidosis-Case reports and review of cases recorded among Bangladeshi population from 1988-2014. Ibrahim Med Coll J 2014; 8(1): 25-31. 4.    Chaowagul W, White N, Dance DAB, Wattanagoon Y, Naigowit P et al. Melioidosis: a major cause of community-acquired septicemia in Northeastern Thailand. Infect Dis 1989; 159: 890-9. 6.    Gibney KB, Cheng AC, Currie BJ. Cutaneous melioidosis in the tropical top end of Australia: a prospective study and review of the literature. Clinical Infectious Diseases 2008; 47: 603-9. 8.    Wang Y, Wong C, Kurup A. Cutaneous melioidosis and necrotizing fasciitis caused by Burkholderia pseudomallei. Emerg Infect Dis 2003; 9: 1484–5. 10.  Ezzedine K, Heenen M, Malvy D. Imported cutaneous melioidosis in traveler, Belgium. Emerg Infec Dis 2007; 13(6): 946-7. 2026 Ibrahim Medical College. All rights reserved.