Mycobacterium avium and Burkholderia pseudomallei (Melioidosis) coinfection in an HIV-positive patient.
A 29 year old HIV positive Thai female with CD4 count of 10 cells/mm3 presented with chronic diffuse abdominal pain, fever, weight loss, anemia and leucopenia. Ultrasonography demonstrated diffuse upper abdominal lymphadenopathy with ascites. Microbiological and molecular work up of the specimen obtained by ultrasound-guided lymph node aspiration revealed co-infection with Burkholderia pseudomallei and Mycobacterium avium. Indirect hemagglutination, IgM-indirect fluorescent antibody, and IgG-indirect fluorescent antibody to Burkholderia pseudomallei were < 1:20, < 1:50 and < 1:50, respectively, at nine months, four months before the culture diagnosis and two months, eight months after the culture diagnosis of Burkholderia pseudomallei infection. The patient was treated initially with two weeks of intravenous ceftazidime, followed by oral cotrimoxazole, doxycycline and chloramphenicol. Clarithromycin and ofloxacin were added after the identification of Mycobacterium avium and its susceptibility test. The patients demonstrated clinical improvement with decreasing abdominal pain and resolution of fever.
Pumpradit
Wadchara
W
JICA-NIH Project, Ministry of Public Health, Thailand. wadchara.p@hivnat.org
Ariyoshi
Koya
K
Petkanchanapong
Wimol
W
Wichukchinda
Nuanjun
N
Chaiprasert
Angkana
A
Rojanawat
Archawin
A
Sawanpanyalert
Pathom
P
Pathipvanich
Panita
P
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D016957:Burkholderia pseudomallei; D004359:Drug Therapy, Combination; D005260:Female; D006679:HIV Seropositivity / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008554:Melioidosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D009162:Mycobacterium avium; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy
D000900:Anti-Bacterial Agents