title: Imported melioidosis with an isolated cutaneous presentation in a 90-year-old traveller from Bangladesh.
abstract: Melioidosis is a tropical disease caused by infection with the bacterium Burkholderia pseudomallei. Most cases present as an acute febrile illness with severe pneumonia and sepsis. Sub-acute and late onset disease can also occur Melioidosis has been diagnosed among travellers who contracted the disease while staying in endemic areas during the rainy season. We report a case of travel-associated B. pseudomallei cutaneous infection in a febrile 90-year-old woman with diabetes mellitus, with early stage manifestations of an isolated inoculation lesion. A 32 weeks' treatment with oral amoxicillin-clavulanate and doxycycline combination regimen led to resolution of the lesion and lack of relapse over fifteen months of follow-up. Melioidosis should be considered in the differential diagnosis of unusual subacute cutaneous lesions in a febrile patients returning from endemic areas, as successful management largely depends on early diagnosis and specific long-term suppressive antimicrobial therapy at an early stage of the course of the disease.
authors.affiliation: Service de dermatologie, Centre hospitalier universitaire Erasme, Bruxelles, B-1070 Belgique. kezzedin@ulb.ac.be
authors.forename: K
authors.initials: K
authors.lastname: Ezzedine
authors.forename: D
authors.initials: D
authors.lastname: Malvy
authors.forename: E
authors.initials: E
authors.lastname: Steels
authors.forename: G
authors.initials: G
authors.lastname: De Dobbeeler
authors.forename: M
authors.initials: M
authors.lastname: Struelens
authors.forename: F
authors.initials: F
authors.lastname: Jacobs
authors.forename: M
authors.initials: M
authors.lastname: Heenen
mesh_terms: D000369:Aged, 80 and over; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D001459:Bangladesh / Q000208:ethnology; D001530:Belgium; D016957:Burkholderia pseudomallei / Q000187:drug effects / Q000302:isolation & purification; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004198:Disease Susceptibility; D004318:Doxycycline / Q000627:therapeutic use; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004550:Elbow; D005260:Female; D006801:Humans; D008554:Melioidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D014195:Travel
chemical_list: D019980:Amoxicillin-Potassium Clavulanate Combination; D004318:Doxycycline