Imported melioidosis with an isolated cutaneous presentation in a 90-year-old traveller from Bangladesh.
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.
Ezzedine
K
K
Service de dermatologie, Centre hospitalier universitaire Erasme, Bruxelles, B-1070 Belgique. kezzedin@ulb.ac.be
Malvy
D
D
Steels
E
E
De Dobbeeler
G
G
Struelens
M
M
Jacobs
F
F
Heenen
M
M
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
D019980:Amoxicillin-Potassium Clavulanate Combination; D004318:Doxycycline