[Septicemia, bilateral community acquired pneumonia and empyema due to Burkholderia pseudomallei (mellioidosis) with a favorable outcome following prolonged specific antibiotic therapy].
BACKGROUND
Melioidosis is an infectious disease due to Burkholderia pseudomallei (Bp). It is regarded as endemic in southeast Asia and northern Australia. The septicaemic form is a severe illness with a high mortality. The tsunami in 2004 has renewed its current importance.


METHODS
A 57 year old man was admitted to hospital with a 2 week history of fever, productive cough and progressive weight loss. On admission he was in septic shock and respiratory failures secondary to a left lower lobe community acquired pneumonia. This progressed to a left sided empyema. Bp was isolated from blood cultures and the pleural pus. Initial intensive therapy with ceftazidime and cotrimoxazole for 4 weeks, followed by cotrimoxazole alone for 20 weeks, led to complete recovery with little residual radiological abnormality. Follow up gave no evidence of relapse but revealed an operable, squamous cell, bronchial carcinoma.


CONCLUSIONS
Melliodosis seems to be an emerging disease in New Caledonia with 10 cases identified since 1999. A favourable climate and possibly an animal reservoir might explain sporadic cases in this region. It is important for the medical profession to be aware of this disease in order to ensure the rapid and correct management of patients whose life is at risk.
Estivals
M
M
Service de Pneumologie, CHT G. Bourret, Nouméa, Nouvelle Calédonie. m.estivals@cht.nc
du Couedic
L
L
Lacassin
F
F
Mermond
S
S
Levenes
H
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016957:Burkholderia pseudomallei / Q000302:isolation & purification; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D016724:Empyema, Pleural / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D018805:Sepsis / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents