title: A first report of pulmonary melioidosis in Cambodia.
abstract: Melioidosis has never been officially reported from Cambodia. Here we report two cases, a 58-year-old male (case 1) and a 49-year-old female (case 2) who presented with respiratory illnesses featuring multiple lung abscesses. The sputum culture of both patients, taken in the framework of a laboratory-based study on aetiologies of (sub-)acute respiratory infections among hospitalized patients in southern Cambodia, grew Burkholderia pseudomallei. The most striking aspect of these case stories was the extent of the delays in diagnosis. Presenting with a 1-month history of respiratory symptoms, case 1 was first suspected of tuberculosis (TB) infection, and then misdiagnosed as 'metastatic lung cancer' in Phnom Penh, Cambodia. Case 2 suffered from pulmonary infections for >10 years, during which time she was treated for TB four times. Neither patient ever produced acid-fast-bacilli (AFB)-positive sputum. Following our laboratory confirmation, the patients were traced for re-admission. Under the 'classical' trimethoprim sulphamethoxazole, chloramphenicol and doxycycline treatment, their clinical status improved considerably within 2 weeks. The two study cases illustrate issues relating to the misdiagnosis of melioidosis in Cambodia; an unfamiliarity of clinicians with the disease, which is associated with a high prevalence of TB. Therefore, a heightened awareness of melioidosis among clinicians would have a substantial impact on public health as the non-septicaemic form of the disease is potentially treatable with antibiotics that are available in Cambodian public hospitals.
authors.affiliation: Swiss Red Cross, Takeo, Cambodia. overtoom.r@gmail.com
authors.forename: Rob
authors.initials: R
authors.lastname: Overtoom
authors.forename: Virak
authors.initials: V
authors.lastname: Khieu
authors.forename: Sopheak
authors.initials: S
authors.lastname: Hem
authors.forename: Philippe
authors.initials: P
authors.lastname: Cavailler
authors.forename: Vantha
authors.initials: V
authors.lastname: Te
authors.forename: Sarin
authors.initials: S
authors.lastname: Chan
authors.forename: Phea
authors.initials: P
authors.lastname: Lau
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillard
authors.forename: Sirenda
authors.initials: S
authors.lastname: Vong
mesh_terms: D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D002160:Cambodia; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D016896:Treatment Outcome