title: Melioidosis presenting as sepsis syndrome: a case report.
abstract: Melioidosis is an important disease in Asia and Australia. It is very rare in Venezuela. We describe the case of a 50-year-old diabetic patient with several episodes of right tibial osteomyelitis, left shoulder arthritis, sternal osteomyelitis, right parietal osteomyelitis, and subperiosteal abscess, followed by septic arthritis of the right knee. In all cases Gram stain smear showed Gram-negative bacilli. Culture yielded Burkholderia pseudomallei, susceptible to third- and fourth-generation cephalosporins, ciprofloxacin and aztreonam, and resistant to aminoglycosides. He developed sepsis syndrome. Blood cultures and culture of abscess and joint fluids also revealed B. pseudomallei. The patient was treated with ceftazidime and ciprofloxacin, then cefepime and trimethoprim-sulfamethoxazole. He was discharged with suppressive therapy consisting of oral doxycycline and trimethoprim-sulfamethoxazole, and follow-up has continued to date. At this time he remains asymptomatic. Melioidosis is an extremely rare disease in our country. To our knowledge, this is only the second case reported in Venezuela.
authors.affiliation: Infectious Diseases Service, Hospital Universitario de Caracas, Caracas, Venezuela. mcarolynr@gmail.com
authors.forename: Maria Carolyn
authors.initials: MC
authors.lastname: Redondo
authors.forename: Maria
authors.initials: M
authors.lastname: Gómez
authors.forename: Maria Eugenia
authors.initials: ME
authors.lastname: Landaeta
authors.forename: H
authors.initials: H
authors.lastname: Ríos
authors.forename: Rosa
authors.initials: R
authors.lastname: Khalil
authors.forename: Rafael Napoleón
authors.initials: RN
authors.lastname: Guevara
authors.forename: Sandra
authors.initials: S
authors.lastname: Palavecino
authors.forename: Manuel
authors.initials: M
authors.lastname: Figuera
authors.forename: Jocays
authors.initials: J
authors.lastname: Caldera
authors.forename: R
authors.initials: R
authors.lastname: Rivera
authors.forename: Alberto
authors.initials: A
authors.lastname: Calvo
authors.forename: Juana
authors.initials: J
authors.lastname: Vitelli
authors.forename: Mariana
authors.initials: M
authors.lastname: Morón
authors.forename: Maria Josefina
authors.initials: MJ
authors.lastname: Nuñez
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D000077723:Cefepime; D002442:Ceftazidime / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077723:Cefepime; D002442:Ceftazidime