title: A traveller presenting with severe melioidosis complicated by a pericardial effusion: a case report.
abstract: BACKGROUND
  Burkholderia pseudomallei, the etiologic agent of melioidosis, is endemic to tropic regions, mainly in Southeast Asia and northern Australia. Melioidosis occurs only sporadically in travellers returning from disease-endemic areas. Severe clinical disease is seen mostly in patients with alteration of immune status. In particular, pericardial effusion occurs in 1-3% of patients with melioidosis, confined to endemic regions. To our best knowledge, this is the first reported case of melioidosis in a traveller complicated by a hemodynamically significant pericardial effusion without predisposing disease.
  
  
  METHODS
  A 44-year-old Caucasian man developed pneumonia, with bilateral pleural effusions and complicated by a hemodynamically significant pericardial effusion, soon after his return from Thailand to Switzerland. Cultures from different specimens including blood cultures turned out negative. Diagnosis was only accomplished by isolation of Burkholderia pseudomallei from the pericardial aspirate, thus finally enabling the adequate antibiotic treatment.
  
  
  CONCLUSIONS
  Melioidosis is a great mimicker and physicians in non-endemic countries should be aware of its varied manifestations. In particular, melioidosis should be considered in differential diagnosis of pericardial effusion in travellers , even without risk factors predisposing to severe disease.
authors.affiliation: Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St, Gallen, Switzerland. detlev.schultze@zlmsg.ch
authors.forename: Detlev
authors.initials: D
authors.lastname: Schultze
authors.forename: Brigitt
authors.initials: B
authors.lastname: Müller
authors.forename: Thomas
authors.initials: T
authors.lastname: Bruderer
authors.forename: Günter
authors.initials: G
authors.lastname: Dollenmaier
authors.forename: Julia M
authors.initials: JM
authors.lastname: Riehm
authors.forename: Katia
authors.initials: K
authors.lastname: Boggian
mesh_terms: D000328:Adult; D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology; D010490:Pericardial Effusion / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D013557:Switzerland; D013785:Thailand; D014195:Travel