title: A case of systemic melioidosis: unravelling the etiology of chronic unexplained fever with multiple presentations.
abstract: Melioidosis, caused by the environmental saprophyte, Burkholderia pseudomallei, is an important public health problem in Southeast Asia and Northern Australia. It is being increasingly reported from other parts, including India, China, and North and South America expanding the endemic zone of the disease. We report a case of systemic melioidosis in a 58-year-old diabetic, occupationally-unexposed male patient, who presented with chronic fever, sepsis, pneumonia, pleural effusion and subcutaneous abscess, was undiagnosed for long, misidentified as Pseudomonas aeruginosa infection elsewhere, but was saved due to correct identification of the etiologic agent and timely institution of appropriate therapy at our institute. A strong clinical and microbiological suspicion for melioidosis should be considered in the differential diagnosis of acute pyrexia of unknown origin, acute respiratory distress syndrome and acute onset of sepsis, especially in the tropics.
authors.forename: Srujana
authors.initials: S
authors.lastname: Mohanty
authors.forename: Gourahari
authors.initials: G
authors.lastname: Pradhan
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Panigrahi
authors.forename: Prasanta Raghab
authors.initials: PR
authors.lastname: Mohapatra
authors.affiliation: All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. bm_mishra@hotmail.com.
authors.forename: Baijayantimala
authors.initials: B
authors.lastname: Mishra
mesh_terms: D000038:Abscess / Q000473:pathology; D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016957:Burkholderia pseudomallei / Q000187:drug effects / Q000302:isolation & purification*; D048909:Diabetes Complications; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005334:Fever / Q000209:etiology*; D006801:Humans; D007194:India; D008297:Male; D008554:Melioidosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging; D011014:Pneumonia / Q000209:etiology; D011552:Pseudomonas Infections / Q000175:diagnosis* / Q000382:microbiology; D012867:Skin / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents
keywords: Burkholderia pseudomallei; diabetes mellitus; melioidosis; pleural effusion; systemic infection