title: Acute pulmonary melioidosis presenting with multiple bilateral cavitary lesions in a healthy young adult: an authentic case report from Sri Lanka.
abstract: BACKGROUND
  Melioidosis is an emerging infectious disease in Sri Lanka. This disease usually develops in a host with an immunocompromised state. Acute pulmonary melioidosis commonly presents as a lobar consolidation with or without pulmonary nodules or abscesses involving the upper lobes of the lungs.
  
  
  METHODS
  We report a young healthy female who does not have known risk factors or immunocompromised state, presented with bilateral multiple cavitary lesions involving all three zones of the lungs. She used to involve in home gardening. Her initial relevant microbiological investigations were all negative. The diagnosis of melioidosis was made by broncho-alveolar lavage fluid culture positivity combined with a highly positive antibody titre. She showed dramatic response to intravenous high dose Meropenem.
  
  
  CONCLUSIONS
  Melioidosis should be suspected early in patients with acute pulmonary involvement who show poor response to conventional antibiotics, even in the absence of known risk factors for disease. Other than known occupational exposures, household exposures such as home gardening should also be considered as a possible mode of exposure.
authors.affiliation: General Medicine, National Hospital, Colombo, Sri Lanka. fonseka.lakmal@gmail.com.
authors.forename: Chathuranga Lakmal
authors.initials: CL
authors.lastname: Fonseka
authors.affiliation: National Hospital, Colombo, Sri Lanka.
authors.forename: Sampath Rukshani
authors.initials: SR
authors.lastname: Galappaththi
authors.affiliation: National Hospital, Colombo, Sri Lanka.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Illagatilaka
authors.affiliation: National Hospital, Colombo, Sri Lanka.
authors.forename: Dulani
authors.initials: D
authors.lastname: Dasanayake
authors.affiliation: National Hospital, Colombo, Sri Lanka.
authors.forename: Nirmali
authors.initials: N
authors.lastname: Tissera
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood*; D000071997:Blood Culture; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D016957:Burkholderia pseudomallei / Q000187:drug effects / Q000254:growth & development / Q000472:pathogenicity; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D051639:Gardening; D006801:Humans; D007275:Injections, Intravenous; D008168:Lung / Q000187:drug effects / Q000382:microbiology* / Q000473:pathology; D008554:Melioidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D000077731:Meropenem; D016273:Occupational Exposure; D013845:Thienamycins / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D013845:Thienamycins; D000077731:Meropenem; D004318:Doxycycline
keywords: Broncho-alveolar lavage; Cavitary lesions; Melioidosis