Melioidosis as a rare cause of deep surgical site infection in a Filipino patient with Metastatic Spinal Disease: A case report
- Author:
Marc Lawrence S. Soco
1
;
Bryan Albert T. Lim
2
Author Information
- Publication Type:Case Reports
- MeSH: Melioidosis; Philippines; Burkholderia pseudomallei
- From: Philippine Journal of Internal Medicine 2022;60(4):299-303
- CountryPhilippines
- Language:English
-
Abstract:
Background:Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei. Over a century after its
discovery, there seems to be a paucity of reported cases in the Philippines relative to other countries where it is found to be endemic. This suggests that the true burden of melioidosis in the country is not well-defined. The rarity of the disease, its protean clinical manifestations, and the lack of pathognomonic features pose a great diagnostic challenge. Furthermore, the proper recognition of the organism is an extreme necessity as it is intrinsically resistant to numerous antibiotics and requires specific long-term treatment.
Case:This is a case of a 49-year-old Filipino diagnosed with a metastatic spinal disease from a primary thyroid carcinoma and underwent posterior spinal decompression and stabilization. Revision of instrumentation was done following identification of an implant loosening. During the interim, wound dehiscence and infection developed. The patient was readmitted and underwent debridement of the lumbosacral spine. Wound cultures all yielded growth of Burkholderia pseudomallei. The patient received meropenem and then trimethoprim-sulfamethoxazole with ciprofloxacin during the intensive and eradication phase, respectively. Erythrocyte sedimentation rate and C-reactive protein were monitored and a significant reduction in both values reflected a good therapeutic response.
Conclusion:This is a rare case of a deep surgical site infection caused by Burkholderia pseudomallei. It is known that melioidosis is a potentially fatal infection but is under-reported in the Philippines. At present, further epidemiological studies along with an increased level of awareness of melioidosis are greatly needed to help define the true burden of illness and optimize patient management following prompt recognition. - Full text:15 - Melioidosis.pdf
