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.
Melioidosis ; Philippines ; Burkholderia pseudomallei

Intestinal Tuberculosis (ITB) presents a significant diagnostic challenge due to its nonspecific clinical presentation and the lack of comprehensive local data to guide diagnostic strategies. This study aims to fill the gap by conducting a twelve-year retrospective cross-sectional analysis at a tertiary hospital in Cebu, Philippines. Electronic records of 209 patients aged 18 years old and above were first reviewed, focusing on clinical features, laboratory results, endoscopic findings, and CT scan of the abdomen. Initial screening identified 54 patients meeting the predefined criteria for gastrointestinal tuberculosis (GITB). In addition, statistical analyses, including logistic regression models, were employed to identify significant predictors of ITB which can further enhance the ITB diagnosis and management in the region.

Clinical manifestations observed include: symptoms and signs resembling those observed in malignancies and inflammatory bowel diseases, such as abdominal pain (92.6%), ascites (57.4%), fever (51.9%), hematochezia (25.9%), abdominal mass (24.1%) and intestinal obstruction (5.6%). The findings from CT scans of the abdomen were consistent with other studies, including the presence of matted mesenteric lymph nodes (79.6%), concentric mural thickening (57.4%), ileocecal involvement (44.4%). However, dilated bowel loops (20.4%), intestinal perforation (5.4%) and strictures (3.7%) were observed in only a few cases. Ileocecal involvement was found to be a dependable predictor among all the variables when logistic regression analysis was employed, emphasizing its diagnostic utility.

Our findings highlight the importance of local epidemiological insights in improving diagnostic strategies and patient outcomes. Consolidating the clinical profiles and diagnostic markers contributes to evidence-based strategies tailored to the Philippine context. This localized approach can further help medical professionals in making more informed decisions. Future studies could validate these findings to develop region-specific predictive tools, for a more time sensitive management of ITB.

Human ; Indicators And Reagents