BACKGROUND

Melioidosis is an infectious disease caused by Burkholderia pseudomallei. It is endemic in the Philippines and is underreported. Of the reported cases, the most common comorbidity is diabetes mellitus. The increasing cases of antibiotic resistance and the relatively high mortality rate highlights the need for increased awareness among clinicians regarding this disease. We aim to report a case of Burkholderia pseudomallei resistant to trimethoprim/sulfamethoxazole (TMP-SMX), used in its eradication following initial intravenous therapy.

CASE PRESENTATION

A 51-year-old male Filipino with poor health-seeking behavior came with generalized body weakness, weight loss, dysarthria, fever, cough, difficulty breathing, bloatedness, dysuria, joint pains, and bilateral lower extremity hyperpigmented macules for four months. He has diabetes mellitus and hypertension and is a mechanic by trade. Initial workups revealed hemoglobin A1c (HbA1c) of 14.7%, and urinalysis with bacteriuria. Imaging revealed bilateral pneumonia on chest xray, hepatosplenomegaly on whole abdomen ultrasound, and old cerebral infarcts on cranial computed tomography scan (CT scan). Empiric antibiotics for the impression of sepsis from community-acquired pneumonia and urinary tract infection were ertapenem and azithromycin. Upon isolation of Burkholderia pseudomallei from blood cultures, the team shifted to TMP-SMX and ceftazidime for initial therapy of melioidosis. Sensitivity showed resistance to TMP-SMX; hence the team revised the antimicrobials to four weeks of levofloxacin and ceftazidime. After eleven hospital days, the team sent the patient home, clinically improved. The team continued levofloxacin for eradication therapy for three months and the patient responded well.

CONCLUSION

Fever with multi-system involvement in a Filipino patient with diabetes mellitus with significant environmental risk factors, poor glycemic control, splenomegaly, and treatment failure with appropriate empiric antibiotic therapy should raise suspicion for melioidosis. It is paramount that antimicrobial resistance be detected and documented upon isolation of Burkholderia pseudomallei, given the high relapse rates and the need for a prolonged duration of treatment.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Melioidosis ; Philippines ; Diabetes Mellitus ; Burkholderia Pseudomallei

INTRODUCTION: Administration of parenteral medications may cause pain in infants. This study aimed to assess the efficacy of a nursery rhyme in increasing the comfort of infants after vaccination. METHODS: Infants who were brought to six barangay health centers for vaccination were recruited. Infants from three barangay health centers were randomly assigned to the experimental group, while infants from the other three were assigned to the control group. A Filipino nursery rhyme Tatlong Bibe was played to the experimental group. The comfort of each infant was then assessed by a pediatrician prior to, immediately after, and two minutes post-vaccination using the COMFORTB scale. Results were analyzed using independent t-tests. RESULTS: Prior to vaccination, the control and experimental groups had mean COMFORT-B scores of 12.46 and 12.74 (p = 0.634), respectively. The immediate post-vaccination mean COMFORT-B scores were 22.14 and 21.63 (p = 0.420), while the 2 minutes post-vaccination mean COMFORT-B scores were 16.40 and 16.49 (p = 0.927), respectively. There were no significant differences between groups for the three determinations. CONCLUSION Based on the study results, the nursery rhyme had no significant effect on the comfort of infants after vaccination.