Melioidosis: An emerging infection with fatal outcomes
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Melioidosis is potentially fatal as early diagnosis is missed due to its varied manifestations such as localized or disseminated infection. Localized manifestations reported are pneumonia, multiple abscesses, septic arthritis, psoas abscess, gluteal abscess, scalp abscess, pericardial effusion, and supraclavicular mass.It also mimics tuberculosis, and there have been reports of patients initially being treated for tuberculosis until a definitive diagnosis was made. Musculoskeletal involvement manifests as osteomyelitis, septic arthritis, paraspinal abscess, arthritis of shoulder joints, and multiple joint swellings.In India, most cases of melioidosis have been reported from the western and eastern coastal belts, thereby signifying a rich load of this bacterium in the environment, especially soil. A 61-year-old male hailing from Pondicherry, South India, presented with a history of intermittent high-grade fever since 1 month, swelling of right knee joint since 1 month which was associated with severe pain, and inability to weight bear. He gave a history of inability to walk due to knee pain since 1 week. A provisional diagnosis of septic arthritis right knee with severe septicemia in septic shock and type 2 diabetes mellitus was made. Patient was transferred to critical care unit for further management, intravenous meropenem and teicoplanin were administered immediately. Blood gas analysis revealed severe metabolic acidosis with lactic acidemia. Patient had anuria, and his baseline investigations revealed severe leukopenia, deranged liver function, renal function, and coagulation profile...
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