A case of acute melioidosis in a traveller

Abstract number: 1135_280

Liassine N., Lucchini R., Descombes M.C., Guinand O.

Burkkolderia pseudomallei is the causative agent of melioidosis and a potential biological weapon. This anthropozoonosis is endemic in regions of southeast Asia and northern Australia and sporadic in Europe. Bacteraemia in melioidosis is associated with high mortality. We report a case of acute melioidosis in a traveler. A 52-year-old man was admitted to hospital with fever, asthenia and vomiting. He had recently traveled in Bangladesh and Vietnam. He had a documented non-insulino-dependent diabetes. On clinical examination he presented fever and abdominal pain. The diagnostic of malaria was excluded after laboratory investigation. CT abdominal scan showed hepatic and splenic abscesses and the diagnosis of visceral amebiasis was discussed although amebic serology was negative. Of four blood-culture bottles, one aerobic bottle was positive with Gram-negative bacilli identified as Burkholderia cepacia by Vitek 2 (very good identification, T-index 0.66). In regard to the doubtful diagnosis of visceral amebiasis and the unusual susceptibility of the isolate to imipenem, a new identification was made by 16S RNAr sequencing and API20-NE that identified a Burkholderia pseudomallei. An appropriate antimicrobial treatment was then prescribed for a total duration of 12 weeks (ceftazidime i.v and association of trimethoprim-sulfamethoxazol/doxycycline). Clinical outcome was favorable. This case emphasizes: 1/the possibility of misidentification of Burkholderia pseudomallei in laboratories that are unfamiliar with this microorganism; 2/the importance of an acute diagnosis of melioidosis to treat correctly this severe disease and to prevent relapses; 3/the necessity to consider the diagnosis of melioidosis in travelers.