Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St, Gallen, Switzerland.
BMC Infect Dis. 2012 Oct 4;12:242. doi: 10.1186/1471-2334-12-242.
Burkholderia pseudomallei, the etiologic agent of melioidosis, is endemic to tropic regions, mainly in Southeast Asia and northern Australia. Melioidosis occurs only sporadically in travellers returning from disease-endemic areas. Severe clinical disease is seen mostly in patients with alteration of immune status. In particular, pericardial effusion occurs in 1-3% of patients with melioidosis, confined to endemic regions. To our best knowledge, this is the first reported case of melioidosis in a traveller complicated by a hemodynamically significant pericardial effusion without predisposing disease.
A 44-year-old Caucasian man developed pneumonia, with bilateral pleural effusions and complicated by a hemodynamically significant pericardial effusion, soon after his return from Thailand to Switzerland. Cultures from different specimens including blood cultures turned out negative. Diagnosis was only accomplished by isolation of Burkholderia pseudomallei from the pericardial aspirate, thus finally enabling the adequate antibiotic treatment.
Melioidosis is a great mimicker and physicians in non-endemic countries should be aware of its varied manifestations. In particular, melioidosis should be considered in differential diagnosis of pericardial effusion in travellers , even without risk factors predisposing to severe disease.
类鼻疽伯克霍尔德菌是类鼻疽病的病原体，流行于热带地区，主要在东南亚和澳大利亚北部。类鼻疽病仅在从疫区返回的旅行者中零星发生。严重的临床疾病主要见于免疫状态改变的患者。特别是，心包积液仅发生在 1-3%的类鼻疽病患者中，局限于流行地区。据我们所知，这是首例在旅行者中报告的心包积液伴血流动力学意义的类鼻疽病病例，无潜在疾病。
一名 44 岁白人男子从泰国返回瑞士后不久，出现肺炎，伴有双侧胸腔积液，并并发血流动力学意义的心包积液。包括血培养在内的不同标本的培养结果均为阴性。仅从心包抽吸物中分离出类鼻疽伯克霍尔德菌，从而最终实现了适当的抗生素治疗，才确诊了该疾病。
类鼻疽病是一种极具模仿性的疾病，非流行地区的医生应意识到其多样的表现。特别是，在旅行者的心包积液鉴别诊断中，即使没有导致严重疾病的危险因素，也应考虑类鼻疽病。
