Afroze Samira Rahat, Rahman Md Raziur, Barai Lovely, Hossain Md Delwar, Uddin Khwaja Nazim
Department of Internal Medicine, BIRDEM General Hospital and Ibrahim Medical College, Dhaka, Bangladesh.
Microbiology Department, BIRDEM General Hospital, Dhaka, Bangladesh.
BMC Res Notes. 2016 Feb 16;9:100. doi: 10.1186/s13104-016-1910-0.
Melioidosis is endemic in tropical Australia and Southeast Asian countries and its causative organism Burkholderia pseudomallei is a recognized cause of pneumonia in these regions. Recent isolation of the organism in the soil of Kapasia, Gazipur, Bangladesh has proven its exposure among the population residing in endemic areas of our country. Pneumonia is the most common presentation of melioidosis. Acute, subacute and chronic pneumonia due to B. pseudomallei can present as primary or secondary pneumonia. Treatment of such cases are challenging as well. Till date, few cases of acute and chronic pneumonia due to melioidosis occurring in local Bangladeshis as well as in returning travelers to Europe have been reported. To the best of our knowledge, this is the first reported case of primary melioidosis pneumonia declared cured after a 27 weeks of treatment regimen from Bangladesh.
A 43-year-old Bangladeshi gentleman, known diabetic, hypertensive, smoker, presented with the complaints of recurrent episodes of low to high grade intermittent fever, productive cough with occasional haemoptysis and 10 kg weight loss over one and half months. Poorly responding to conventional antibiotics, he was suspected as a case of pulmonary tuberculosis. Examination and investigations revealed left sided consolidation with cavitary lesion, hepato-splenomegaly and sputum analysis confirmed growth of Burkholderia pseudomallei. The patient was successfully treated as a case of primary melioidosis pneumonia.
Often misdiagnosed and empirically treated as tuberculosis, untreated melioidosis pneumonia may even lead to death. Therefore, melioidosis should be suspected in appropriate clinical scenario in patients with a history of residing in or traveling to endemic areas. In Bangladesh, time has come to explore whether melioidosis should be considered as an emerging infectious disease.
类鼻疽在热带澳大利亚和东南亚国家呈地方流行性，其病原体伯克霍尔德菌是这些地区公认的肺炎病因。最近在孟加拉国加济布尔卡帕西亚的土壤中分离出该病原体，证明我国流行地区的人群接触过该病原体。肺炎是类鼻疽最常见的表现形式。由伯克霍尔德菌引起的急性、亚急性和慢性肺炎可表现为原发性或继发性肺炎。此类病例的治疗也具有挑战性。迄今为止，很少有关于当地孟加拉人以及返回欧洲的旅行者患类鼻疽急性和慢性肺炎的病例报道。据我们所知，这是孟加拉国首例经27周治疗方案后宣布治愈的原发性类鼻疽肺炎病例。
一名43岁的孟加拉国男性，患有糖尿病、高血压，有吸烟史，出现低到高热间歇性发热反复发作、咳痰伴偶尔咯血以及在一个半月内体重减轻10公斤的症状。对传统抗生素反应不佳，他被怀疑患有肺结核。检查和调查显示左侧实变伴空洞性病变、肝脾肿大，痰分析证实有伯克霍尔德菌生长。该患者作为原发性类鼻疽肺炎病例得到成功治疗。
类鼻疽肺炎常被误诊并按经验当作肺结核治疗，未经治疗的类鼻疽肺炎甚至可能导致死亡。因此，对于有在流行地区居住或旅行史的患者，在适当的临床情况下应怀疑类鼻疽。在孟加拉国，是时候探讨是否应将类鼻疽视为一种新发传染病了。
