Prasad Rohit, Pokhrel Nishan B, Uprety Suresh, Kharel Himal
Orthopaedics, Tribhuvan University Institute of Medicine, Kathmandu, NPL.
Internal Medicine, Tribhuvan University Institute of Medicine, Kathmandu, NPL.
Cureus. 2020 Feb 16;12(2):e7011. doi: 10.7759/cureus.7011.
Melioidosis, also called Whitmore's disease, is an infectious disease caused by the bacterium Burkholderia pseudomallei. It is predominantly a disease of tropical climates, especially in Southeast Asia and northern Australia. Due to a wide range of signs and symptoms that can be mistaken for other diseases such as tuberculosis or common forms of pneumonia, patients can be frequently misdiagnosed, which can have adverse consequences and can make management more complicated. This case report elaborates on the clinical course of a middle-aged nondiabetic male patient who presented to our hospital with fever for two months and painful swelling of the right proximal leg for 10 days, following a previous diagnosis of disseminated abdominal tuberculosis made at a different healthcare center. Preliminary investigations confirmed multiple diagnoses of acute osteomyelitis and septic arthritis complicated by multiple hepatic and splenic abscesses. Given the patient was in a state of septic shock at the time of presentation, he was managed as an emergency case and an arthrotomy of the knee joint was performed followed by decompression and drainage of the right proximal tibia. As per standard hospital protocol, the pus and synovial fluid were sent for microbial culture and sensitivity, at which point B. pseudomallei was isolated and the diagnosis was confirmed. Diagnosis of melioidosis requires a high degree of suspicion among clinicians and microbiologists, especially in individuals that have frequent exposure to contaminated soil and water and have a travel history to endemic countries.
类鼻疽，又称惠特莫尔氏病，是一种由类鼻疽伯克霍尔德菌引起的传染病。它主要发生在热带气候地区，尤其是东南亚和澳大利亚北部。由于其有广泛的体征和症状，可能被误诊为其他疾病，如肺结核或常见类型的肺炎，患者常常被误诊，这可能会产生不良后果，并使治疗变得更加复杂。本病例报告详细阐述了一名中年非糖尿病男性患者的临床病程，该患者因发热两个月、右大腿近端疼痛肿胀10天前来我院就诊，此前在另一家医疗中心被诊断为播散性腹部结核。初步检查确诊为急性骨髓炎和化脓性关节炎，并伴有多发性肝脾脓肿。鉴于患者就诊时处于感染性休克状态，作为急诊病例进行处理，对膝关节进行了关节切开术，随后对右大腿近端胫骨进行了减压引流。按照医院标准流程，将脓液和滑液送去进行微生物培养及药敏试验，此时分离出了类鼻疽伯克霍尔德菌，确诊了病情。类鼻疽的诊断需要临床医生和微生物学家高度怀疑，尤其是对于那些经常接触受污染土壤和水且有前往流行国家旅行史的人。
