Melioidosis Acquired by Traveler to Nigeria | CDC EID

Melioidosis Acquired by Traveler to Nigeria | CDC EID: "EID Journal Home > Volume 17, Number 7–July 2011
Volume 17, Number 7–July 2011
Dispatch
Melioidosis Acquired by Traveler to Nigeria

Alex P. Salam, Nisa Khan, Henry Malnick, Dervla T.D. Kenna, David A.B. Dance, and John L. Klein Comments to Author
Author affiliations: Guy's and St. Thomas' National Health Service Trust, London, UK (A.P. Salam, N. Khan, J.L. Klein); Health Protection Agency, London, UK (H. Malnick, D.T.D. Kenna, D.A.B. Dance); Mahosot Hospital, Vientiane, Laos (D.A.B. Dance); University of Oxford, Oxford, UK (D.A.B. Dance); and Churchill Hospital, Oxford (D.A.B. Dance)

Suggested citation for this article

Abstract
We describe melioidosis associated with travel to Nigeria in a woman with diabetes, a major predisposing factor for this infection. With the prevalence of diabetes projected to increase dramatically in many developing countries, the global reach of melioidosis may expand.


The Patient

A 46-year-old woman sought treatment in the emergency department of St Thomas' Hospital, London, UK. She described a 2-day history of frontal headache, fever, and painful swelling in the right postauricular region. She had received a diagnosis of type 2 diabetes mellitus 5 months before admission, for which she took metformin (500 mg 2×/d). She did not smoke or drink alcohol. She was born in Ogun State, Nigeria, and had moved to the United Kingdom at the age of 31 years. She recently had visited relatives in Sagamu City, Ogun State, and returned to the United Kingdom 6 weeks before onset of her illness. She had no history of travel outside the United Kingdom or Nigeria.

Examination at admission indicated a temperature of 39.5°C, a heart rate of 108 beats per minute, and a blood pressure level of 132/84 mm Hg. Other examination findings were unremarkable, apart from a tender, firm, erythematous, and hot swollen area (4 cm × 3 cm) in the right postauricular region. Initial investigations found a leukocyte count of 6.1 × 109 cells/L (neutrophils 4.4 × 109 cells/L) and a C-reactive protein level of 406 mg/L; renal and liver profiles were normal. Results of a hemoglobin A1c blood test for diabetes were 13%, which is consistent with poorly controlled diabetes, and results of an HIV test and malaria screen were both negative. Ultrasonography of the swollen area showed localized, superficial, enlarged lymph nodes, posterior and inferior to the right pinna. Blood was drawn for culturing, and a course of intravenous flucloxacillin treatment was begun. Subsequently, the aerobic bottles of 2 sets of blood cultures were positive for gram-negative bacilli, and subculturing yielded an oxidase-positive, gram-negative bacillus that grew rapidly on blood agar as a gray colony with a metallic sheen. The organism was subsequently identified as Burkholderia pseudomallei (see characterization of blood culture isolate). The antimicrobial drug therapy was changed to intravenous co-amoxiclav (1.2 g 3×/d), and 3 days later, when the identification of the organism was confirmed, the patient's treatment was switched to intravenous meropenem (2 g 3×/d). Results of a computed tomography scan of the chest and abdomen were normal. The patient's fever and lymphadenopathy subsequently resolved, and after 9 days of receiving meropenem, she was discharged with a 12-week course of oral co-trimoxazole (1,920 mg daily). The patient did not attend her scheduled outpatient appointment.

Two microbiology laboratory workers were judged to have had low-risk exposure to the organism before its identification (1). They were counseled, and both chose not to receive antimicrobial drug prophylaxis. Serologic follow up at 2 and 6 weeks' postexposure for 1 worker showed no evidence of seroconversion to B. pseudomallei. The other did not attend her scheduled occupational health outpatient appointment.

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Suggested Citation for this Article

Salam AP, Khan N, Malnick H, Kenna DTD, Dance DAB, Klein JL. Melioidosis acquired by traveler to Nigeria. Emerg Infect Dis [serial on the Internet]. 2011 Jul [date cited]. http://www.cdc.gov/EID/content/17/7/1296.htm

DOI: 10.3201/eid1707.110502

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

John L. Klein, Directorate of Infection, 5th Floor, North Wing, St. Thomas' Hospital, London SE1 7EH, UK; email: john.klein@gstt.nhs.uk