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Abstract

Introduction: Melioidosis is an infection caused by gram negative bacterium, Burkholderia pseudomallei. In 2015, it is estimated that there may have been 1,65,000 melioidosis cases globally, with 89000 deaths. The predominant mode of transmission is percutaneous inoculation during exposure to soil or contaminated water.

Case series: Case 1: A six month old female child presented with complaints of fever, cough, hurried breathing and convulsion. On examination child was irritable, tachypnoeic with chest wall retractions and rhonchi. Child was not maintaining saturation at room air. Lab investigations showed leucopenia and elevated CRP. Chest X-ray - opacity in left midzone. Child had 2 more episodes of convulsions, loaded on anticonvulsants and IV antibiotics were started. Child went to refractory shock the following day and sudden cardiac arrest, could not be revived. Blood culture report showed growth of Burkholderia pseudomallei; Case 2: Four year old male child, elder sibling of the same child, presented with fever since 3 days. On examination child was tachypnoeic, tachycardic, maintaining saturation at room air. Mild icterus was present. Lab investigations showed elevated CRP. Chest X-ray was normal. On day 2 fevers persisted, icterus increased, child went into shock with increased work of breathing. IV antibiotics were hiked up. Despite all resuscitative measures, child could not be revived. Blood culture report showed the growth of Burkholderia pseudomallei.

Conclusion: Meliodosis is commonly seen in adults, its presentation in infants is rare. Most common clinical manifestations are pneumonia and localized skin infection. Probable route of infection in case 1 may be from aerosols (presence of sprinkler system in the vicinity of the house). Culture is the mainstay of diagnosis. IV ceftazidime is the drug of choice. Consuming safe drinking water and avoiding contact with wet soil plays an important role in preventing spread of meliodosis.

Biography

Sanjay H R is a Resident in the Department of Pediatrics in Father Muller Medical College, Mangalore, India. He graduated from the prestigious JJM Medical College, Davangere, India before finding Pediatrics as his calling. He has also served as a Chief Medical Officer in a community health center. His current research pursuit is his thesis on Neonatal hypoglycemia and Persistent pulmonary hypertension in newborns.