A fatal acute appendicitis with sepsis and pneumonia was caused by melioidosis: a case report

https://doi.org/10.19106/JMedSci0052022020010

Abu Tholib Aman(1*), Yuli Mawarti(2), Agus Barmawi(3), Faisal Heryono(4), Rizka Humardewayanti Asdie(5)

(1) Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia Indonesia-Research Partnership on Infectious Disease (INA-RESPOND) Site 580,
(2) Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia Indonesia-Research Partnership on Infectious Disease (INA-RESPOND) Site 580,
(3) Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(4) Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
(5) Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia Indonesia-Research Partnership on Infectious Disease (INA-RESPOND) Site 580,
(*) Corresponding Author

Abstract


We report anunderdiagnosed fatal case of melioidosis that involved dygestion system which complicated with pneumonia, and sepsis. The case was initially diagnosed as acute appendicitis, and subsequently the patient underwent an exploratory laparatomy and appendectomy. He was discharged afer 3 days of hospitalization. Thirty days afterward, he was admitted to another private hospital to experience another exploratory laparatomy with indication of pancreatitis, intra-abdominal organs adhesions, and postoperative enterocutaneous fistula (ECF), and hospitalized there for 25 days. He eventually suffered from sepsis, pneumonia, unclosed ECF, anemia, hypoalbuminemia, and electrolyte imbalance. He then referred to a tertiary teaching hospital and hospitalized there for a total 134 days until he passed away. His clinical condition was declining, despite a long course of broad spectrum antibiotics. Treatment delay, prolong hospitalization, and complications were the inevitable, although Burkholderia pseudomallei was finally identified 2 weeks prior to his death. This case highlight that melioidosis canassociate with acute appendicitis, and that the delay on its diagnosis and treatment may trigger complications and death.


Keywords


melioidosis; fatal; delay in diagnosing; B. pseudomallei; appendicitis;

Full Text:

PDF


References

  1. Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacoco SJ, Dance DAB, et al. Melioidosis. Nat Rev Dis Primers 2018; 4:17107. https://doi.org/10.1038/nrdp.2017.107
  2. Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005; 18(2):383-416. https://doi.org/10.1128/CMR.18.2.383-416.2005
  3. Crowe A, McMahon N, Currie BJ, Baird RW. Current antimicrobial susceptibility of first-episode melioidosis Burkholderia pseudomallei isolates from the Northern Territory, Australia. Int J Antimicrob Agents 2014; 44(2):160-2. https://doi.org/10.1016/j.ijantimicag.2014.04.012
  4. Lipsitz R, Garges S, Aurigemma R, Baccam P, Blaney DD, Cheng AC, et al. Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. mallei infection, 2010. Emerg Infect Dis 2012; 18(12):e2. https://dx.doi.org/10.3201/eid1812.120638
  5. Currie BJ, Dance DA, Cheng AC. The global distribution of Burkholderia pseudomallei and melioidosis: an update. Trans R Soc Trop Med Hyg 2008; 102(Suppl 1):S1-4. https://dx.doi.org/10.1016/S0035-9203(08)70002-6
  6. Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 2016; 1(1):15008. htpp://doi.org/10.1038/nmicrobiol.2015.8
  7. Hoffmaster AR, AuCoin D, Baccam P, Baggett HC, Baird R, Bhengsri S, et al. Melioidosis diagnostic workshop, 2013. Emerg Infect Dis 2015; 21(2):e141045. https://doi.org/10.3201/eid2102.141045
  8. Fisher DA, Harris PN. Melioidosis: refining management of a tropical time bomb. Lancet 2014; 383(9919): 762-4. https://doi.org/10.1016/S0140-6736(13)62143-1
  9. Anuntagool N, Naigowit P, Petkanchanapong V, Aramsri P, Panichakul T, Sirisinha S. Monoclonal antibody-based rapid identification of Burkholderia pseudomallei in blood culture fluid from patients with community-acquired septicaemia. J Med Microbiol 2000; 49(12):1075-8. https://doi.org/10.1099/0022-1317-49-12-1075
  10. Chantratita N, Tandhavanant S, Wongsuvan G, Wuthiekanun V, Teerawattanasook N, Day NPJ,et al. Rapid detection of Burkholderia pseudomallei in blood cultures using a monoclonal antibody-based immunofluorescent assay. Am J Trop Med Hyg 2013; 89(5):971-2. https://doi.org/10.4269/ajtmh.13-0212
  11. Chantratita N, Meumann E, Thanwisai A,Limmathurotsakul D, Wuthiekanun V, Wannapasni S, et al. Loop-mediated isothermal amplification method targeting the TTS1 gene cluster for detection of Burkholderia pseudomallei and diagnosis of melioidosis. J Clin Microbiol 2008; 46(2):568-73. https://doi.org/10.1128/JCM.01817-07
  12. Jorakate P, Higdon M, Kaewpan A, Makprasert S, Yuenprakhon S, Tawisaid K, et al. Contribution of the BacT/Alert MB Mycobacterium bottle to bloodstream infection surveillance in Thailand: added yield for Burkholderia pseudomallei. J Clin Microbiol 2015; 53(3):910-4. https://doi.org/10.1128/JCM.02008-14
  13. Dulsuk A, Paksanont S, Sangchankoom A, Ekchariyawat P, Phunpang R, Jutrakul Y, et al. Validation of a monoclonal antibody-based immunofluorescent assay to detect Burkholderia pseudomallei in blood cultures. Trans R Soc Trop Med Hyg 2017; 110(11):670-2. httpss://doi.org/10.1093/trstmh/trw079
  14. Pongsunk S, Thirawattanasuk N, Piyasangthong N, Ekpo P. Rapid identification of Burkholderia pseudomallei in blood cultures by a monoclonal antibody assay. J Clin Microbiol 1999; 37(11):3662-7.
  15. Woods KL, Boutthasavong L, NicFhogartaigh C, Lee SJ, Davong V, AuCoin DP, et al. Evaluation of a rapid diagnostic test for detection of Burkholderia pseudomallei in the Lao People’s Democratic Republic. J Clin Microbiol 2018; 56(7):02002-17. https://doi.org/10.1128/JCM.02002-17
  16. Karger A, Stock R, Ziller M, Elschner MC, Bettin B, Melzer F, et al. Rapid identification of Burkholderia mallei and Burkholderia pseudomallei by intact cell Matrix-assisted Laser Desorption/Ionisation Mass Spectrometric typing. BMC Microbiol 2012; 12:229. https://doi.org/10.1186/1471-2180-12-229
  17. 17. Peddayelachagiri BV, Paul S, Gogoi M, Sripathy MH, Batra HV. Evaluation of fimC and bdha based duplex PCR for specific identification and differentiation of Burkholderia pseudomallei from near-neighbor Burkholderia species. Int J Med Microbiol 2018; 308(2):271-8. https://doi.org/10.1016/j.ijmm.2017.11.007
  18. Tellapragada C, Shaw T, D’Souza A, Eshwara VK, Mukhopadhyay C. Improved detection of Burkholderia pseudomallei from non-blood clinical specimens using enrichment culture and PCR: narrowing diagnostic gap in resource-constrained settings. Trop Med Int Health 2017; 22(7):866-70. https://doi.org/10.1111/tmi.12894
  19. Wuthiekanun V, Dance D, Limmathurosakul D. Colony morphology of Burkholderia pseudomallei on different culture media. Bandung, Indonesia: Welcome trust MORU Tropical Health Network; 2017. p.1.
  20. Kingsley PV, Arunkumar G, Tipre M, Leader M, Sathiakumar N. Pitfalls and optimal approaches to diagnose melioidosis. Asian Pac J Trop Med 2016; 9(6):515-24. https://doi.org/10.1016/j.apjtm.2016.04.003



DOI: https://doi.org/10.19106/JMedSci0052022020010

Article Metrics

Abstract views : 1553 | views : 2578


Bookmark and Share


Copyright (c) 2020 Abu Tholib Aman, Yuli Mawarti, Agus Barmawi, Faisal Heryono, Rizka Humardewayanti Asdie

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.