AKUTE SEPTISCHE VERLAUFSFORM EINER MELIOIDOSE NACH THAILANDAUFENTHALT

HISTORY AND CLINICAL FINDINGS: Two weeks after returning from a trip to Thailand a 79-year-old man developed a higher fever, pain in the right flank and progressive clouding of consciousness. She had meningism on admission. INVESTIGATIONS: There was a marked leukocytosis (WBC count 17,700/microliter) and raised C-reactive protein (6.5 mg/dl). Cerebrospinal fluid was clear, containing 119 cells/mm3 and elevated protein (90 mg/dl). Abdominal sonography demonstrated segmental pyelonephritis, and blood culture grew Pseudomonas pseudomallei. TREATMENT AND COURSE: On the basis of sensitivity tests imipenem was chosen as the antibiotic and was given for 6 weeks. Because of an inadequate response and a right renal abscess a right nephrectomy was performed. After marked improvement the septicaemia recurred one week after antibiotic treatment had been discontinued, and the patient died. CONCLUSION: Efficacious treatment of melioidosis (a glanders-like disease) presupposes diagnosis of the causative microorganism and testing of its antibiotic sensitivity. As Pseud. pseudomallei may encapsulate and persist intracellularly, the selection of antibiotic and the duration of treatment are crucial.