Melioidosis in a patient with type 1 diabetes mellitus on an insulin pump
| Autor: | Simon Smith, Melissa Katz, Ashim Sinha, Luke Conway |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Melioidosis Opportunistic infection Endocrinology Diabetes and Metabolism 030231 tropical medicine 030106 microbiology Disease lcsh:Diseases of the endocrine glands. Clinical endocrinology 03 medical and health sciences 0302 clinical medicine Internal medicine Diabetes mellitus Internal Medicine Medicine Risk factor Type 1 diabetes lcsh:RC648-665 biology Burkholderia pseudomallei business.industry Unique/Unexpected Symptoms or Presentations of a Disease bacterial infections and mycoses biology.organism_classification medicine.disease business Kidney disease |
| Zdroj: | Endocrinology, Diabetes & Metabolism Case Reports Endocrinology, Diabetes & Metabolism Case Reports, Vol 1, Iss 1, Pp 1-3 (2018) |
| ISSN: | 2052-0573 |
| DOI: | 10.1530/edm-18-0062 |
| Popis: | Diabetes mellitus is a well-recognised risk factor for melioidosis, the disease caused by Burkholderia pseudomallei, which is endemic in northern Australia and Southeast Asia. We present the initial diagnostic dilemma of a febrile patient from northern Australia with type 1 diabetes mellitus and negative blood cultures. After a 6-week history of fevers and undifferentiated abdominal pain, MRI of her spine revealed a psoas abscess. She underwent drainage of the abscess which cultured B. pseudomallei. She completed 6 weeks of intravenous (IV) ceftazidime and oral trimethoprim/sulphamethoxazole (TMP/SMX) followed by a 12-week course of oral TMP/SMX. We postulate that the likely route of infection was inoculation via her skin, the integrity of which was compromised from her insulin pump insertion sites and an underlying dermatological condition. Learning points: Diabetes mellitus is the strongest risk factor for developing melioidosis. Atypical infections need to be considered in individuals with diabetes mellitus who are febrile, even if blood cultures are negative. There is heterogeneity in the clinical presentation of melioidosis due to variable organ involvement. Consider melioidosis in febrile patients who have travelled to northern Australia, Asia and other endemic areas. Background Melioidosis is an opportunistic infection endemic in the tropics and caused by the environmental bacterium Burkholderia pseudomallei (1, 2). Risk factors for the disease include diabetes mellitus (DM), hazardous alcohol use, chronic kidney disease and chronic lung disease. Diabetes mellitus, most commonly type 2, is the most frequent risk factor, occurring in 40–60% of patients who are diagnosed with melioidosis (1, 3, 4, 5). Acquisition of melioidosis most often occurs through inoculation, with compromised skin integrity increasing the risk of developing the disease (4). Given the protean clinical manifestations of melioidosis, a high index of suspicion is required to ensure appropriate investigations and empirical management is initiated in those at risk living in endemic areas. |
| Databáze: | OpenAIRE |
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