Emergence of Melioidosis in Brazil: A Case Series

Dilbert Silva Velôso; Samuel Pinheiro da Silva; Conceição Maria Sousa de Coelho; José Miguel Luz Parente; Thaline Alves Elias Veloso; Murilo Moura Lima; Caroline Torres Sampaio; Maria Fátima Alencar Bezerra de Freitas; Dionne Bezerra Rolim; Elba Regina Sampaio de Lemos; Marco Aurélio Pereira Horta

Disclosures

J Med Case Reports. 2023;17(362)

Abstract and Introduction

Abstract

Background: Melioidosis is a serious disease caused by the bacterium Burkholderia pseudomallei which affects humans and animals. It results in a wide spectrum of clinical manifestations, mainly in the respiratory tract, progressing to septic shock and death.

Case Presentation: Herein, we present a series of seven patients (median age: 41 years) with confirmed melioidosis, treated at a public hospital in Piauí State, Brazil between 2019 and 2021. The most common clinical presentations were fever, cough, pneumonia, and abdominal pain. The mean duration of antibacterial therapy with 1 g of meropenem was 28.6 ± 1.1 days. Six patients recovered and one died. The mean hospitalization time was 51.0 ± 39.2 days.

Conclusions: Melioidosis is an emerging infectious disease in Brazil. Health professionals in endemic areas need to be aware of the clinical presentation and appropriate clinical management of the disease because early diagnosis and early initiation of antibiotic therapy can be life-saving.

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Table 1. Clinical and laboratorial findings of cases of meliodosis in Piauí State, Brazil
Case no.	Age/sex	Clinical presentation	Clinical features	BP isolated from	(HB) g/dL	(HT) %	LEUC × 10³/μL	PLAT × 10³/μL	URE mg/dL	CRE mg/dL	CRP mg/dL	Na + mmol/L	K + mmol/L	Outcome
1	50/F	MS, pneumonia	Dyspnea, productive cough, without fever	Urine	12.1	38.2	7.88	296	45.6	0.25	4.13	130.0	4.7	Recovered
2	80/M	ITP	Petechial rash, abdominal pain, and dyspnea	Blood	6.5	21.1	24.0	5	110	1.13	160.9	133.0	3.7	Death
3	22/M	DM type 1, SLE, fibromyalgia, osteomyelitis	Abdominal pain, leg weakness, fever	Blood	8.0	25.0	5.43	458	52.1	1.08	105.26	137.0	4.6	Recovered
4	63/F	Hypertension, CKD, history of liver transplantation, tuberculosis	Weakness, productive cough, fever	Blood	6.9	20.3	3.7	107	126.6	3.35	137.91	130.0	5.1	Recovered
5	38/F	DM type 1, hypothyroidism	Productive cough, daily afternoon fever, abdominal pain, weight loss	BALF	8.6	25.8	11.52	392	48	0.91	138	3.9	17.25	Recovered
6	25/M	DM type 1, pyelonephritis	Fever, asthenia, pain in the right hypochondrium	Liver abscess	7.5	22.9	9.02	450	22.3	0.63	146.83	123.0	4.0	Recovered
7	41/M	DM type 2	Fever, chills, pale feces, dark urine, dry cough, leg edema	Blood, liver abscess	10.9	32.7	12.45	198	27.0	1.03	184.79	128	4.1	Recovered

All patients were self-identified as "pardos", of visibly mixed racial origin
BALF bronchoalveolar lavage fluid, BP Burkholderia pseudomallei, CKD chronic kidney disease, CRE creatinine, DM diabetes mellitus, HB hemoglobin, HT hematocrit, ITP idiopathic thrombocytopenic purpura, LEUC leukocytes, MS multiple sclerosis, PLAT platelets, SLE systemic lupus erythematosus, URE urea

Table 2. Distribution of melioidosis cases reported between 2021 and 2022, according to melioidosis.info [12]
Year	Location	Source			Deaths
Year	Location	Environment	Human	Animal	Deaths
2021	Australia (553), Bangladesh (2), Brunei (1), Colombia (16), Congo (3), India (93), Laos (16), Madagascar (1), Malaysia (10), Mali (1), Myanmar (11), Nepal (2), Nicaragua (1), Philippines (1), Singapore (15), Sri Lanka (1), Thailand (292)	304	715	–	95
2022	Australia (398), Bangladesh (1), Benin (1), China (1), Ghana (56), India (737), Malaysia (47), Panama (1), Philippines (2), Sri Lanka (4), Thailand (2574), United States of America (4), Viet Nam (3)	574	3254	1	787

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Emergence of Melioidosis in Brazil: A Case Series

Abstract and Introduction

Abstract

Tables

Tables

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Authors and Disclosures

Authors and Disclosures

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