Affiliation:
1. MD, General Medicine.
2. DNB, General medicine.
3. MD(Path), DNB(Path).
4. MD DCH MRCPCH(UK)FRCPCH(UK).
Abstract
Melioidosis or Whitmore's disease is an infection of humans and animals caused by aerobic gram
negative bacillus Burkholderia pseudomallei. This infection with a wide clinical spectrum is
predominantly present in tropical climates, mainly Southeast Asia and Northern Australia. The clinical manifestations include
pneumonia, skin ulcers or abscesses, osteomyelitis, prostatitis, encephalomyelitis and fulminant septic shock. The denitive
diagnosis is made by a positive culture of Burkholderia pseudomallei. The bacteria is innately resistant to 6 classes of
commonly used antibiotics. CDC recommends an intensive phase of intravenous antibiotics for 10 to 14 days followed by
eradication therapy with oral antibiotics for 3 – 6 months. The intravenous agents effective against the bacteria are meropenem
and ceftazidime. Trimethoprim sulfamethoxazole and amoxicillin/clavulanic acid are the oral antimicrobial agents used. Here
we present two cases of Melioidosis, at opposite ends of the spectrum with varying antibiotic response. One patient is a young
non immunocompromised female and the second an elderly immunocompromised (T2DM) male, both presented with skeletal
melioidosis.