Rare Bacterial Infection Diagnosed and Treated at Paras Hospital Srinagar

A 53-year-old patient presented with nonspecific symptoms, including fever, joint pain, and headaches, and eventually developed complications such as pneumonia, osteomyelitis, and sepsis. Despite spending over a month in one of the hospitals in Srinagar, where empiric anti-tubercular treatment was initiated, there was no clinical improvement. The patient’s condition worsened, culminating in sepsis and multiorgan failure. Patient came to our hospital in a critical state, the patient was promptly diagnosed with a rare bacterial infection—Melioidosis. This timely diagnosis proved crucial in managing the patient’s condition.

Melioidosis is caused by the environmental bacterium Burkholderia pseudomallei. Among South Asian countries, Bangladesh and Sri Lanka are considered endemic for melioidosis; a few cases have been reported from Nepal, and a few imported cases from Pakistan have also been reported. India has had several melioidosis cases in recent years mostly from south India. To the best of our knowledge, this is the first case of Melioidosis presenting as osteomyelitis in Jammu and Kashmir. The bacteria are inherently present in the soil and enter the human body via skin abrasions, inhalation, or ingestion.

As clinicians are often ignorant about the similar characteristics of this disease and several other common tropical diseases, it causes a major delay in the timely diagnosis and management. The poor diagnostic facilities also lead to missed diagnoses. The key Microbiology diagnostic facilities and medical interventions in the form of state-of-the-art ICU and multidisciplinary approach at Paras Hospital, Srinagar, helped to save this patient with timely intervention. The patient was admitted to our medical ICU for 9 days with a diagnosis of acute osteomyelitis right tibia with septic shock and multiple organ dysfunction syndrome with decompensated heart failure.

The patient was managed with DC shock for recurrent ventricular arrhythmia and he underwent debridement of the right tibia under the able care of our orthopedic surgeon. He was shifted to the ward after cutting-edge critical care support in ICU and was discharged in a stable state with the patient currently being on the eradication phase of the treatment.

Clinicians should consider melioidosis in a patient with fever, sepsis or osteomyelitis if the patients have risk factors, including diabetes (the single most important risk factor), liver disease, renal disease, thalassemia, heavy alcohol use, cancer, immune-suppressing conditions not related to HIV, or chronic lung disease (such as cystic fibrosis, chronic obstructive pulmonary disease (COPD) and if a patient reports recent travel to an endemic area.

In this case, the patient had a travel history to Madhya Pradesh. Melioidosis is diagnosed by isolating the bacteria, B. pseudomallei, from blood, urine, sputum, skin lesions, cerebrospinal fluid, oropharyngeal swabs, rectal swabs, or abscesses. We also confirmed the case by MALDI-TOF. The treatment consists of an intensive phase of 2-4 weeks followed by an eradication phase of 3- 6 months. The key preventive interventions for melioidosis are avoiding contact with loose and muddy soils of melioidosis-endemic areas, and provision of safe drinking water.

Dr Insha Altaf is Consultant Microbiology and Infection Control Officer, Paras Hospital, Srinagar