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Am. J. Trop. Med. Hyg., 79(3), 2008, pp. 455-457
Copyright © 2008 by The American Society of Tropical Medicine and Hygiene

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Right arrow Melioidosis

CASE REPORT


Non-septicemic Melioidosis Presenting as Cardiac Tamponade

Hsing-Chun Chung, Ching-Tai Lee, Chung-Hsu Lai, Chun-Kai Huang, Jiun-Nong Lin, Shiou-Haur Liang, AND Hsi-Hsun Lin*
Division of Infectious Diseases and Division of Gastroenterology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, Republic of China

 

ABSTRACT

Melioidosis is endemic in Taiwan. It is caused by infection with Burkholderia pseudomallei. A prolonged course of oral eradication therapy to avoid relapse after an intensive intravenous therapy is recommended to treat melioidosis. Melioidosis with cardiac involvement is rare and is often combined with septicemia, for which the mortality rate is 20–60%. The initial clinical presentations of melioidosis mimic Mycobacterium tuberculosis infection, which is the most common etiology of bacterial pericarditis in Taiwan. We present a case of non-septicemic melioidosis that presented as non-suppurative cardiac tamponade and left subcarinal lymphadenopathy. Underlying diseases included hepatitis B–related liver cirrhosis and hepatocellular carcinoma. The patient was successfully treated with 2 weeks of intravenous ceftazidime and 12 weeks of oral doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin/clavulanate. Melioidosis-related pericarditis should be considered in the differential diagnoses of bacterial pericarditis in Taiwan.

Received March 1, 2008. Accepted for publication May 23, 2008.

* Address correspondence to Hsi-Hsun Lin, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC. E-mail: ed100233{at}edah.org.tw

Authors’ addresses: Hsing-Chun Chung, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011-5556, E-mail: ed102749{at}edah.org.tw. Ching-Tai Lee, Division of Gastroenterology, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011-2981, E-mail: ed102164{at}edah.org.tw. Chung-Hsu Lai, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011-5558, E-mail: ed101746{at}edah.org.tw. Chun-Kai Huang, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011, E-mail: ed103536{at}edah.org.tw. Jiun-Nong Lin, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011, E-mail: ed103623{at}edah.org.tw. Shiou-Haur Liang, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011, E-mail: ed103519{at}edah.org.tw. Hsi-Hsun Lin, Division of Infectious Disease, Department of Internal Medicine, E-Da Hospital, No.1, E-Da Rd., Yanchau Sheng, Kaohsiung County 824, Taiwan, ROC, Tel: 886-7-6150011-5550, Fax: 886-7-6150928, E-mail: ed100233{at}edah.org.tw.






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Copyright © 2008 by the American Society of Tropical Medicine and Hygiene.