Case Report Burkholderia pseudomallei : An Uncommon Cause of Bacteraemic Pneumonia in a Diabetic Malladi V.S. Subbalaxmi 1 , Naval Chandra 1 , M. Nageswara Rao 1 , Lakshmi Vemu 2 and Y.S. Raju 1 Departments of General Medicine 1 and Microbiology 2 , Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India ABSTRACT A 55-year-old woman presented with fever, breathlessness and shock. She was diagnosed to have diabetes mellitus (Type 2) after admission. Blood culture grew Burkholderia pseudomallei. The patient responded to intravenous ceftozidime for two weeks and a prolonged course of six months with cotrimoxazole and doxycycline. [Indian J Chest Dis Allied Sci 2011;53:185-187] Key words: Type 2 diabetes mellitus, Pneumonia, Sepsis, Burkholderia pseudomallei. [Received: August 10, 2010; accepted after revision: January 19, 2011] Correspondence and reprint requests: Dr Malladi V.S. Subbalaxmi, Assistant Professor, Department of General Medicine, Nizam's Institute of Medical Sciences, Hyderabad-500 082 (Andhra Pradesh), India; Phone: 91-949-0457909; E-mail: subbalaxmimvs@yahoo.com INTRODUCTION Melioidosis, an infection caused by Burkholderia pseudomallei , a gram-negative aerobic bacillus, is endemic in northern Australia and parts of South- East Asia, including Vietnam and the Philippines. 1 It has also been reported in tsunami survivors from Indonesia, Sri Lanka and Thailand. The likely modes of transmission include percutaneously through skin abrasions and by inhalation. Minor wounds and abrasions are common in farmers during the planting season, and inoculation through these wounds during their occupational exposure might be the common mode of spread. The organism has also been considered as a potential agent for biological warfare and biological terrorism. However, melioidosis is under-reported from India. We report a case of a middle aged woman who presented with shortness of breath, arthralgias and septic shock and was diagnosed as having melioidosis. CASE REPORT A 55-year-old woman presented with a history of fever, severe breathlessness and cough with mucoid expectoration of 10 days duration. She gave history of pain and had difficulty in moving the left shoulder, left elbow and the right knee. There was no history of diabetes or hypertension. She used to work in the rice fields as a farmer 10 years ago. Physical examination on admission revealed tachycardia, a respiratory rate of 40 per minute, and blood pressure of 80/50mmHg. Swelling and tenderness of the left shoulder and right knee were noted. Crepitations were also heard on left side of the chest. Laboratory investigations revealed random blood sugar of 525mg/dL. Haemoglobin was 13gm/dL, and total leukocyte count was 13,000/cmm with a neutrophilic predominance. Chest radiograph (postero-anterior view) showed a left upper lobe consolidation (Figure). Renal function, liver function tests and 2D echocardiogram were normal. Two sets of blood culture were sent to the microbiology laboratory and empirically, intra- Figure. Chest radiograph (postero-anterior view) showing left upper lobe consolidation.