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Open Access Highly Accessed Case report

A traveller presenting with severe melioidosis complicated by a pericardial effusion: a case report

Detlev Schultze1*, Brigitt Müller2, Thomas Bruderer1, Günter Dollenmaier1, Julia M Riehm3 and Katia Boggian4

Author affiliations

1 Center of Laboratory Medicine, Frohbergstrasse 3, CH-9001 St. Gallen, Switzerland

2 Department of Internal Medicine, Cantonal Hospital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland

3 Bundeswehr Institute of Microbiology, Neuherbergstr 11, D-80937, Munich, Germany

4 Department of Internal Medicine, Division of Infectious Diseases, Cantonal Hospital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland

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Citation and License

BMC Infectious Diseases 2012, 12:242  doi:10.1186/1471-2334-12-242

Published: 4 October 2012

Abstract

Background

Burkholderia pseudomallei, the etiologic agent of melioidosis, is endemic to tropic regions, mainly in Southeast Asia and northern Australia. Melioidosis occurs only sporadically in travellers returning from disease-endemic areas. Severe clinical disease is seen mostly in patients with alteration of immune status. In particular, pericardial effusion occurs in 1-3% of patients with melioidosis, confined to endemic regions. To our best knowledge, this is the first reported case of melioidosis in a traveller complicated by a hemodynamically significant pericardial effusion without predisposing disease.

Case presentation

A 44-year-old Caucasian man developed pneumonia, with bilateral pleural effusions and complicated by a hemodynamically significant pericardial effusion, soon after his return from Thailand to Switzerland. Cultures from different specimens including blood cultures turned out negative. Diagnosis was only accomplished by isolation of Burkholderia pseudomallei from the pericardial aspirate, thus finally enabling the adequate antibiotic treatment.

Conclusions

Melioidosis is a great mimicker and physicians in non-endemic countries should be aware of its varied manifestations. In particular, melioidosis should be considered in differential diagnosis of pericardial effusion in travellers , even without risk factors predisposing to severe disease.

Keywords:
Melioidosis; Burkholderia pseudomallei; Pericardial effusion; Traveller