Meliodosis, Japanese Encephalitis

Question 1

50year old farmer from NE Thailand presented with cough, fever x 10 days. Prior h/o DM, WBC 14.3k.

Answer 1

Burkholderia Pseudomallei
Tx: Ceftazidime, then Bactrim

Question 2

What type of bacteria is melioidosis

Answer 2

burkholderia pseudomallei -facultative intracellular GNR ; in soil, water

Question 3

Where is melioidosis most endemic

Answer 3

haiti, panama, west africa, china, india, northern aus

Question 4

associations of risk factors with meliodosis

Answer 4

Diabetes, alcohol/liver disease

Question 5

Clinical manifestations of melioidosis

Answer 5

pneumonia, skin ulcers/abscesses, visceral abscess, bacteremia

Question 6

Answer 6

melioidosis

Question 7

How to diagnose melioidosis

Answer 7

gram stain, culture

Question 8

Treatment of melioidosis

Answer 8

ceftazidime (sometimes mero); then long course of TMP-SMX to prevent relapses

Question 9

59yoM returned from vacation in Bali with fever, headache, confusion. Developed flaccid paralysis, altered mentation, respriatory failure. CSF with lymphocytosis, N protein, glc.

Answer 9

Japanese encephalitis- CSF+ for JE IgM

Question 10

A medical student plans a rotation in thailand for 1 month; when do you need the vaccine?

Answer 10

Only if its in rainy season