MELIOIDOSIS - 2 INDIGENOUS CASES IN TAIWAN

We report the first two indigenously acquired cases of melioidosis in Taiwan, diagnosed by positive culture and biochemically identified usi ng the ID 32 GN system (BioMerieux Vitek Inc, Hazelwood, MO, USA). The first patient was a 75-year-old Chinese woman who had not travelled a broad since her arrival from mainland China (San-Tung province) 47 yea rs ago. She presented with spontaneous bacterial peritonitis and hepat itis C-related liver cirrhosis with septic shock. Burkholderia pseudom allei (formerly Pseudomonas pseudomallei) was isolated from cultures o f both blood and ascites fluid. The second patient, a 70-year-old Chin ese man, presented with right lower lobar pneumonia complicated with e mpyema and septic shock. Blood cultures grew B. pseudomallei. Both pat ients had underlying diabetes mellitus; one also had liver cirrhosis a nd chronic renal failure, while the other had a renal stone. The first patient died of refractory septic shock prior to diagnosis. The secon d patient survived with the use of intravenous ceftazidime for 30 days , followed by oral amoxicillin-clavulanic acid for a further 3 months. These cases serve as a reminder to clinical physicians that melioidos is is now no longer exclusive to patients with a history of travel to endemic areas. A high index of clinical suspicion is required for earl y diagnosis and treatment in order to reduce the mortality and improve clinical outcome.