ACUTE SEPTIC COURSE OF MELIOIDOSIS (PSEUD -PSEUDOMALLEI INFECTION) AFTER A VISIT TO THAILAND

History and clinical findings: Two weeks after returning from a trip t o Thailand a 79-year-old man developed a higher fever, pain in the rig ht flank and progressive clouding of consciousness. She had meningism on admission. Investigations: There was a marked leukocytosis (WBC cou nt 17,700/mu l) and raised C-reactive protein (6.5 mg/dl). Cerebrospin al fluid was clear, containing 119 cells/mm(3) and elevated protein (9 0 mg/dl). Abdominal sonography demonstrated segmental pyelonephritis, and blood culture grew Pseudomonas pseudomallei. Treatment and course: On the basis of sensitivity tests imipenem was chosen as the antibiot ic and was given for 6 weeks. Because of an inadequate response and a right renal abscess a right nephrectomy was performed. After marked im provement the septicaemia recurred one week after antibiotic treatment had been discontinued, and the patient died. Conclusion: Efficacious treatment of melioidosis (a glanders-like disease) presupposes diagnos is of the causative microorganism and testing of its antibiotic sensit ivity. As Pseud. pseudomallei may encapsulate and persist intracellula rly, the selection of antibiotic and the duration of treatment are cru cial.