Saudi Journal of Kidney Diseases and Transplantation

: 2020  |  Volume : 31  |  Issue : 6  |  Page : 1411--1414

Septicemic melioidosis complicating undiagnosed chronic kidney disease and beta-thalassemia minor in a Bangladeshi farmer

Muhammad Abdur Rahim, Muhammad Abu Yousuf Khan, Tufayel Ahmed Chowdhury, Mehruba Alam Ananna 
 Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka, Bangladesh

Correspondence Address:
Muhammad Abdur Rahim
Department of Nephrology, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital, Dhaka


Melioidosis is an emerging infectious disease in many countries including Bangladesh. Patients with diabetes mellitus are at increased risk for infection by Burkholderia pseudomallei, the causative agent for melioidosis. Here, we report an autochthonous case of septicemic melioidosis occurring in a middle-aged non-diabetic Bangladeshi farmer who presented with prolonged pyrexia and splenomegaly. Diagnostic workup revealed splenic micro-abscesses, previously undetected chronic kidney disease (CKD) and beta-thalassemia minor. This case stresses the importance of searching for less common risk factors for melioidosis such as CKD and hemolytic anemia.

How to cite this article:
Rahim MA, Khan MA, Chowdhury TA, Ananna MA. Septicemic melioidosis complicating undiagnosed chronic kidney disease and beta-thalassemia minor in a Bangladeshi farmer.Saudi J Kidney Dis Transpl 2020;31:1411-1414

How to cite this URL:
Rahim MA, Khan MA, Chowdhury TA, Ananna MA. Septicemic melioidosis complicating undiagnosed chronic kidney disease and beta-thalassemia minor in a Bangladeshi farmer. Saudi J Kidney Dis Transpl [serial online] 2020 [cited 2021 Nov 30 ];31:1411-1414
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Full Text


Melioidosis is endemic in south-east Asia and northern Australia, but sporadic and imported cases are reported elsewhere.[1],[2] There is increasing evidence of the expansion of the geographic distribution of Burkholderia pseudomallei, the causative organism for melioidosis.[2] Melioidosis is an emerging infectious disease in Bangladesh.[3] Patients with diabetes mellitus are at increased risk for melioidosis.[2],[3] Isolation of B. pseudomallei from the environment has confirmed Bangladesh as endemic for melioidosis[4] though clinical cases were occasionally reported.[2],[5],[6] We report an autochthonous case of melioidosis occurring in a non-diabetic Bangladeshi farmer who presented with prolonged pyrexia and splenomegaly. This infective episode helped to unveil that he had chronic kidney disease (CKD) and beta-thalassemia minor.

 Case Report

A 55-year-old Bangladeshi farmer, not known to be diabetic, got admitted with a 5-month history of fever, anorexia and 11 -kg weight loss. Over this period, he consulted several physicians, underwent various investigations and received several courses of antibiotics without much benefit and no definite diagnosis could be established. He never traveled outside Bangladesh and denied any high-risk sexual activity. The man was looking very ill and was wasted and anemic. He had 4-cm splenomegaly below the left subcostal margin and crepitations on lung auscultation.

He had anemia (hemoglobin 8.7 g/dL) with low mean corpuscular volume (61 fl), neutrophil leukocytosis (total white cells 17,100/mm3, neutrophils 87%), thrombocytopenia (21,000/ mm3), high erythrocyte sedimentation rate (77 mm/1st h) and C-reactive protein (126 mg/L). Chest X-ray revealed bilateral pulmonary infiltrates [Figure 1]. Ultrasonography showed 15-cm splenomegaly with micro-abscesses and echogenic kidneys. Non-contrast computed tomography scan showed hepato-splenomegaly with splenic abscesses [Figure 2]a and [Figure 2]b and small kidneys. Urine routine examination showed plenty of pus cells/high power field, serum creatinine was 8.1 mg/dL, random blood glucose was 5.2 mmol/L and glycated hemoglobin was 5.9%. Blood culture grew B. pseudomallei [Figure 3], while urine and sputum appeared sterile. Hemoglobin electro-phoresis revealed beta-thalassemia minor.{Figure 1}{Figure 2}{Figure 3}

He was started with meropenem (dose adjusted for kidney function) and continued for four weeks. Co-trimoxazole and doxycycline were added in eradication phase. Initially, he required three sessions of hemodialysis and three units of blood transfusion. Other medications included paracetamol and folic acid. He was discharged after 31 days of admission in afebrile state with oral medications and stable kidney function (serum creatinine 3.2 mg/dL without dialysis). He completed 22-weeks of oral antibiotics with periodic follow-up without any adverse effects, without deterioration of renal function and recurrence of symptoms.

Informed consent was obtained from the patient for the publication of this case report.


Melioidosis is an uncommon but emerging infection in Bangladesh.[3] Sero-epidemiological surveillance reports,[4],[7] organism isolation from soil specimens[4] and autochthonous cases[3],[5] established Bangladesh as endemic for melioidosis.

Patients with B. pseudomallei infection may present with fever, pneumonia, cutaneous and visceral abscess and septic arthritis.[3],[6] Splenic abscess is usually a consequence of septicemic melioidosis and rarely splenic rupture may occur.[8],[9] Clinical presentation of melioidosis often mimics tuberculosis[10] and it is not unlikely that in nonendemic regions many patients are empirically treated with antituberculosis drugs, resulting in unfavorable outcome.

Most patients with melioidosis have underlying conditions such as diabetes mellitus, CKD, alcoholism, malignancy or immunosup-pressive conditions, receiving chemotherapy, organ transplant recipients and taking immuno-suppressive drugs.[2],[3],[5],[11] Thalassemia is also a recognized risk factor for melioidosis, especially in childhood cases.[12],[13] Our patient being a farmer was at risk for being infected by B. pseudomallei. He was non-diabetic, but had two other potential but unidentified risk factors for melioidosis in him, like CKD and thalassemia.

Identification of B. pseudomallei from blood and other specimens in culture remains the gold standard in diagnosing melioidosis. Often culture specimens are discarded as contamination from microbiology laboratories.[3] High index of clinical suspicion is important and good communication between treating physician and microbiology laboratory is important, especially in countries like Bangladesh, where melioidosis is emerging and tuberculosis is endemic.[3] Failure to suspect fairly earlier in the disease course, delay in diagnosing and initiating appropriate antibiotics remain as major causes of death in melioidosis. Hence, a high index of clinical suspicion is emphasized.

In conclusion, melioidosis should be a differential diagnosis in any patient with fever, organomegaly and internal organ abscess, especially if occurring in a farmer and having risk factors such as diabetes, thalassemia or CKD and especially if not responding to commonly prescribed antibiotics.


The authors would like to thank Dr. Lovely Barai, Associate Professor of Microbiology, BIRDEM General Hospital, for guiding antibiotic selection for the patient.

Conflict of interest: None declared.


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