5,6 The mode of acquisition is by inhalation, inoculation, or ingestion. In high-endemic countries melioidosis is the most common cause of pneumonia with septicemia during the rainy season.3Burkholderia pseudomallei is also a potential agent for biological terrorism. The two patients presented are to our knowledge the first Norwegian melioidosis cases ever reported. Outside the endemic areas, melioidosis is usually diagnosed in returning tourists or in people
originating from these regions. Various clinical presentations of melioidosis have been reported in surviving selleck compound Swedish and Finnish tourists after the tsunami in 2004,7,8 and in a recent publication five cases from Denmark were presented.9 Still, the risk of contracting infection with B pseudomallei is low among tourists and melioidosis is a rare disease in Scandinavia. Thus, the awareness of melioidosis is limited among the clinicians. Melioidosis is a clinically diverse disease, with a wide range of manifestations and severities, varying from potentially fatal bacteraemia to subacute or chronic infections that can be localized or disseminated involving any organ.3 In a study from the Northern Territory
in Australia, the mortality rate was 4% in the cases without bacteraemia, compared to 37% in the cases with bacteraemia.10 Abscesses in abdominal organs are well recognized, FDA approved Drug Library cost especially in the kidney, spleen, and prostate, as in our patients. Antibiotics most often resolve the infection, but prostatic abscesses may require drainage because treatment failures have developed when this was not performed.6 Splenic abscesses are generally uncommon, but in a recent study from Singapore, the most common etiological agent was B pseudomallei.11Burkholderia pseudomallei can be reactivated from latent disease long after exposure, resembling infections with Mycobacterium tuberculosis both clinically and histologically.3 Patient 1 did not return to Sri Lanka or visit other tropical areas in the period of 2005 to 2007. Thus, this might be a case of reactivation of latent
Molecular motor melioidosis or progression of subclinical infection because the patient suffered from abdominal pain at regular intervals throughout this time period. Risk factors for developing severe melioidosis are diabetes, excessive alcohol consumption, chronic lung disease, and chronic renal disease.3,12 It seems that patients with cystic fibrosis are at special risk of airway colonization and pulmonary infections,13 and they should be warned about the risk of traveling to melioidosis endemic regions. Still, as much as one third of the cases of melioidosis have no predisposing risk factors.4 Healthy individuals may develop fulminant melioidosis, but severe disease and fatalities are uncommon in patients without risk factors.