Lobar Pneumonia in a Farmer Responded to Anti-melioidosis Antibiotics | ||||
| Afro-Egyptian Journal of Infectious and Endemic Diseases | ||||
| Article 18, Volume 10, Issue 3, September 2020, Page 323-326 PDF (321.28 K) | ||||
| Document Type: Case report | ||||
| DOI: 10.21608/aeji.2020.30749.1085 | ||||
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| Author | ||||
Chee Yik Chang 
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| Medical Department, Sarawak General Hospital, Kuching, Malaysia. | ||||
| Abstract | ||||
| A 46-year-old male, farmer, with no prior medical illness presented with a one-month history of intermittent right-sided pleuritic chest pain and productive cough. He complained of fever and breathlessness 3 days before current presentation to the district hospital. He denied any haemoptysis, night sweats, or contact with pulmonary tuberculosis. On examination, the vital signs were normal and lung auscultation revealed bronchial breath sounds and crepitation over the right upper zone. Chest radiograph demonstrated a right upper lobe consolidation with presence of air bronchogram and abdominal ultrasonography was normal. He was admitted for intravenous antibiotic therapy for a presumptive diagnosis of community-acquired pneumonia. He was initially treated with intravenous amoxicillin-clavulanic acid 1.2 g every 8 hours. Differential diagnosis of pulmonary tuberculosis was also considered but later ruled out as the sputum for direct smear microscopy, GenXpert and culture for Mycobacterium tuberculosis were negative. The melioidosis IgM (ELISA), multiple blood and sputum cultures were also negative. A PCR-based confirmatory test for melioidosis was however not available at our setting. In the ward, he continued to have persistent fever and repeated chest radiograph after 1 week of antibiotic showed worsening of right upper lobe consolidation. At this point in time, melioidosis was suspected due to the risk factor of farming. Antibiotic was then changed to intravenous ceftazidime 2 g every 6 hours. The patient responded positively as evidenced by the resolution of fever and respiratory symptoms, and repeated chest radiograph showed improving consolidation at 2 weeks. He was discharged after completing a 2-week course of intravenous ceftazidime, and simultaneously started on oral trimethoprim-sulfamethoxazole as eradication therapy. Upon review in the outpatient clinic 6 weeks later, chest radiograph showed marked improvement with minimal residual right upper lobe consolidation. He was clinically well and did not show any symptoms of relapse. He was planned for eradication therapy of 20 weeks’ duration. | ||||
| Keywords | ||||
| Melioidosis; Pneumonia; Burkholderia pseudomallei | ||||
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