Patient Presenting with Abscess Unresponsive to Treatment and Progressive to Osteomyelitis: A Rare Cause Burkholderia mallei

Glanders is a rare zoonotic disease caused by Burkholderia mallei (B. mallei). B. mallei can cause pneumonia, abscesses, osteomyelitis in severe cases, sepsis, and even death in humans. In this report, we present a 15-year-old male patient living in a rural area who was diagnosed with glanders. The patient, who did not have any previous disease, was followed up with a diagnosis of pneumonia in the hospital, where he was admitted with complaints of cough and abdominal pain and presented to us with pain, redness, and swelling in his leg. Magnetic resonance imaging of the lower extremity revealed osteomyelitis in the fourth and fifth metatarsals of the right foot. B. mallei growth was detected in the abscess culture. Meropenem treatment was started. The patient's symptoms regressed with treatment. The patient was discharged with oral ciprofloxacin for B. mallei eradication. Glanders are usually transmitted through direct contact with infected animals, especially single-hoofed animals such as horses, or through inhalation of aerosol containing B. mallei. It is a rare disease causing pneumonia and abscesses and can be life-threatening in severe cases. Diagnosis of glanders is difficult because the initial symptoms are non-specific. Isolation of B. mallei in culture is the gold standard for diagnosing the disease. There is no clear recommendation for treating glanders and imipenem; meropenem ceftazidime can be used based on antibiotic susceptibility tests.

Apse ile Baþvuran Tedaviye Yanýtsýz ve Osteomiyelite Ýlerleyen Hasta: Nadir Bir Neden Burkholderia Mallei

Ruam, Burkholderia mallei'nin (B. mallei) neden olduðu nadir görülen zoonotik bir hastalýktýr. B. mallei, insanlarda pnömoni, apse, ciddi vakalarda osteomiyelit, sepsis ve hatta ölüme neden olabilir. Bu raporda kýrsal kesimde yaþayan ve ruam tanýsý alan 15 yaþýnda erkek hasta sunulmaktadýr. Daha önce herhangi bir hastalýðý olmayan hasta, öksürük ve karýn aðrýsý þikayetleri ile baþvurduðu hastanede pnömoni tanýsý ile takip edilirken; bacaðýnda aðrý, kýzarýklýk ve þiþlik geliþmesi ile bize baþvurdu. Hastanýn alt ekstremite manyetik rezonans görüntülemesinde sað ayak 4. ve 5. metatarslarda osteomiyelit saptandý. Apse kültüründe B. mallei üremesi saptandý. Hastaya meropenem tedavisi baþlandý. Hastanýn semptomlarý tedavi ile geriledi. Hasta B. mallei eradikasyonu için oral siprofloksasin ile taburcu edildi. Ruam hastalýðý genellikle enfekte hayvanlarla, özellikle at gibi tek týrnaklý hayvanlarla doðrudan temas yoluyla veya B. mallei içeren aerosolün solunmasý yoluyla bulaþýr. Pnömoni ve apseye neden olan ve aðýr vakalarda yaþamý tehdit edebilen nadir bir hastalýktýr. Ýlk belirtiler spesifik olmadýðý için ruam teþhisi zordur. B. mallei'nin kültürde izolasyonu ruam tanýsýnda altýn standarttýr. Ruam tedavisinde net bir öneri yoktur ve antibiyotik duyarlýlýk testine göre imipenem, meropenem, seftazidim kullanýlabilir. (SETB-2023-07-115)