TL;DR
This case series aimed to increase physicians' awareness of melioidosis in high-risk patients presenting with diverse clinical symptoms, thereby improving diagnostic accuracy and ensuring timely and appropriate treatment.
Brucellosis is a zoonotic infection with diverse clinical manifestations. Pulmonary involvement is rare—occurring in less than 1% of cases—and typically limited to endemic regions. In Slovakia, where brucellosis is non-endemic, human cases are exceptional. We present a rare and severe respiratory form of brucellosis in a patient with occupational exposure to livestock. We describe a 40-year-old female dairy farm worker admitted with fever, chills, and dyspnea. Initial workup revealed mild laboratory abnormalities and chest infiltrates. Despite empirical antibiotics, her condition rapidly progressed to acute respiratory distress syndrome (ARDS), acute kidney injury, and septic shock. Mechanical ventilation and vasopressor support were required. Serological testing confirmed Brucella abortus infection. Antibiotic therapy was escalated to tigecycline and meropenem, with subsequent clinical improvement. Follow-up imaging showed significant regression of pulmonary infiltrates. The patient completed a six-week course of doxycycline and fully recovered. This case underlines the importance of considering brucellosis in febrile patients with livestock exposure, even in non-endemic settings. Severe pulmonary forms are rare but life-threatening. Early recognition, targeted antibiotic therapy, and multidisciplinary care are critical for favorable outcomes. Pulmonary brucellosis is rare (< 1% of cases) but can be life-threatening, even in non-endemic regions. Occupational exposure to livestock is the primary risk factor in non-endemic settings such as Slovakia. Tigecycline is a viable alternative in complicated brucellosis with renal failure due to its non-renal elimination. Multidisciplinary care and dynamic serological monitoring were crucial for successful patient management.
Melioidosis, caused by the gram-negative bacillus Burkholderia pseudomallei - a Tier 1 Select Biological agent - remains a significant cause of severe community-acquired infection in tropical regions, but with recent expanding recognition in temperate climates, including the United States. Pulmonary involvement is the most frequent clinical manifestation, ranging from subclinical nodules to fulminant necrotizing pneumonia and acute respiratory distress syndrome. Despite its clinical severity, melioidosis remains underdiagnosed due to its radiologic mimicry of tuberculosis, broad clinical manifestations, and limited laboratory capacity in many endemic areas. Special Operations Forces (SOF) participating in field exercises or operations in B. pseudomallei endemic countries are at significantly increased risk of infection. Accordingly, SOF medical providers should maintain a high index of suspicion for melioidosis and be familiar with its clinical recognition, diagnosis, and management.
Melioidosis, caused by Burkholderia pseudomallei , is an important but frequently under-recognized cause of severe infection in tropical regions, including Vietnam. Although cases have been reported from several parts of the country, published clinical data from remote island settings remain scarce. To our knowledge, no clinical case series of melioidosis from Phu Quoc Island has been previously reported. This study describes the clinical presentations, underlying comorbidities, management, and outcomes of patients diagnosed with melioidosis at a tertiary hospital on Phu Quoc Island, Vietnam. We retrospectively reviewed all patients with culture-confirmed melioidosis admitted to Vinmec Phu Quoc General Hospital between July 2022 and February 2026. Archived isolates underwent molecular confirmation using a TTS1-targeted quantitative polymerase chain reaction (qPCR) assay, followed by recA gene sequencing. Nine patients were included. Clinical, laboratory, microbiological, radiological, treatment, and outcome data were extracted from medical records. Pneumonia was the predominant manifestation, occurring in seven patients, and eight patients presented with bacteremic disease. Diabetes mellitus was the most common underlying condition (7/9), followed by chronic liver disease and previous tuberculosis. Most patients were admitted with sepsis, including four cases complicated by septic shock. Two patients developed rapidly progressive pulmonary melioidosis with acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) and died despite intensive antimicrobial and supportive therapy, including one previously healthy individual. The remaining seven patients survived. TTS1 qPCR confirmed all available isolates, while recA sequencing demonstrated the presence of at least two closely related sequence variants among circulating isolates. Antimicrobial susceptibility testing by broth microdilution showed preserved susceptibility to amoxicillin/clavulanic acid, ceftazidime, imipenem, and trimethoprim/sulfamethoxazole in all tested isolates. This report represents, to our knowledge, the first published clinical case series of melioidosis from Phu Quoc Island. The findings highlight the broad clinical spectrum of melioidosis and its potential for rapid progression to life-threatening pneumonia, septic shock, and multiorgan failure. Clinicians should maintain a high index of suspicion in patients presenting with severe pneumonia or sepsis, particularly during the rainy season and among individuals with diabetes mellitus or chronic liver disease. Strengthening conventional microbiological capacity, including timely blood culture, accurate organism identification, and standardized antimicrobial susceptibility testing, remains essential for improving diagnosis and patient outcomes in geographically isolated settings.
Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, highly endemic in Central and South America, the United States, and Africa. The fungus exists as a mold in the environment and as yeast in human tissue, proliferating in soils contaminated by bird and bat excrement in environments like caves, abandoned buildings, and construction sites. In immunocompetent hosts, histoplasmosis is often asymptomatic, but in immunocompromised individuals, including pediatric patients, it can lead to disseminated disease with severe outcomes. Misdiagnosis as tuberculosis is common, and incidence rates are underreported. Nonspecific symptoms such as fever, fatigue, hepatosplenomegaly, and hematologic abnormalities complicate diagnosis, and the disease disproportionately affects children under 2 years old or those with compromised cellular immunity. This study reports four pediatric cases of disseminated histoplasmosis from Hospital Escuela in Honduras. Case 1: A 3-year-old male with interleukin-12 receptor deficiency and a history of Mycobacterium bovis infection developed severe disseminated histoplasmosis and succumbed to multiorgan failure. Case 2: A 3-year-old female from a rural area presented with neuroinfection and hydrocephalus; post-mortem analysis confirmed Histoplasma capsulatum. Case 3: A 14-year-old male with previous histoplasmosis presented with reactivation and responded favorably to itraconazole. Case 4: A 6-year-old male with disseminated tuberculosis and histoplasmosis faced disease related complications resulting in death. Disseminated histoplasmosis in pediatric patients presents unique challenges, particularly in resource-limited settings, where diagnostic tools such as antigen detection, cultures, and molecular techniques may be unavailable. Increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes. This study emphasizes the importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches.
Histoplasmosis is a systemic fungal infection caused by inhalation of spores of Histoplasma capsulatum . The disease is endemic in several geographical regions worldwide, including parts of India such as West Bengal, Assam, and selected areas of southern and northern India. Sporadic cases have also been reported from Gujarat and Rajasthan. However, being tropical countries with lots of other infections, histoplasmosis becomes a relatively rare infection and is often missed in routine clinical practice. In patients presenting with pyrexia of unknown origin, delayed diagnosis of disseminated histoplasmosis may result in catastrophic consequences. We report the case of a 29-year-old male, grain merchant by occupation, presented with a fever of 1-month duration. He had previously received empirical broad-spectrum antimicrobial therapy at another hospital without clinical improvement. At presentation, the patient was ill-appearing and hemodynamically unstable. On physical examination, mild splenomegaly was present, and the chest was clear on auscultation. Laboratory evaluation demonstrated bicytopenia, raising suspicion for hematological malignancy or overwhelming systemic infection. Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography demonstrated diffuse marrow hypermetabolism and FDG-avid hepatosplenomegaly, further increasing suspicion for malignancy. Bone marrow aspiration and biopsy were planned, but due to hemodynamic instability could not be performed; however, peripheral blood smear examination revealed intra- and extracellular small oval yeast-like organisms morphologically suggestive of H. capsulatum . The patient was treated with an induction therapy dose of Liposomal amphotericin B 3 mg/kg/day for 7 days. Fever subsided within 24 h of therapy, accompanied by rapid clinical and hemodynamic improvement. Following induction therapy, maintenance treatment with oral itraconazole was initiated with a loading dose of 200 mg thrice daily for 3 days, followed by 200 mg twice daily, planned for 1 year. Disseminated histoplasmosis should be considered in patients with prolonged unexplained fever, even in the absence of apparent immunodeficiency. Peripheral blood smear examination may provide an important diagnostic clue and, in selected cases, may help avoid invasive procedures such as bone marrow examination. Early recognition and prompt initiation of antifungal therapy can result in rapid clinical improvement and may be lifesaving.
BACKGROUND Human brucellosis remains a significant public health concern in northeastern Türkiye and is among the leading causes of visits to infectious disease clinics. In this study, we aimed to describe the clinical characteristics and laboratory findings of patients with brucellosis in high-burden regions, with a particular focus on identifying diagnostic indicators of complicated disease. METHODS We conducted a retrospective study of patients with positive serology for brucellosis who were admitted to Harakani State Hospital in Kars between September 2022 and December 2023. Patients were grouped based on whether they had complicated or uncomplicated brucellosis. Potential diagnostic indicators of complicated brucellosis were identified using univariate and multivariate logistic regression. RESULTS The study included 97 patients with a median age of 42 years; 41.2% were female. Rose Bengal and Brucellacapt/Coombs Wright (BC/CW) tests were positive in 94.8% and 98.9% of patients, respectively. Cases were classified as acute (55.7%), subacute (28.9%), and chronic (15.5%). Complicated brucellosis was identified in 33 patients (34%). In univariate analyses, complicated brucellosis was associated with thrombocytopenia (OR: 5.53; 95% CI: 1.01-30.29), elevated C-reactive protein (CRP) (OR: 5.9; 95% CI: 2.31-15.15), elevated erythrocyte sedimentation rate (ESR) (OR: 3.23; 95% CI: 1.14-9.18), and a BC/CW titer >1:320 (OR: 2.76; 95% CI: 1.13-6.72). Elevated CRP levels were observed in 43.3% of patients and remained independently associated with complicated brucellosis in multivariable analysis (adjusted OR: 4.36; 95% CI: 1.60-11.87). Relapse occurred in 13 patients (13.4%) within six months. CONCLUSIONS The presence of thrombocytopenia, high CRP and ESR levels, and high BC/CW titers was a diagnostic indicator of complicated brucellosis. Early identification of high-risk patients using combined clinical and laboratory parameters may improve follow-up strategies and clinical outcomes.