CRA51 MELIOIDOSIS WHICH TRAVESTY TUBERCULOSIS: A CASE SERIES

T Abdul Aziz1, UN Daut1
1University Putra Malaysia, Selangor, Malaysia

Introduction:

Melioidosis is a tropical infectious disease that is often mistaken for tuberculosis, especially in high-incidence TB countries.

Case Presentation 1: A 35-year-old man with underlying diabetes mellitus and a smoker with a history of pulmonary tuberculosis 3 years ago presented with a cough for 1 month and a fever for 1 week. Lung examination revealed right upper zone bronchial breathing. The chest X-ray showed new opacity in the right upper lobe with a small cavity within. Sputum AFB and MTB cultures were negative. The BAL culture demonstrated Burkholderia pseudomallei after several days.

Case Presentation 2: A 41-year-old man with underlying diabetes mellitus presented with a fever and cough for 2 weeks. On examination, he was febrile, and a lung examination revealed bronchial breath sounds in the left upper zone. The chest radiograph showed left upper lobe consolidation, and the CT thorax also showed left upper lobe consolidation with a small cavity. Sputum culture showed Burkholderia pseudomallei. MTB culture showed no growth after 6 weeks.

Case Presentation 3: A 52-year-old man with underlying diabetes mellitus and an ex-smoker presented with cough for 2 weeks associated with weight loss of 5 kg and a loss of appetite. Lung examination revealed right upper zone crepitation and bronchial breathing. A chest radiograph showed right upper lobe fibrosis with cavitation. Sputum AFB was negative, and MTB culture grew non-tuberculous Mycobacterium. BAL culture grew Burkholderia pseudomallei.

Discussion:

Melioidosis shares similar clinical presentation and risk factors as Tuberculosis. Our case for instituting presumptive anti-TB treatment is justified in areas where both diseases are prevalent.

Conclusion:

Certain minor clinical details differences might distinguish between melioidosis and tuberculosis. A high index of suspicion is required for an early diagnosis. It avoids unnecessary exposure to anti-TB medications.