Nephrol Dial Transplant (2002) 17: 137-139
© 2002 European Renal Association-European Dialysis and Transplant Association
Case Reports
Burkholderia pseudomallei infection, or melioidosis, and nephrotic syndrome
1 Department of Renal Medicine and 2 Clinical Infection Unit, St George's Hospital Medical School, Cranmer Terrace, London, UK
Keywords: Burkholderia pseudomallei; melioidosis; nephrotic syndrome
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Burkholderia pseudomallei is a Gram-negative intracellular bacillus that causes melioidosis. It is endemic in south-east Asia and areas of northern Australia. In some tourist destinations, such as parts of northern Thailand, it is the cause of 20% of community-acquired septicaemias, and 50% of sepsis-related deaths.
Resistance to a wide range of antibiotics, including most aminoglycosides and first- and second-generation cephalosporins, used as blind treatment for Gram-negative sepsis, is inherent. Optimal initial treatment is with either intravenous imipenem or ceftazidime, which is continued for 2 weeks [1]. Even with this treatment the mortality is 35% in clinical disease and is over 50% with other antibiotic combinations. Following this initial treatment, oral therapy with doxycycline, cotrimoxaxole and chloramphenicol should be given for 3 months to prevent relapse [2]. Abscesses are a common complication.
Infection may follow an acute or sub-acute course, and may affect one or more of
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