Acute Respiratory Failure in Melioidosis

SD Puthucheary, J Vadivelu, KT Wong, GSY Ong
Correspondence: Prof S D Puthucheary, puthu@medicine.med.um.edu.my

ABSTRACT
Background In melioidosis caused by Burkholderia pseudomallei, although every organ in the body may be involved, the highest mortality of 73% occurs when the respiratory system is affected. These patients invariably die of acute respiratory failure. Most of them also have underlying predisposing factors like diabetes mellitus.
Aim of Study A retrospective study of six such cases was carried out in order to elicit the possible causes and mechanisms of acute respiratory failure in patients with melioidosis.
Method Patients' records were reviewed for demographic, clinical, laboratory, radiological and histopathological data.
Results The rapidity of onset of respiratory failure was remarkable and was accompanied by relentless hypoxaemia that was refractory to treatment despite the application of high positive end expiratory pressure and other supportive measures. All had bilateral opacities on frontal chest radiographs, focal and diffuse necrotizing pneumonia and presence of hyaline membranes in lung tissues seen histologically, supporting the accepted criteria for ALI/ARDS.
Conclusion Patients with sepsis due to B. pseudomallei develop ALI/ARDS very rapidly resulting in high mortality rates. Possible mechanisms involved are discussed. Awareness of the disease in endemic areas, the development of rapid diagnostic methods and appropriate management procedures are urgently needed for the prevention of ARDS and subsequent reduction in mortality in such cases.

Keywords: melioidosis, acute lung injury, acute respiratory syndrome
Singapore Med J 2001; 42(3): 117-121