When returning, he had diarrhea, Selleck Palbociclib fever, dry cough, symptoms of urinary tract infection (UTI), and a skin abscess on his buttock that had ruptured spontaneously. At the outpatient clinic he was diagnosed with possibly pneumonia and UTI, and he was treated with oral amoxicillin. When his condition

deteriorated he was admitted to the local hospital and received cefotaxime and eventually ciprofloxacin. The patient then developed kidney failure and was transferred to the regional hospital. At admission, he had fever, ataxia, and urine retention, and was mentally disorientated. His blood samples showed hemoglobin 7.8 g/mL, platelets 64 × 109 L−1, WBC 9.9 × 109 L−1, creatinine 379 umol/L, and CRP 218 mg/L. Hemolytic uremic syndrome/thrombotic thrombocytopenic purpura was excluded. A CT scan demonstrated normal abdominal parenchymal organs, muscles, and skeleton. In the lungs there were minor parenchymal infiltrates and some pleural fluid. The prostate was significantly enlarged and revealed several prostatic abscesses (Figure 1B) that were drained through the urethra. Cerebral CT and magnetic resonance selleck chemical imaging (MRI) scans were normal. In the blood culture taken at the local hospital, a gram-negative nonfermentative rod grew after 24 hours of aerobic incubation and the next day the rod grew on blood (sheep) and lactose agars (incubated at 35°C with 5% CO2).

The same bacteria were found in the urine. Pseudomonas sp. was suspected because the bacteria were nonfermentative, motile, and oxidase positive. However, subculture on Burkholderia medium [oxidative-fermentative polymyxin B-bacitracin-lactose agar (OFPBL)] revealed growth consistent with Burkholderia sp. Identification performed with API 20 NE did not give conclusive results (probability of B pseudomallei 51%, Pseudomonas fluorescens 39%, and Burkholderia cepacia 11%). 16S rRNA gene sequencing identified the

rod as Burkholderia sp., most likely B pseudomallei or B mallei. The rod was aminoglycoside resistant and motile; therefore, B pseudomallei was concluded. The identity was later confirmed with specific real-time PCR at the Norwegian Institute of Public Health.2 Selleckchem C59 The MIC values obtained from the E-tests (AB Biodisk, BioMérieux) performed on the blood isolate are summarized in Table 1. When B pseudomallei was suspected, the patient was treated with meropenem for 14 days and his clinical condition improved. Thereafter he received eradication therapy with doxycycline and TMP-SMX for 20 weeks. No relapse of his illness had occurred 1 year after therapy. Further investigation of his renal function showed chronic renal failure with anemia because of unrecognized hypertension. Melioidosis is an infectious disease caused by the bacteria B pseudomallei,3,4 a strict aerobic, nonspore-forming, gram-negative rod.