CHRONIC MELIOIDOSIS: DISCUSSION, CASE REPORT, AND SPECIAL STUDIES

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Abstract
Chronic melioidosis is a rare disease occurring in a well-demarcated oriental area about Burma and southern China. Approx. 6 cases have survived any length of time. The disease is reported in a 25-yr.-old white American soldier who contracted it in Luzon, P. I. The onset was characterized by gastrointestinal symptoms and a pleuro-pneumonic process, the latter progressing on to effusion and chronic suppurative lung disease. Approx, 11 months after onset, left cervical lymphadenopathy and splenomegaly, accompanied by a positive heterophile antibody reaction, appeared. The former went on to suppuration (most unusual in infectious mononucleosis) and 6 months later cultures finally revealcd Malleomyces pseudomallei. Confirmation was obtained by guinea plg inoculation with the development of the typlcal Straus reaction in the testes, by cultural studies and by agglutination with specific antiserum. The patient''s serum agglutinated the organisms in a dilution of 1:2560. Patient is alive approx. 2 1/2 yrs. after onset of the disease. The organism could not be inhibited in vitro up to the following practicable concns.: (1) streptomycin[long dash]125 y per ml ; (2) penicillin[long dash]1000 U./ml.; (3) sulfadiazine[long dash]1000 mg. %; (4) urea[long dash]1000 mg. %; (5) any combinations of these. Clinically, he responded only to surgical excision and drainage. The possibility of a false positive heterophile antibody reaction occurring in this disease is discussed.
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