Cluster of cases of pulmonary melioidosis presenting as acute fulminant pneumonia in the East of Sri Lanka

Melioidosis is a potentially fatal infection caused by the soil-associated, Gram negative bacterium Burkholderia pseudomallei. It is still largely under recognized as a cause of community acquired, acute fulminant pneumonia. We identified 16 patients from a single rural village in the Eastern Province of Sri Lanka who were admitted with pulmonary melioidosis during a fourmonth period (October 2017 to February 2018). They presented with fever, cough, and shortness of breath for 3-5 days. Chest radiographs showed bilateral multiple pulmonary nodules with cavitation. Diagnosis was confirmed by positive blood cultures and/or rising antibody titers. The unique features of this cluster were the female predominance and asthma being the predominant risk factor. Epidemiological observations suggest that host behavior and prevailing weather conditions may have triggered this cluster of pulmonary melioidosis. Hence, melioidosis should be considered in the differential diagnosis of patients with severe community acquired pneumonia in the relevant epidemiological setting.