Pulmonary melioidosis. Observations in thirty-nine cases.

During the 6-year period from 1965 through 1970, 39 patients with pulmonary melioidosis were treated at Fitzsimons Army Medical Center. Although this is a disease with a well-defined endemic area that does not include the United States, cases will no doubt continue to be seen in this country. These cases may result from acute infection in the endemic area, with subsequent travel to this country, or from delayed reactivation of a latent infection acquired months or years earlier. Given the potential for occurrence of this disease in the United States, continued awareness by the medical profession is important. The typical patient with subacute or chronic pulmonary melioidosis presents with fever, productive cough, weight loss, and a history of visiting an endemic area sometime in the past. Chest radiographs disclose upper lobe infiltrates and/or cavitation, suggesting granulomatous disease. With careful bacteriologic examination, sputum cultures are positive for Pseudomonas pseudomallei, which is susceptible to tetracycline, chloramphenicol, sulfonamides, and kanamycin. The titer of the indirect hemagglutinating antibodies will almost always be greater than 1:40. Most patients respond to therapy with tetracycline alone of in combination with chloramphenicol. Occasionally, a patient may require surgical intervention; if so, ideally the sputum should be negative, and a lobectomy, rather than segmentectomy, should be performed.