Melioidosis presenting as sepsis syndrome: a case report.

Melioidosis is an important disease in Asia and Australia. It is very rare in Venezuela. We describe the case of a 50-year-old diabetic patient with several episodes of right tibial osteomyelitis, left shoulder arthritis, sternal osteomyelitis, right parietal osteomyelitis, and subperiosteal abscess, followed by septic arthritis of the right knee. In all cases Gram stain smear showed Gram-negative bacilli. Culture yielded Burkholderia pseudomallei, susceptible to third- and fourth-generation cephalosporins, ciprofloxacin and aztreonam, and resistant to aminoglycosides. He developed sepsis syndrome. Blood cultures and culture of abscess and joint fluids also revealed B. pseudomallei. The patient was treated with ceftazidime and ciprofloxacin, then cefepime and trimethoprim-sulfamethoxazole. He was discharged with suppressive therapy consisting of oral doxycycline and trimethoprim-sulfamethoxazole, and follow-up has continued to date. At this time he remains asymptomatic. Melioidosis is an extremely rare disease in our country. To our knowledge, this is only the second case reported in Venezuela.

Brote de bacteremía nosocomial por Klebsiella pneumonae / Break nosocomial bacteremia by klebsiella pneumoniae

Bacteremia por comtaminación extrínseca de fluidos de infusión es un evento poco frecuente. Reportamos un brote ocurrido en una sala de medicina general del Hospital Vargas de Caracas, entre el 18 y 28 de julio de 1994 siete pacientes tuvieron hemocultivos positivos para Klebsiella pneumoniae, la investigación epidemiológica demostró K. pneumoniae de igual sensibilidad a la aislada en los hemocultivos, en un frasco de solución dextrosal al 0,30 por ciento y en un frasco de solución dextrosal 0,45 por ciento, ambos utilizados en la sala para dilución de medicamentos, Seis de los siete pacientes evolucionaron satisfactoriamente