A disease process which presents very much like TB

Q: Which of the following disease processes presents very much like tսbеrϲսloѕiѕ in its subacute or chronic form?

A) Legionnaire's disease

B) respiratory syncytial virus (RSV) 

C) Меliοiԁоsiѕ 

D) Fungal pneumonia

E) COVID-19

Answer: C

Меliοidоsis is caused by the facultative intracellular gram-negative bacterium Burkholderia pseudomallei. It is a widely distributed environmental saprophyte in soil and fresh surface water in endemic regions like Southeast Αѕiа, Northern Αսѕtrаliа, South Aѕia, and China. Countries from that region, particularly Thailand, Malaysia, Singapore, Papua New Guinea, and New Caledonia, are the most commonly affected regions. Northeastern Thailand and parts of northern Αuѕtrаlia are considered "hyperendemic."

The incubation period is up to 3 weeks, and in its acute form, it presents mostly as pneumonia and septic shock.

In its subacute or chronic form, it becomes very difficult to differentiate from tսbеrϲսloѕiѕ (TB), as many of the endemic areas are also endemic for TB. In subacute or chronic form, Меliοidоsis manifests as chronic cough, purulent sputum production, hemoptysis, and night sweats. Chest X-rays also mimic TB with cavitation, nodular, or streaky infiltrates with fibrotic changes. Upper lobe consolidation is common and makes differential diagnosis more difficult, particularly in patients who also have pleural effusion.

Please see references for the latest reviews on epidemiology, diagnosis, radiological findings, and management.

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References:

1. Savelkoel J, Dance DAB, Currie BJ, Limmathurotsakul D, Wiersinga WJ. A call to action: time to recognise melioidosis as a neglected tropical disease. Lancet Infect Dis. 2022 Jun;22(6):e176-e182. doi: 10.1016/S1473-3099(21)00394-7. Epub 2021 Dec 23. PMID: 34953519.

2. Chakravorty A, Heath CH. Melioidosis: An updated review. Aust J Gen Pract. 2019 May;48(5):327-332. doi: 10.31128/AJGP-04-18-4558. PMID: 31129946.

3. Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, Limmathurotsakul D. Melioidosis. Nat Rev Dis Primers. 2018 Feb 1;4:17107. doi: 10.1038/nrdp.2017.107. PMID: 29388572; PMCID: PMC6456913.

4. Chowdhury S, Barai L, Afroze SR, Ghosh PK, Afroz F, Rahman H, Ghosh S, Hossain MB, Rahman MZ, Das P, Rahim MA. The Epidemiology of Melioidosis and Its Association with Diabetes Mellitus: A Systematic Review and Meta-Analysis. Pathogens. 2022 Jan 25;11(2):149. doi: 10.3390/pathogens11020149. PMID: 35215093; PMCID: PMC8878808.