You are on vacation in Thailand when you meet a diabetic drinker with renal disease. He presents with fever, cough with sputum, chills, rigors, and respiratory distress. Even though you're on vacation, you get interested when you find out the organism that grew out is rarely seen in the U.S. A gram negative bacillus with characteristic bipolar staining looking like a "safety pin" is isolated.Challenge: The causative organism is a facultative intracellular bacterium called what?
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Vacation
This is melioidosis, a clinically diverse disease caused by the Burkholderia pseudomallei. In endemic regions (Thailand, Malaysia, Singapore, northern Australia), this organism is found in soil and fresh water. The patient has the three main risk factors for acquiring melioidosis. Pneumonia is the most common presentation, but skin ulcers, abscesses, GU infection, septic arthritis, osteomyelitis, and encephalomyelitis are also seen.
Source: UpToDate; phil.cdc.gov.
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