Two Cases of Melioidosis

Two cases of fatal melioidosis are described. The first a robust Indian labourer; the second a well-nourished, muscular European.Case 1. Gradual onset. Irregular fever. Pain in the epigastrium. No physical signs of disease at first, except enlarged spleen; later, there were signs of consolidation at the bases of both lungs. Constipated at first; diarrhoea came on towards the end and the patient collapsed and died at the end of the third week.At the autopsy; there were small patches of consolidation in the lungs, composed of minute suppurating tubercles. In the liver there were similar aggregations of small suppurating tubercles and two circumscribed abscesses. The gall-bladder was thickened. The spleen was enlarged and contained septic infarcts and abscesses. In the caecum there were small superficial ulcers. B. whitmori was cultivated from the lungs, spleen, liver and gall-bladder.Animals were inoculated as follows: A guinea-pig, inoculated in the anterior nares with pus from the liver, died nine days later with caseous inflammation of the nasal passages and a caseous inguinal gland from which B. whitmori was recovered. A guinea-pig, inoculated subcutaneously with pus from the liver, died on the twenty-fifth day with abscesses in the lymphatic glands from which B. whitmori was cultivated. A guinea-pig, inoculated subcutaneously with a culture of the organism, died within sixteen hours from septicaemia. B. whitmori was recovered from the heart and spleen. A guinea-pig, inoculated subcutaneously with an attenuated culture, died on the twenty-fifth day with suppurating buboes and with abscesses in the liver and lungs from which B. whitmori was cultivated. Two horses were inoculated subcutaneously with cultures of the strain of B. whitmori cultivated from the patient. An abscess developed at the site of inoculation, in each case, but the local lesion healed and the animals have, so far, remained healthy.Case 2. The illness commenced gradually with pain after food, occasional vomiting and looseness of the bowels. The temperature became high and of the swinging type, accompanied by rigors and sweats. The liver was enlarged. The patient died on the twenty-fifth day.At the autopsy, two large abscesses were found in the liver, the gall-bladder was thickened and there were a few small superficial ulcers in the caecum. B. whitmori was cultivated from the liver abscess. No amoebae were found.The following animals were inoculated. Two wild rats were inoculated subcutaneously with a culture from this case and both died from septicaemia in less than twenty-four hours. B. whitmori was recovered from the heart's blood. The result of the subcutaneous inoculation of a guinea-pig was the same. A guinea-pig, inoculated in the nostril, died on the fifth day with a cheesy deposit in the nose and septicaemia. Another guinea-pig, inoculated in the same way, but after the organism had been subcultivated repeatedly, died on the twelfth day, with caseous tracheal glands containing B. whitmori. A rabbit, inoculated subcutaneously, died in twenty-six hours from septicaemia with tubereles in the peritoneum. B. whitmori was cultivated from the peritoneum and from the heart's blood. A monkey fed on a culture remained healthy. A pony inoculated intravenously recovered after a week's fever.