Text by Patricia Pintac
An Intern Case Presentation, focusing on the Neurosciences, was held last February 12, 2014 at the Angelo King Auditorium. The presenter, Intern Carmela San Luis, was introduced by Dr. Geraldine Mariano, faculty member of the Neurology Department.
Intern Carmela San Luis began by sharing the relevant history and physical examination findings of the patient who presented with headache, fever, neck discomfort, and behavioral changes with positive meningeal signs. The impression was a suboptimally treated meningoencephalitis to consider bacterial etiology. The case was challenging as the patient was unresponsive to the initial course of treatment and cerebrospinal findings were devoid of etiologic agents. A breakthrough occurred when blood culture results isolated Burkholderia pseudomallei.
Burkholderia pseudomallei is the causative agent of melioidosis and is said to be endemic in the Philippines. However, the actual prevalence rate is unavailable due to possible underreporting and misdiagnosis. This bacterium can either cause localized or disseminated symptoms which may mimic tuberculosis, one of the considerations of the case. Case reports that indicate melioidosis with meninges involvement total to only 4 worldwide so initially the healthcare team was skeptical with the proposed management as the drug suggested penetrates the blood brain barrier poorly. Fortunately, the patient was responsive and signs and symptoms resolved eventually.
Following the presentation, the reactors Dr. Cristobal Dumo, internist and infectious disease expert, and Dr. Mariano shared their own views regarding the diagnosis and the management of the patient. Afterwards, moderator Dr. Esteban Pasol opened the floor for questions and clarifications. The topic of the general assembly definitely proved as an eye-opener and certainly piqued the interest of the audience. [x]
An Intern Case Presentation, focusing on the Neurosciences, was held last February 12, 2014 at the Angelo King Auditorium. The presenter, Intern Carmela San Luis, was introduced by Dr. Geraldine Mariano, faculty member of the Neurology Department.
Intern Carmela San Luis began by sharing the relevant history and physical examination findings of the patient who presented with headache, fever, neck discomfort, and behavioral changes with positive meningeal signs. The impression was a suboptimally treated meningoencephalitis to consider bacterial etiology. The case was challenging as the patient was unresponsive to the initial course of treatment and cerebrospinal findings were devoid of etiologic agents. A breakthrough occurred when blood culture results isolated Burkholderia pseudomallei.
Burkholderia pseudomallei is the causative agent of melioidosis and is said to be endemic in the Philippines. However, the actual prevalence rate is unavailable due to possible underreporting and misdiagnosis. This bacterium can either cause localized or disseminated symptoms which may mimic tuberculosis, one of the considerations of the case. Case reports that indicate melioidosis with meninges involvement total to only 4 worldwide so initially the healthcare team was skeptical with the proposed management as the drug suggested penetrates the blood brain barrier poorly. Fortunately, the patient was responsive and signs and symptoms resolved eventually.
Following the presentation, the reactors Dr. Cristobal Dumo, internist and infectious disease expert, and Dr. Mariano shared their own views regarding the diagnosis and the management of the patient. Afterwards, moderator Dr. Esteban Pasol opened the floor for questions and clarifications. The topic of the general assembly definitely proved as an eye-opener and certainly piqued the interest of the audience. [x]