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Case Report

Development of Neutropenic Sepsis During the Eradication Phase with Co-Trimoxazole in Patients with Melioidosis: Two Case Reports

by
Jayaweera Arachchige Asela Sampath Jayaweera
1,* and
Gerard Ranasinghe
2
1
Department of Microbiology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura 50008, Sri Lanka
2
Department of Microbiology, Teaching Hospital, Kurunegala 60000, Sri Lanka
*
Author to whom correspondence should be addressed.
GERMS 2023, 13(3), 266-272; https://doi.org/10.18683/germs.2023.1393
Submission received: 11 April 2023 / Revised: 16 July 2023 / Accepted: 5 August 2023 / Published: 30 September 2023

Abstract

Introduction: Burkholderia pseudomallei is the bacterium that causes melioidosis. It is mostly a tropical disease, and particularly common in Southeast Asia and northern Australia. The intensive intravenous phase and the oral prolonged eradication phase are the two phases of melioidosis treatment. The current recommended treatment for melioidosis eradication is oral co-trimoxazole (TMP/SMX). Case report: Two patients were diagnosed with B. pseudomallei bacteremia without a focus and were treated with oral TMP/SMX with folic acid during the eradication phase. Both presented with neutropenic sepsis with pneumonia and pyelonephritis at days 48 and 45 following TMP/SMX 320/1600 mg q12h (4 tablets) and in both of them, the folic acid compliance was poor. One patient died and the other survived following intensive treatment for neutropenia. At the presentation following neutropenic sepsis among both patients, the red blood cells and platelets were within normal limits. Both patients were on a high dose of TMP/SMX, as both were within 40–60 kg of body weight the ideal TMP/SMX dose would be 240/1200 mg q12h (3 tablets). Pancytopenia caused by TMP/SMX can frequently develop gradually over time. Alternately, it can develop rapidly and swiftly escalate to fulminant sepsis, disseminated intravascular coagulation, and fast hemolysis. However, the development of isolated neutropenia is rarely described in the literature. Conclusions: Prolonged use of TMP/SMX is important to eradicate B. pseudomallei and always the possibility of rare adverse effects has to be considered. Always weight-based TMP-SMX dosing has to be encouraged with need to ensure the compliance of folic acid. During the eradication phase, continuous monitoring of blood cell lines with weekly full blood count would be essential to identify neutropenia in advance.
Keywords: melioidosis; co-trimoxazole; adverse effects; neutropenia; folic acid; compliance and blood cell monitoring melioidosis; co-trimoxazole; adverse effects; neutropenia; folic acid; compliance and blood cell monitoring

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MDPI and ACS Style

Jayaweera, J.A.A.S.; Ranasinghe, G. Development of Neutropenic Sepsis During the Eradication Phase with Co-Trimoxazole in Patients with Melioidosis: Two Case Reports. GERMS 2023, 13, 266-272. https://doi.org/10.18683/germs.2023.1393

AMA Style

Jayaweera JAAS, Ranasinghe G. Development of Neutropenic Sepsis During the Eradication Phase with Co-Trimoxazole in Patients with Melioidosis: Two Case Reports. GERMS. 2023; 13(3):266-272. https://doi.org/10.18683/germs.2023.1393

Chicago/Turabian Style

Jayaweera, Jayaweera Arachchige Asela Sampath, and Gerard Ranasinghe. 2023. "Development of Neutropenic Sepsis During the Eradication Phase with Co-Trimoxazole in Patients with Melioidosis: Two Case Reports" GERMS 13, no. 3: 266-272. https://doi.org/10.18683/germs.2023.1393

APA Style

Jayaweera, J. A. A. S., & Ranasinghe, G. (2023). Development of Neutropenic Sepsis During the Eradication Phase with Co-Trimoxazole in Patients with Melioidosis: Two Case Reports. GERMS, 13(3), 266-272. https://doi.org/10.18683/germs.2023.1393

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