Causes and risk factors
Whitmore’s disease is caused due to infection with the bacteria Burkholderia pseudomallei. The bacteria are found in contaminated soil and water. Direct contact with contaminated soil or water can spread the disease. Inhalation of contaminated dust, drinking water containing bacteria; direct contact, especially entry of bacteria through skin abrasions can cause the disease. People with following diseases are at increased risk of getting the disease: Diabetes, liver disease, chronic renal failure, thalassemia, cancer, or other immune-suppressing conditions not related to HIV, or chronic lung disease.
Clinical presentation
Whitmore’s disease usually affects the lungs, but the infection can spread via bloodstream to the eyes, heart, liver, kidneys, and joints. Symptoms appear 2 to 4 weeks after exposure. Symptoms depend upon the site of infection. Localized infection leads to localized pain, swelling, and abscess accompanied by fever. There appears a nodule on the skin where bacteria have entered through tear in the skin. Pulmonary infection can cause mild bronchitis to severe pneumonia. It includes signs and symptoms like cough, chest pain, headache, anorexia, and fever. Infection in the blood stream gives rise to sepsis. It involves symptoms like abscesses throughout the body, pus-filled lesions on the skin, abdominal discomfort, diarrhea, respiratory distress, joint pains, muscular pains, mental confusion, and disorientation. It can also cause seizures.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Culture of blood, urine, sputum, or discharge sample is done to detect bacteria. Imaging studies such as chest x-ray is useful for further evaluation in case of pulmonary infection.
Treatment
Whitmore’s disease is treated with antibiotic therapy. The treatment is divided into two phases – intravenous high intensity phase and eradication phase. In Intravenous high intensity phase antibiotics are given intravenously for a period of 10-14 days and are not usually stopped until the patient’s temperature has returned to normal for more than 48 hours. In eradication phase, oral antibiotics are used for a period of 3-6 months to reduce the rate of recurrence. Prevention includes avoiding contact with infected persons, avoiding contact with contaminated soil and water, avoiding drinking contaminated water or eating uncovered food, and practicing personal hygiene.
