TEMPLATE DESIGN © MELIOIDOSIS IN PREGNANCY : A Case Study Ridzuan J, Zaridah S O&G Department Hospital Tuanku Fauziah, Kangar, Perlis, Malaysia Conclusions References Melioidosis is caused by an environmental saprophyte Burkholderia Pseudomallei. The range of the symptoms is varies. It can be in milder form eg bronchitis to life threatening condition eg sepsis. Usually it affected lung and liver (abcess). In a very rare condition it will affect the gall bladder. The mortality rate is 50% and treatment is very problematic. White NJ, Melioidosis:Lancet 2003; 361: Currie, BJ, Fischer D, et al. The epidimeology of melioidosis in Australia & Papua New Guinea. Acta Tropica 2000; 74; S D Putchucheary: Melioidosis in Malaysia ( invited review article ) Madam F, 37 years old housewife at 32/52 POA presented with low grade fever, jaundice and abdominal pain for the past 1/52 duration. She denied passing tea colour urine and pale stool. No history of travelling. She denied any high risk behavior. No bleeding tendencies and taking any herbs medication. On admission, physical examination revealed as vital signs stable, afebrile but jaundice. Her abdomen was soft, non tender and no organomegaly. Her uterus corresponded to her gestation and estimated birth weight was 1.2 – 1.4kg. Her initial investigations showed leucocytosis with neutrophil as predominant. Coagulation and renal profile were normal. All liver enzymes and total bilirubin were raised. Random blood sugar was normal. PE profile were normal. Ultrasound hepatobilliary system Chr Cholycystitis.. At ICU, her condition deteriorated and she was reintubated. Her sepsis and DIVC not subside. IV Tazosin was added. Another 2 cycle of DIVC regime was transfused. She developed acute renal failure. Her liver enzymes and total bilirubin both markedly raised. CT scan of the brain was normal. CT of hepatobiliary system was normal. At this time, our diagnosis was Chr Cholycystitis with acute renal and liver failure. On day day 8 post EmLSCS the fever settling and renal profile became normalized. She was extubated. Her liver enzymes and bilirubin were reducing in trend. However her jaundice still persist. Ultrasound of hepatobilliary system showed similar finding as on admission ultrasound. She was planned for ERCP later. The IV antibiotics were continued till 14 days. She requested for AOR discharge on day 16 post EmLSCS because wanted to go for traditional medicine. 2/52 later, the bacteriological result came back as Ig M positive for Melioidosis. We called her back but she refused for any treatment. The diagnosis was Chr cholycystitis and she was treated with IV Cefoperazone and IV Metrodinazole. After 2/7 in ward, she developed sepsis with DIVC.. Her blood and urine culture were negative. At this time, IV Unasyn was started and 2 pint pack cell with 2 set of DIVC regime were transfused. However it was not corrected. She started to have spontaneous bruises and bleeding from her gum. At the same time she passed out pale stool. Another 2 cycle of DIVC regime was transfused on that day. Unfortunately the CTG showed fetal distress and EmLSCS was done after discussion with O&G Consultant. Intra-operatively, the uterus looked very yellowish and atonic. Uterotonic agents were administered and another 2 cycle of DIVC regime and whole blood were transfused. The blood loss was 1500ml.