Tuesday, December 16, 2008


Systemic Melioidosis, What? you ask, that is what I said too. Honestly, I thought Bill was making this up when he said that is what this patient I admitted has. At times, Bill does say fictitious things, and despite knowing him for over a year now and thinking I had figured out when he was making something up and when he was serious, I was wrong.
Over the weekend, I admitted this very sick guy who was transferred from another hospital with a very bad soft tissue infection of his neck. His neck was swollen and very indurated. I did an ultrasound and couldn't find a pocket of fluid to drain, but thought he was going to need it later on so I talked to Kevin and admitted him to the surgical ward on 4 antibiotics (Kudjip special). He was septic, sat 76% on RA, and his CXR had patchy infiltrates B/L. The next day I see him and find he is significantly jaundiced, I didn't remember seeing that the day before, but I could have missed it. AST 280, bili 10 - yep, jaundice. Monday, Kevin sees him and asks me to please transfer him as he is too sick to be on his surgical ward. He was definitely declaring himself as a medical patient and so I agreed.
I had mentioned this pt to Bill over the weekend and asked him to take a look at him to give me his thoughts on what could be going on. We talked about it on Monday, and didn't come up with anything, but knew it wasn't good. Tuesday am a bunch of us are in the Xray room, Lawrence and I had just talked about this guy and looked at the CXR and Bill comes in and says he has Systemic Melioidosis, what?
We won't know if he really has Melioidosis as we can't do blood cultures or anything here, but it is still interesting to read about and learn about. I likely would never had heard of this if this patient hadn't come it. So, what is Melioidosis you are asking. It is a gm neg bacterial infection that can cause pneumonia, septicemia, and localized infections. The organism is found in soil and water, and is not transmitted from other infected persons (this is a good thing). The septicemia variant, is what our guy has, if he has it, and it can be fatal. Based on his CXR it looks like he should have died already (for the nonmedical folks the white stuff in his lungs shouldn't be there), but he continues to fight.
He told us on Monday that he will be alright no matter what - he trusts in God. Today he told me his hope is in Christ - how encouraging for me to hear. His illness could easily take his life, but he knows he will see his Savior who was born this Christmas season if he does die. In the mean time, we keep treating him, praying for him, and are encouraged and blessed each day we get to talk with him and see his faith in action.
What do I learn from all this - we have a lot of bad diseases here in PNG, I have a lot to learn in medicine, God is good and uses people you don't expect to encourage you, and Bill is amazing. How does he know this stuff? I am thankful to have the opportunity to learn from him and hope to continue to glean knowledge from him while I am here.