Aug 2026· American Journal of Tropical Medicine and Hygiene· 0 citations· 10 references
Medicine
TL;DR
The presence of severe melioidosis in the Peruvian Amazon highlights the presence of Burkholderia pseudomallei and underscores the need to consider this pathogen in patients presenting with severe sepsis in tropical regions with high environmental exposure and metabolic risk factors.
Abstract
Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Although well described in Southeast Asia and northern Australia, its burden in South America remains poorly characterized and likely underestimated. A case of severe disseminated melioidosis in a 35-year-old man with poorly controlled diabetes mellitus residing in the Peruvian Amazon is reported here. The patient presented multifocal pneumonia, bacteremia, and septic shock requiring mechanical ventilation and vasopressor support. During hospitalization, he developed cutaneous microabscesses and septic arthritis of the left knee. Burkholderia pseudomallei was isolated from both blood cultures and synovial fluid, confirming hematogenous dissemination. This case highlights the presence of severe melioidosis in the Peruvian Amazon and underscores the need to consider this pathogen in patients presenting with severe sepsis in tropical regions with high environmental exposure and metabolic risk factors. Strengthening microbiological diagnostic capacity is essential to improve detection of this emerging infection in South America.
Melioidosis, caused by the gram-negative bacillus Burkholderia pseudomallei - a Tier 1 Select Biological agent - remains a significant cause of severe community-acquired infection in tropical regions, but with recent expanding recognition in temperate climates, including the United States. Pulmonary involvement is the most frequent clinical manifestation, ranging from subclinical nodules to fulminant necrotizing pneumonia and acute respiratory distress syndrome. Despite its clinical severity, melioidosis remains underdiagnosed due to its radiologic mimicry of tuberculosis, broad clinical manifestations, and limited laboratory capacity in many endemic areas. Special Operations Forces (SOF) participating in field exercises or operations in B. pseudomallei endemic countries are at significantly increased risk of infection. Accordingly, SOF medical providers should maintain a high index of suspicion for melioidosis and be familiar with its clinical recognition, diagnosis, and management.
Chase Goldberg, Akira A. Shishido· Journal of special operation...· 0 citations
Background Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infection endemic to Southeast Asia and northern Australia. Disseminated disease with bacteremia and multifocal organ involvement carries high mortality, particularly among patients with diabetes mellitus (DM) and hazardous alcohol use. Symmetrical peripheral gangrene (SPG) is a rare complication that may result in permanent disability. Case presentation A 57-year-old man with poorly controlled type 2 DM, chronic alcohol use, and malnutrition presented with septic shock and acute hypoxemic respiratory failure. Imaging revealed cavitary pneumonia and abscesses involving the liver, kidney, and prostate. Two independently collected blood cultures and a prostatic abscess aspirate yielded B. pseudomallei, confirmed through a multistep microbiological workflow with final VITEK 2 identification. The patient required vasopressors, mechanical ventilation, continuous venovenous hemofiltration, intravenous meropenem, and image-guided drainage of the prostatic abscess. Distal cyanosis was present at admission and progressed to dry gangrene of multiple fingers and toes. The symmetric acral distribution and absence of major-vessel obstruction were clinically consistent with SPG. Recurrent hyperkalemia and renal dysfunction prevented continued trimethoprim-sulfamethoxazole therapy, necessitating six months of doxycycline plus amoxicillin-clavulanate. Secondary infection and osteomyelitis of the gangrenous digits required multiple amputations. At follow-up 11 months after completion of eradication therapy, there was no evidence of recurrent melioidosis. Conclusion SPG is a rare but devastating complication of disseminated melioidosis. Prompt antimicrobial therapy, intensive organ support, source control, and early recognition of peripheral ischemia are important. Even after survival and successful treatment, substantial long-term functional disability may persist.
Chen-Hsuan Lin, Ping-Chang Lin, Ching-Yi Tsai et al.· Frontiers in Immunology· 0 citations
Emerging strains of hypervirulent
Klebsiella pneumoniae
are increasingly recognized to cause life-threatening, community-acquired infections in persons without significant immunocompromise. Beyond the association with pyogenic liver abscesses and bacteremia, additional sites of involvement include skin and soft tissue, bone, eyes, and the central nervous system. Individuals with diabetes mellitus and originating from the Asian Pacific Rim appear to be at higher risk for colonization and infection. Genetic testing for defining virulence factors was recently proposed as a standard for differentiating hypervirulent from classical
K. pneumoniae
strains.
Retrospective review of a
K. pneumoniae
infection in a middle-aged male.
The patient had untreated type 2 diabetes, hypertension, and obesity, and immigrated from a southeast Asian country to Canada over one decade prior. He presented with profound refractory septic shock leading to progressive multiorgan system failure. In totality, the infection involved necrotizing fasciitis of bilateral legs, bilateral emphysematous pyelonephritis, emphysematous cholecystitis, multifocal necrotizing pneumonia, and bacteremia notably without liver abscess.
K. pneumoniae
was later isolated from blood and sputum. Whole-genome sequencing identified
K. pneumoniae sensu stricto
with K1 capsule belonging to sequence type 23 and harbouring the characteristic virulence genes
iucA
,
iroB
,
peg-344
,
rmpA
, and
rmpA2
.
This case demonstrates a remarkable extent of dissemination and expands the known clinical spectrum for hypervirulent
K. pneumoniae
infection. Genetic testing has the potential to proactively identify hypervirulent strains and inform clinical management. Heightened clinical vigilance, development of accessible rapid diagnostic tools, and further research into treatment strategies are needed for this emerging pathogen.
Victor Mocanu, Q. Salehmohamed, Kelsey Wagner et al.· Journal of the Association o...· 0 citations
ABSTRACT. Melioidosis is an emerging tropical infectious disease with diverse clinical manifestations and a high fatality rate. We report a rare case of chronic melioidosis manifesting as pulmonary infection, empyema, and splenic abscess. The patient presented with recurrent chest pain, cough, and abdominal discomfort for 11 months, initially misdiagnosed as common bacterial infection. Computed tomography imaging revealed pulmonary infection, left pleural effusion, and multiple abnormal low-density lesions in and around the spleen. Pleural effusion culture identified Burkholderia pseudomallei. Management included thoracic puncture and catheter drainage, an intensive phase of intravenous ceftazidime, followed by an eradication phase with oral trimethoprim/sulfamethoxazole. The patient showed clinical and radiological improvements. Clinicians should consider chronic melioidosis in patients with pneumonia and parapneumonic pleural effusion accompanied by splenic abscesses, particularly in patients with diabetes mellitus from endemic areas. Early recognition, definitive diagnosis, and tailored antimicrobial therapy are essential to prevent the progression of severe pneumonia and sepsis.
Yamei Zheng, Xiaozhou Yao, Min Wang et al.· American Journal of Tropical...· 0 citations
Nocardiosis is an uncommon infection that presents as a chronic, debilitating illness with radiographic manifestations simulating lung cancer or tuberculosis. Immunocompromised hosts may develop a fulminant disease resembling acute bacterial pneumonia or disseminated disease. We report a case of a juvenile lupus who developed disseminated Nocardia pseudobrasilienisis infection in form of necrotizing pneumonia, subcutaneous nodules and central nervous system (CNS) lesion in the right parietal lobe, following inadvertent hiking of steroids after a minor organ flare. This case was successfully treated with intravenous meropenem, amikacin, and oral cotrimoxazole therapy for 6 weeks which lead to resolution of pneumonia, and partial resolution of of the cutaneous and CNS lesion. As the patient was immunosuppressed, and had disseminated nocardiosis, we planned to put her on oral cotrimoxazole for the next 1 year.
K. Bhowmick, Angan Karmakar, Dipendranath Ghosh et al.· Lupus· 0 citations
A 61-year-old male farmer from Itaiçaba, Ceará, Brazil, with type 2 diabetes mellitus, who presented with prolonged fever, abdominal pain, and weight loss is reported, highlighting an atypical disseminated presentation and reinforces clinical suspicion of melioidosis in diabetic patients with visceral abscesses in endemic regions.
O. A. Barbosa, José Walter Correia, André Luiz Coutinho Araújo Macêdo et al.· Journal of Health & Biol...· 0 citations