TL;DR
This case series aimed to increase physicians' awareness of melioidosis in high-risk patients presenting with diverse clinical symptoms, thereby improving diagnostic accuracy and ensuring timely and appropriate treatment.
This case underlines the importance of considering brucellosis in febrile patients with livestock exposure, even in non-endemic settings, and presents a rare and severe respiratory form of brucellosis in a patient with occupational exposure to livestock.
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.
Clinicians should maintain a high index of suspicion in patients presenting with severe pneumonia or sepsis, particularly during the rainy season and among individuals with diabetes mellitus or chronic liver disease, and strengthening conventional microbiological capacity remains essential for improving diagnosis and patient outcomes in geographically isolated settings.
The importance of recognizing histoplasmosis in high-risk populations and the need for integrated care approaches is emphasized and increased awareness, early clinical suspicion, and access to appropriate diagnostics are essential to improve outcomes.
Disseminated histoplasmosis should be considered in patients with prolonged unexplained fever, even in the absence of apparent immunodeficiency, and in selected cases, may help avoid invasive procedures such as bone marrow examination.
The presence of thrombocytopenia, high CRP and ESR levels, and high BC/CW titers was a diagnostic indicator of complicated brucellosis.