Melioidosis as a rare cause of deep surgical site infection in a Filipino patient with Metastatic Spinal Disease: A case report

Background@#Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei. Over a century after its discovery, there seems to be a paucity of reported cases in the Philippines relative to other countries where it is found to be endemic. This suggests that the true burden of melioidosis in the country is not well-defined. The rarity of the disease, its protean clinical manifestations, and the lack of pathognomonic features pose a great diagnostic challenge. Furthermore, the proper recognition of the organism is an extreme necessity as it is intrinsically resistant to numerous antibiotics and requires specific long-term treatment.@*Case@#This is a case of a 49-year-old Filipino diagnosed with a metastatic spinal disease from a primary thyroid carcinoma and underwent posterior spinal decompression and stabilization. Revision of instrumentation was done following identification of an implant loosening. During the interim, wound dehiscence and infection developed. The patient was readmitted and underwent debridement of the lumbosacral spine. Wound cultures all yielded growth of Burkholderia pseudomallei. The patient received meropenem and then trimethoprim-sulfamethoxazole with ciprofloxacin during the intensive and eradication phase, respectively. Erythrocyte sedimentation rate and C-reactive protein were monitored and a significant reduction in both values reflected a good therapeutic response.@*Conclusion@#This is a rare case of a deep surgical site infection caused by Burkholderia pseudomallei. It is known that melioidosis is a potentially fatal infection but is under-reported in the Philippines. At present, further epidemiological studies along with an increased level of awareness of melioidosis are greatly needed to help define the true burden of illness and optimize patient management following prompt recognition.

Partial characterization of bacteriocin-like compound (BLIS) produced by Burkholderia stagnalis strain K23/3 against Burkholderia pseudomallei

Aims@#Burkholderia pseudomallei, the human pathogen that causes melioidosis, is intrinsically resistant towards a wide range of antibiotics and there have been reports of acquired resistance towards antibiotics used for melioidosis treatments. Antimicrobial peptides (AMP) such as bacteriocins are gaining the interests of researchers as alternative for treating infections caused by multidrug resistant bacteria. In this study, we aimed to identify Burkholderia spp. isolated from soil in Sarawak that possess the potential in inhibiting the growth of B. pseudomallei and to further characterize the antagonistic compound produced.@*Methodology and results@#A total of 50 Burkholderia spp. isolates of environmental origin and two isolates of Ralstonia solanacearum were screened against five clinical isolates of B. pseudomallei using spot-on-lawn assay and flip streak method. Burkholderia stagnalis isolate K23/3 showed clear zones of inhibition (ZOI) in both preliminary tests. Cell-free supernatant (CFS) was obtained from B. stagnalis K23/3 broth culture and was tested via agar well diffusion assay (AWDA). The antagonistic compound secreted at the early log phase of the bacterial growth was shown to be stable in a wide range of temperatures and pH. Treatment with different enzymes revealed that it was sensitive towards proteinase K, suggesting that it is proteinaceous. The bacteriocin-like-substance (BLIS) was subjected to ammonium sulfate precipitation and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). The SDS-PAGE gel was overlaid with indicator B. pseudomallei isolates where the active protein was shown to be less than 7.1 kDa.@*Conclusion, significance and impact of study@#Burkholderia stagnalis isolate K23/3 was able to secrete bacteriocin-like-substance (BLIS) that has the potential in biocontrol of B. pseudomallei in the environment or as potential treatment for melioidosis.

Melioidosis en Colombia, descripción de un caso clínico y consideraciones epidemiológicas / Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Resumen La melioidosis es una enfermedad infecciosa causada por Burkholderia pseudomallei cuyo diagnóstico clínico puede ser difícil debido a su variada presentación clínica y a las dificultades del diagnóstico microbiológico, por lo cual pueden requerirse técnicas moleculares para su adecuada identificación una vez se sospecha su presencia. Son pocos los antibióticos disponibles para el tratamiento de esta enfermedad y, además, deben usarse durante un tiempo prolongado. Aunque se conoce por ser endémica en Tailandia, Malasia, Singapur, Vietnam y Australia, en Colombia se han reportado algunos pocos casos. Se presenta un caso de melioidosis en la región norte de Colombia, se hace una revisión de las características clínicas y el tratamiento, y se describe la epidemiología local de esta enfermedad.

Abstract Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Liver Abscess Harbors Melioidosis: A case report on this rare finding in a potentially endemic community

Introduction@#Melioidosis among Filipinos may be underreported. The causative agent, Burkholderia pseudomallei, thrives in soil and water in tropical regions. Because our country thrives on agriculture as a source of livelihood, occupational exposure through farming needs to be recognized. @*Case Presentation@#We report a case of a 40-year-old male complaining of intermittent fever, progressive weight loss and jaundice for three weeks prompting consult. Whole abdominal ultrasound showed presence of a hepatic mass. Further evaluation using CT scan of the whole abdomen with contrast revealed multiple cystic hepatic nodules with wall/septal enhancement. He was admitted and was initially managed as sepsis secondary to a complicated intra-abdominal infection (liver abscess, pyogenic or amebic). Ciprofloxacin and metronidazole were started. Aspiration of the hepatic abscess showed many pus cells. Culture of the aspirate grew Burkholderia pseudomallei, sensitive to ceftazidime. Antibiotics were shifted accordingly. Defervescence ensued. Patient was discharged improved after two weeks of ceftazidime wo grams every eight hours given intravenously followed by a three-month oral course of cotrimoxazole 160mg/800mg tablet, two tablets every 12 hours and doxycycline 150mg capsule every 12 hours. On follow-up after three months, he had no recurrence of symptoms and was able to resume his usual work.@*Discussion@#Melioidosis is a disease of humans and animals that is geographically restricted to tropical countries since the organism thrives in soil and water. Symptom onset may be delayed due to the ability of the organism to produce latent infection. Isolation of B. pseudomallei from clinical specimens sent for culture and sensitivity testing is the diagnostic gold standard.@*Conclusion@#Melioidosis may present as an intraabdominal infection. A high clinical index of suspicion among those with occupational exposure to contaminated soil and water is important to promptly recognize and treat this infection.

Imported case of melioidosis in Oman: case report

Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei. It is most commonly described in Southeast Asia and Northern Australia and some imported cases in non-endemic areas. We describe the case of a 55-year-old Omani man with fulminant sepsis who worked in Laos, Cambodia. B. pseudomallei was isolated from the patient's blood and was identified by means of microbiological and biochemical tests. We highlight the importance of careful attention to non-fermentative gram-negative rods in a septic patients who have worked or travelled to Southeast Asia

Clinical Outcomes in Musculoskeletal Involvement of Burkholderia Pseudomallei Infection

BACKGROUND: Musculoskeletal involvement in melioidosis is often seen in conjunction with a disseminated illness. Recent reports suggest that operative management of musculoskeletal melioidosis has favourable results. The purpose of this study was to review the patient profile and clinical outcomes of Burkholderia pseudomallei infection in the musculoskeletal system. METHODS: Hospital records of 163 patients who were diagnosed to have B. pseudomallei infection between January 2009 and December 2014 were reviewed. Patients underwent surgical and nonsurgical management depending upon the tissue of involvement. Epidata software was used to record the data. The SPSS ver. 17.0 was used for analysis. RESULTS: Eighteen out of 24 patients who had musculoskeletal melioidosis were available for follow-up. Septic arthritis, osteomyelitis, and intramuscular abscess were the common diagnosis, with 6 patients in each group. Twelve patients required surgical intervention. All patients received a full course of parenteral ceftazidime followed by oral doxycycline and co-trimoxazole. Two out of 6 patients (33.3%) died among those who had nonsurgical management as compared to none in the group who had surgical management. This was significant at 10% level of significance (p = 0.098). The rest were followed up for a minimum of 1 year with no evidence of disease recurrence. CONCLUSIONS: This series describing musculoskeletal involvement in melioidosis is the largest such study from a recently recognized ‘endemic’ region. Of importance are the patterns of musculoskeletal involvement, pitfalls in diagnosis and adequate clinical response with timely diagnosis and appropriate surgical management.

Efeito inibitório in vitro do composto farnesol frente ao biofilme de Burkholderia pseudomallei

A intrínseca resistência apresentada pela bactéria Burkholderia pseudomallei é um grave empecilho para o tratamento da melioidose. Muitas pesquisas focam na busca de adjuvantes que aumentem a sensibilidade desta bactéria aos antimicrobianos. Nesse contexto, a açãoinibitória do farnesol frente às cepas de B. pseudomallei, na forma planctônica, já foi relatadaem estudo prévio. Diante disso, esse estudo objetivou analisar a atividade in vitro do farnesol contra cepas de B. pseudomallei na forma de biofilme. Aliado à análise da ação do farnesolisoladamente, foi investigada a combinação desse composto com os antimicrobianosamoxicilina, ceftazidima, doxiciclina, imipenem e sulfametoxazol/trimetoprim frente a obiofilme. A sensibilidade foi avaliada por meio do teste de microdiluição em caldo e a leiturada viabilidade celular feita com a resazurina. A concentração inibitória mínima em biofilme(CEMB) para o farnesol foi de 75 a 2400 mM. Ademais, o farnesol reduziu em até 256, 16, 4e 4 vezes os valores de CEMB para ceftazidima, amoxicilina, doxiciclina esulfametoxazol/trimetoprim, respectivamente (P<0.05). Por meio de técnicas de microscopia,tais como óptica, confocal e eletrônica, observou-se que o farnesol foi capaz de causar danosna matriz do biofilme, facilitando assim, a penetração dos antibióticos. Deste modo, opresente estudo mostrou a eficácia do farnesol contra biofilmes de B. pseudomallei e seuefeito potenciador, em especial com ceftazidima, amoxicilina, doxiciclina esulfametoxazol/trimetoprim.

The intrinsic antimicrobial resistance of Burkholderia pseudomallei is a serious challenge tothe treatment of melioidosis. Many studies have searched for adjuvants that increasesusceptibility bacteria to antimicrobials. In this context, the antimicrobial activity of farnesolagainst B. pseudomallei in planktonic growth has been reported. Thus, the aim of this studywas to analyze the in vitro activity of farnesol alone against Burkholderia pseudomalleibiofilms, as well as its combination with the antibacterials amoxicillin, doxycycline,ceftazidime and sulfamethoxazole-trimethoprim. Susceptibility was assessed by the brothmicrodilution test and cell viability was read with the oxidation-reduction indicator dyeresazurin. The interaction between farnesol and antibacterial drugs against B. pseudomalleibiofilms was evaluated through the calculation of the fractional inhibitory concentrationindex. The minimum biofilm erradication concentration (MBEC) for farnesol was 75 to 2400mM. In addition, farnesol significantly reduced the MBEC values for ceftazidime,amoxicillin, doxycycline and sulfamethoxazole-trimethoprim by 256, 16, 4 and 4 timesrespectively (P<0.05). Optical, confocal and electronic microscopic analyses of farnesoltreatedB. pseudomallei biofilms demonstrated that this compound damages biofilm matrix,facilitating antimicrobial penetration in the biofilm structure. This study demonstrated theeffectiveness of farnesol against B. pseudomallei biofilms and its potentiating effect on theactivity of antibacterial drugs, in particular ceftazidime, amoxicillin, doxycycline andsulfamethoxazole-trimethoprim.

Pediatric suppurative parotitis caused by Burkholderia pseudomallei

Background: Suppurative parotitis caused by Burkholderia pseudomallei has been rarely found outside endemic areas. Case presentation: Herein, we report the recovery of Burkholderia pseudomallei from the pus of a suppurative parotitis observed in a 12-year-old boy who lived in Hainan province, China. Specimens of necrotic tissue were collected and sections were stained with hematoxylin and eosin. Pus sample was also collected for bacteriological examination. The suppurative inflammation was observed in the necrotic tissue section and Burkholderia pseudomallei were detected in the sample. Conclusion: In this adolescent, Burkholderia pseudomallei infection was present in the parotid, which consists of the first report of this bacterium in a parotitis case acquired in China.(AU)

Melioidosis parotitis in children

A recent paper published in JVATiTD reporting a child in Hainan with parotitis caused by Burkholderia pseudomallei misleadingly described parotitis as a rare manifestation of melioidosis. In fact, it is one of the commonest forms of paediatric melioidosis seen in other parts of Southeast Asia, although interestingly not in Australia.(AU)

Melioidosis parotitis in children

A recent paper published in JVATiTD reporting a child in Hainan with parotitis caused by Burkholderia pseudomallei misleadingly described parotitis as a rare manifestation of melioidosis. In fact, it is one of the commonest forms of paediatric melioidosis seen in other parts of Southeast Asia, although interestingly not in Australia.

Pediatric suppurative parotitis caused by Burkholderia pseudomallei

Suppurative parotitis caused by Burkholderia pseudomallei has been rarely found outside endemic areas. Case presentation: Herein, we report the recovery of Burkholderia pseudomallei from the pus of a suppurative parotitis observed in a 12-year-old boy who lived in Hainan province, China. Specimens of necrotic tissue were collected and sections were stained with hematoxylin and eosin. Pus sample was also collected for bacteriological examination. The suppurative inflammation was observed in the necrotic tissue section and Burkholderia pseudomallei were detected in the sample. Conclusion: In this adolescent, Burkholderia pseudomallei infection was present in the parotid, which consists of the first report of this bacterium in a parotitis case acquired in China.

Non-Caseating Granulomatous Infective Spondylitis: Melioidotic Spondylitis

STUDY DESIGN: Retrospective clinical analysis. PURPOSE: To delineate the clinical presentation of melioidosis in the spine and to create awareness among healthcare professionals, particularly spine surgeons, regarding the diagnosis and treatment of melioidotic spondylitis. OVERVIEW OF LITERATURE: Melioidosis is an emerging disease, particularly in developing countries, associated with a high mortality rate. Its causative pathogen, Burkholderia pseudomallei, has been labeled as a bio-terrorism agent. METHODS: We performed a retrospective analysis of patients who were culture positive for B. pseudomallei. Assessment of patients was performed using clinical, radiological, and blood parameters. Clinical measures included pain, neurological deficit, and return to work. Radiological measures included plain radiography of the spine and magnetic resonance imaging. Blood tests included erythrocyte sedimentation rate and C-reactive protein levels. RESULTS: Four patients having melioidosis with spondylitis were evaluated. All of them had diabetes mellitus; three had multiple abscesses which required incision and drainage. Their clinical spectrum was similar to that of tuberculous spondylitis; all had back pain and radiology revealed infective spondylodiscitis with prevertebral and paravertebral collections with psoas abscess. Three patients underwent ultrasound-guided drainage of the psoas abscess and one had aspiration of the subcutaneous abscess. Bacteriological cultures showed presence of B. pseudomallei, and histopathology showed non-caseating granulomatous inflammation. All patients were treated with intravenous Ceftazidime for 2 weeks, followed by oral bactrim double strength and Doxycycline for 20 weeks. All patients improved with treatment and were healed at follow up. CONCLUSIONS: Melioidosis presents with a clinical spectrum similar to that of tuberculosis. A diagnosis of melioidotic spondylitis should be considered, particularly in patients with diabetes with neutrophilic leukocytosis and clinical-radiological features suggestive of infective spondylodiscitis. Bacteriological culture and histopathology helps in differentiating the two conditions. Health education for healthcare professionals is important for correctly diagnosing this disease.

Development and systematical evaluation of an up-converting phosphor technology based lateral flow assay for quantitative detection of Burkholderia pseudomallei / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop an up-converting phosphor technology-based lateral-flow (UPT-LF) assay for rapid quantitative detection of Burkholderia pseudomallei on site.</p><p><b>METHODS</b>The strip Bps-UPT-LF strip was prepared with up-converting phosphor (UCP) particles as the bio-label using double-antibody sandwich method. Detection performance, including sensitivity, quantitative accuracy, precision, and specificity, were first evaluated using bacterial suspensions of Burkholderia pseudomallei, the related species and the strains which had similar routes of transmission with serial standard concentrations diluted by phosphate buffer, then biological and chemical reagents and simulated samples with series concentrations were employed for sample tolerance evaluation, while the operation error during on site detection was also evaluated through adjusting liquid measure.</p><p><b>RESULTS</b>The whole detection was accomplished within 20 minutes, and the sensitivity was 10(4) CFU/ml with linear quantitative range from 10(4) CFU/ml to 10(7) CFU/ml, which covered four orders of magnitude. Bps-UPT-LF strip demonstrated high specificity with the absence of any false-positive result even at 10(7) and 10(8) CFU/ml of non-specific bacterial contamination. Not only Bps-UPT-LF strip could tolerate to high concentration of the extreme acid and basic matter (pH 1-12), saline matter (≤ 2 mol/L mixture of NaCl and KCl), viscous materials (≤ 50 g/L of PEG 20000 and ≤ 20% of glycerol) and bio-macromolecule (≥ 400 g/L of bovine serum albumin or ≥ 80 g/L of casein), but also it can directly detect animal, environmental and powder specimen, such as ≥ 400 g/L of milk powder, flour powder, fruit juice, fresh and decomposed viscera, and ≤ 200 g/L of putty powder, sucrose, gourmet powder, and soil. Operation errors of liquid measure had few effects on sensitivity and specificity, including -50%-200% of sample, -22%-44% of sample-treating buffer and -30%-30% of loading mixture.</p><p><b>CONCLUSION</b>The good detection performance and tolerance performance bring the bright future for Bps-UPT-LF strip to detect Burkholderia pseudomallei on site rapidly and quantitatively for nature foci surveillance and anti-bioterrorism.</p>

A Case of Ceftazidime-Nonsusceptible Burkholderia pseudomallei Infection

Melioidosis, which is an infectious disease caused by Burkholderia pseudomallei, is prevalent mostly in Southeast Asia and northern Australia; it can progress to abscess formation, pneumonia and sepsis, and ultimately cause death. A 66-yr-old male patient with diabetes mellitus was hospitalized for sepsis 3 months after coming back from Cambodia, and B. pseudomallei was identified from the blood culture. The B. pseudomallei strain was found to be susceptible to carbapenem, and non-susceptible to trimethoprim/sulfamethoxazole and ceftazidime. Although the patient was treated with carbapenem, to which the strain was susceptible, the bacteremia persisted, and progressed to septic shock and pneumonia, and eventually to acute respiratory distress syndrome (ARDS). The patient died on the 12th day of hospitalization. This study, which reports the first case of ceftazidime-nonsusceptible B. pseudomallei in Korea, indicates the importance of B. pseudomallei infection, which is highly likely to be imported to Korea, and discuss its clinical progress, which can lead to fatality.

Colonization or spontaneous resolution: expanding the role for Burkholderia pseudomallei

A 19-year-old Asian Indian female presented with productive cough since the past one month and low grade fever since the past two weeks. She was diagnosed with pulmonary tuberculosis and treated with antitubercular drugs. Subsequently, delayed cultures of bronchoalveolar lavage fluid grew Burkholderia pseudomallei (B. pseudomallei). On follow up the patient reported significant subjective improvement and ESR progressively returned to normal. In summary, this case report raises two distinct and equally intriguing roles for B. pseudomallei, i.e. respiratory colonization and spontaneously resolving pulmonary infection. The pathogenic potential of B. pseudomallei, the etiologic agent of melioidosis, is well known. Confirmation of either colonization or spontaneous resolution, would potentially spare many patients unnecessary and expensive therapy with broad-spectrum antibiotics, and contribute to more rational usage of antibiotics, especially in co-infection with Mycobacterium tuberculosis and B. pseudomallei-two bacterial diseases with closely similar clinical, radiologic and histopathologic features.

Tos y disnea de seis años de evolución en un adulto joven con melioidosis pulmonar crónica. Reporte de caso / Cough and dyspnea during six years in a young adult with chronic pulmonary melioidosis: Case report

Resumen: La melioidosis es una enfermedad infecciosa causada por una bacteria gram-negativa intracelularBurkholderia pseudomallei. Este microorganismo es un saprofito ambiental en regiones endémicas,algunas de ellas ubicadas probablemente en el territorio nacional y presenta alto riesgo de propagación como epidemia en zonas no endémicas. La melioidosis es una enfermedad clínicamente diversa, la mayoría de las infecciones son asintomáticas; sin embargo, si el paciente es sintomático, se puede clasificar como aguda o crónica según su persistencia. La presentación clínica más común es la afectación pulmonar y al diagnóstico predominan baciloscopias persistentemente negativas. Aquí se presenta un caso de un paciente con tos crónica, expectoración mucopurulenta, sudoración nocturna y disnea.

Abstract: Melioidosis is an infectious disease caused by the intracellular gram-negative bacterium Burkholderia pseudomallei. This microorganism is an environmental saprophyte in endemic regions, some of which are likely located in our country and have a high risk of spreading to non-endemic areas. Melioidosis is a clinically diverse disease. Most infections are asymptomatic; however, if symptoms are present, the disease can be classified as acute or chronic according to persistence of symptoms. In addition, lung involvement is the most common clinical presentation and one of the main diagnostic features is consistently negative bacilloscopy. Here we present a case report of a patient with chronic cough, mucopurulent expectoration, night sweats and dyspnea.

Burkholderia pseudomallei infection in a healthy adult from a rural area of South India.

Melioidosis is an emerging disease producing protean manifestations, and is more common in alcoholics and diabetics. The disease can be a trivial localized lesion or a fatal septicemia. Early diagnosis and appropriate antimicrobial treatment greatly reduces the mortality rate. We report a case of localized form of the disease in an elderly male with no known predisposing medical disease who responded well to oral amoxycillin-clavulanic acid and cotrimoxazole treatment.

Severe coinfection of melioidosis and dengue fever in northeastern Brazil: first case report / Coinfecção grave de melioidose e dengue no nordeste do Brasil: primeiro caso

This report focuses on a fatality involving severe dengue fever and melioidosis in a 28-year-old truck driver residing in Pacoti in northeastern Brazil. He exhibited long-term respiratory symptoms (48 days) and went through a wide-ranging clinical investigation at three hospitals, after initial clinical diagnoses of pneumonia, visceral leishmaniasis, tuberculosis, and fungal sepsis. After death, Burkholderia pseudomallei was isolated in a culture of ascitic fluid. Dengue virus type 1 was detected by polymerase chain reaction in cerebrospinal fluid (CSF); this infection was the cause of death. This description reinforces the need to consider melioidosis among the reported differential diagnoses of community-acquired infections where both melioidosis and dengue fever are endemic.

Estudo de caso fatal de coinfecção de melioidose e dengue grave em um motorista de 28 anos, residente no município de Pacoti, nordeste do Brasil. O paciente apresentou inicialmente sintomas respiratórios com evolução por 48 dias. Foi internado em três diferentes unidades de saúde com suspeitas de pneumonia, leishmaniose visceral, tuberculose e sepse fúngica. Após o óbito, a cultura de líquido ascítico identificou a bactéria Burkholderia pseudomallei. O vírus da dengue tipo 1 foi detectado por PCR no líquor do paciente. Esta descrição reforça a necessidade de considerar a melioidose entre os diagnósticos diferenciais de infecções comunitárias onde as duas doenças são endêmicas.

Ceftazidime resistance in Burkholderia pseudomallei: first report from India

Melioidosis, a disease of public health importance in Southeast Asia and Northern Australia, of late has shown an increasing trend in India, particularly Southern India. We describe a case of a 39-year-old diabetic patient with left elbow septic arthritis, multiple liver, splenic abscesses, pneumonia, pleural effusion, followed by sepsis syndrome. Blood cultures and culture of the joint aspirate yielded pure growth of Burkholderia pseudomallei (B. pesudomallei), sensitive to carbapenem, co-trimoxazole and resistant to ceftazidime. The patient was successfully treated with imipenem- cilastin. He was discharged on co-trimoxazole to complete the 24 weeks course and follow-up has continued to date. The patient continues to remain asymptomatic. The case re-emphasizes the need to monitor the trend of B. pseudomallei in India, particularly the development of ceftazidime resistance, which incidentally is the drug of choice.

Septicemic Melioidosis Presenting as Head and Neck Abscesses

Melioidosis is a life-threatening disease caused by Burkholderia pseudomallei , which is endemic in Southeast Asia and Northern Australia. It may manifest as a pulmonary lesion, osteomyelitis, septicemia, or abscesses of soft tissue or various organs. However, soft tissue abscess associated with bacteremia, especially those found in the head and neck, are rarely reported. We report a case of disseminated septicemia due to Burkholderia pseudomallei presenting as head and neck abscesses in a 55-year-old Korean man with a history of working in Malaysia. This is the first report of fatal melioidosis presenting as a complicated skin and soft tissue infection, in Korea.