Pyrexia of Unknown Origin in a Young Male: Unmasking Melioidosis in a Tuberculosis-Endemic Setting.

A young male, plantation worker from Southeast Asia, presented with a non-productive cough, intermittent high-grade fever with chills, and significant weight loss over two months. Prior investigations were non-contributory, despite various antibiotics, his symptoms persisted. Physical examination and routine investigations, including an extensive microbiological workup for fever were non-contributory. A positron emission tomography-computed tomography (PET-CT) scan performed for pyrexia of unknown origin (PUO) revealed pulmonary consolidation, mediastinal lymphadenopathy, and splenic microabscesses. Material aspirated via endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) from the left interlobar lymph node was positive for Burkholderia pseudomallei on conventional nested polymerase chain reaction (PCR), confirming a diagnosis of melioidosis. Following appropriate antibiotic therapy, there was a complete resolution of symptoms. This case underscores the diagnostic challenges and the need for advanced techniques in identifying melioidosis, which can mimic tuberculosis.

A Rare Case of Melioidosis in the Bronx.

Melioidosis is caused by a gram-negative bacillus Burkholderia pseudomallei (B. pseudomallei), which is found in water and soil in endemic areas. There are indicators that B. pseudomallei is increasing in endemic regions and expanding into new locations. It is unclear whether this is because of expanded boundaries or improved detection capabilities. It is even theorized to be endemic in certain parts of the USA. The most common medical risk factor is diabetes mellitus, and it frequently presents as acute pneumonia, and often progresses to bacteremia. It is designated as a tier 1 select biological agent and toxin by the CDC. In this case report, we present a 67-year-old male with multiple comorbidities, who contracted melioidosis while visiting Honduras, as well as the laboratory's response to the occupational exposure.

Systemic Melioidosis Presenting as Septic Arthritis.

Melioidosis is a pyogenic infection that is potentially fatal, caused by the bacterium Burkholderia pseudomallei, which is commonly a soilborne pathogen.It is endemic in the Indian subcontinent, northern Australia, and Southeast Asia. Melioidosis has a wide spectrum of clinical manifestations that can mimic various diseases. Septic arthritis is a rare but well-known clinical presentation. Here, we report a case of an adult presenting with acute knee joint pain and swelling. He was subsequently found to have septic arthritis with other system involvement and diagnosed as a case of melioidosis; he responded well to the treatment.