Multi-systemic melioidosis

Abstract

This editorial is a commentary on the article by Ni et al, which was published in the World Journal of Clinical Cases. The article discusses the diagnostic and therapeutic challenges of melioidosis caused by Burkholderia pseudomallei. The case study highlights a rare instance of multisystemic melioidosis in a female patient who did not have a travel history, emphasizing the significance of recognizing this condition in non-endemic regions. Diagnostic complexities and therapeutic strategies are addressed, emphasizing the need for heightened clinical suspicion, comprehensive evaluation, and multidisciplinary collaboration. The editorial delves into the clinical presentation, diagnostic dilemmas, therapeutic approaches, and their implications for patient care in managing multi-systemic melioidosis.

Key Words: Melioidosis; Burkholderia pseudomallei; Multi-systemic; Diagnosis; Treatment

Core Tip: Multi-systemic melioidosis poses diagnostic challenges, especially in non-endemic regions, necessitating a comprehensive approach involving clinical vigilance, microbiological confirmation, imaging, and tailored antibiotic therapy. Timely recognition and multidisciplinary management are essential for optimizing outcomes in affected patients.

INTRODUCTION

Melioidosis, caused by Burkholderia pseudomallei (B. pseudomallei), is a life-threatening infectious disease endemic to Southeast Asia and Northern Australia. However, sporadic cases have been reported in regions outside these endemic areas, posing diagnostic challenges to healthcare providers[1]. Ni et al[2] describe a remarkable case of multi-systemic melioidosis in a female patient without a travel history, highlighting the importance of considering this condition even in non-endemic regions.

EPIDEMIOLOGY

Melioidosis, primarily endemic in Southeast Asia and Northern Australia, has been increasingly recognized in non-endemic areas, including India[3]. The global distribution of B. pseudomallei extends beyond previous estimates owing to factors such as climate change, travel, and migration, necessitating vigilance among healthcare providers worldwide[3].

Pathophysiology

B. pseudomallei, a Gram-negative bacterium found in soil and water, typically infects humans by percutaneous inoculation, inhalation, or ingestion. Diabetes mellitus is a significant risk factor[4,5]. The bacterium's ability to evade host immune responses and form biofilms contributes to the severity and chronicity of melioidosis[6].

Clinical presentation

The patient in this case presented with fever, skin manifestations, genitourinary symptoms, and neurological abnormalities, illustrating the diverse clinical spectrum of melioidosis. Cutaneous, genitourinary, and neurological involvement highlight the complexity of the disease presentation[7].

Diagnostic dilemmas

Diagnosing melioidosis is challenging, especially in non-endemic areas with limited awareness[8]. Clinical suspicion is crucial, particularly in patients with predisposing factors such as diabetes and recent steroid use[9]. Microbiological confirmation by B. pseudomallei isolation remains the gold standard, but it is fraught with challenges, including misidentification and contamination[10].

Therapeutic strategies

The treatment of melioidosis involves a multidisciplinary approach, including tailored antimicrobial therapy, and when indicated, surgical intervention[11,12]. Prolonged antibiotic therapy, typically with ceftazidime or meropenem followed by oral eradication therapy, is recommended[9]. However, treatment regimens should be adapted based on clinical response and susceptibility testing[13].

Clinical implications

This case underscores the importance of heightened clinical suspicion, comprehensive evaluation, and multidisciplinary collaboration in managing multisystemic melioidosis[14]. Healthcare providers must be vigilant in recognizing the diverse clinical manifestations of melioidosis and navigating diagnostic challenges[15]. Timely diagnosis and appropriate management are crucial for optimizing outcomes and preventing complications[16].

EDITORIAL COMMENTS

The case presented by Ni et al[2] highlights the evolving epidemiology of melioidosis and the challenges it poses worldwide. The occurrence of multisystemic melioidosis in a patient without a travel history in a non-endemic area underscores the need for heightened clinical suspicion and comprehensive diagnostic evaluation. This case serves as a reminder of the importance of considering melioidosis in the differential diagnosis of febrile illnesses, even in regions where the disease is not endemic.

CONCLUSION

Multisystemic melioidosis presents diagnostic and therapeutic challenges, especially in non-endemic areas[17]. Heightened clinical suspicion, comprehensive evaluation, and multidisciplinary management are paramount in optimizing outcomes for affected patients[18]. Through sharing clinical experiences and disseminating knowledge, we aim to enhance understanding and improve patient care in managing this elusive infectious disease.