Melioidosis Acquired by Traveler to Thailand: A Case Report

Abstract

Background: Burkhalter pseudomallei (B. pseudomallei) is a gram-negative, saprophytic bacillus found in soil and water, and it is endemic in the tropical and subtropical areas. Melioidosis is a rare infection caused by B. pseudomallei, and it occurs only sporadically in travellers returning from disease-endemic areas. Severe clinical disease is seen mostly in patients with alteration of immune status, especially related to diabetes. To our best knowledge, this is the first reported case of melioidosis in a traveller complicated by diabetes in Chongqing, China. Case presentation: A 55-year-old man with diabetes presented with erosions and ulcers on right leg with purulent discharge and painful sensation for a one-month history. On presentation she had high fever and urinary tract infection, then developed pneumonia, soon after his return from Thailand to China. Cultures from different specimens including blood cultures and urine cultures turned out positive, and then the organisms were finally identified as B. pseudomallei, thus the patient’s treatment was switched to intravenous meropenem. Subsequently, the patient’s urinary tract infection and fever resolved, and after 15 days of receiving meropenem, his general condition improved. Conclusions: Given the frequency of travel between China and other countries, the existence of imported cases from endemic countries until now is striking, and physicians should be aware of its varied manifestations. In particular, melioidosis should be considered when diabetic patients returning from endemic countries, even without risk factors predisposing to severe disease.