We report chronic pulmonary melioidosis in a 69-year-old diabetic farmer in Suriname, initially misidentified as Burkholderiacepacia complex infection by MALDI-TOF mass spectrometry. Standard commercial databases lack Burkholderia pseudomallei spectra due to biosafety restrictions and limited endemicity in database development regions. The patient presented with hemoptysis and a cavitating upper-lobe consolidation mimicking tuberculosis. Clinical suspicion based on occupation, radiological findings, and known presence of Burkholderiathailandensis (a less virulent species within the B. pseudomallei complex) in Surinamese soil led to empiric melioidosis treatment, with dramatic response. This case highlights critical gaps in diagnostic capabilities for melioidosis in emerging endemic regions and underscores the need for increased clinical awareness as climate change potentially expands the geographic distribution of B. pseudomallei.
References
[1]
Sousa, S.A., Ramos, C.G. and Leitão, J.H. (2011) Burkholderiacepacian Complex: Emerging Multihost Pathogens Equipped with a Wide Range of Virulence Factors and Determinants. International Journal of Microbiology, 2011, 1-9. https://doi.org/10.1155/2011/607575
[2]
LiPuma, J.J. (2005) Update on the Burkholderiacepacia Complex. Current Opinion in Pulmonary Medicine, 11, 528-533. https://doi.org/10.1097/01.mcp.0000181475.85187.ed
[3]
Ledson, M.J., Gallagher, M.J. and Walshaw, M.J. (1998) Chronic Burkholderiacepacia Bronchiectasis in a Non-Cystic Fibrosis Individual. Thorax, 53, 430-432.
[4]
Jones, A.M., Dodd, M.E. and Webb, A.K. (2001) Burkholderiacepacia: Current Clinical Issues, Environmental Controversies and Ethical Dilemmas. European Respiratory Journal, 17, 295-301.
[5]
Bruns, A.H.W., Oosterheert, J.J., El Moussaoui, R., Opmeer, B.C., Hoepelman, A.I.M. and Prins, J.M. (2009) Pneumonia Recovery; Discrepancies in Perspectives of the Radiologist, Physician and Patient. Journal of General Internal Medicine, 25, 203-206. https://doi.org/10.1007/s11606-009-1182-7
[6]
Agarwal, A., Samota, R., Agarwal, A., Shrivastava, U. and Godara, S. (2023) Acute, Chronic, and Latent Infection with (Re)Activation Melioidosis. European Journal of Clinical Medicine, 4, 15-21. https://doi.org/10.24018/clinicmed.2023.4.5.316
[7]
Karunanayake, P. (2022) Melioidosis: Clinical Aspects. Journal of the Royal College of Physicians of London, 22, 6-8.
[8]
Alsaif, H. and Venkatesh, S. (2016) Melioidosis: Spectrum of Radiological Manifestations. Saudi Journal of Medicine and Medical Sciences, 4, Article 74. https://doi.org/10.4103/1658-631x.178286
[9]
Lim, K.S. and Chong, V.H. (2010) Radiological Manifestations of Melioidosis. Clinical Radiology, 65, 66-72. https://doi.org/10.1016/j.crad.2009.08.008
[10]
Campbell, S., Taylor, B., Menouhos, D., Hennessy, J., Mayo, M., Baird, R., et al. (2024) Performance of MALDI-TOF MS, Real-Time PCR, Antigen Detection, and Automated Biochemical Testing for the Identification of Burkholderia pseudomallei. Journal of Clinical Microbiology, 62, 1-10. https://doi.org/10.1128/jcm.00961-24
[11]
Watthanaworawit, W., Roberts, T., Hopkins, J., Gassiep, I., Norton, R., Robinson, M.T., et al. (2021) A Multi-Country Study Using MALDI-TOF Mass Spectrometry for Rapid Identification of Burkholderia Pseudomallei. BMC Microbiology, 21, Article No. 213. https://doi.org/10.1186/s12866-021-02276-1
[12]
Nithimongkolchai, N., Hinwan, Y., Kaewseekhao, B., Chareonsudjai, P., Reungsang, P., Kraiklang, R., et al. (2023) MALDI-TOF MS Analysis of Burkholderia pseudomallei and Closely Related Species Isolated from Soils and Water in Khon Kaen, Thailand. Infection, Genetics and Evolution, 116, Article 105532. https://doi.org/10.1016/j.meegid.2023.105532 https://www.sciencedirect.com/science/article/pii/S1567134823001302
[13]
Mandal, A., et al. (2015) Cystic Fibrosis in India: Past, Present and Future. Pulmonary Medicine & Respiratory Research, 1, 1-8. https://doi.org/10.24966/pmrr-0177/100002
[14]
Abbas, U., Kumar, H., Hussain, N., Ahmed, I., Laghari, R.N., Tanveer, M., et al. (2025) Immune Dysregulation in Type 2 Diabetes Mellitus: Implications for Tuberculosis, COVID-19, and HIV/AIDS. Infectious Medicine, 4, Article 100211. https://doi.org/10.1016/j.imj.2025.100211 https://www.sciencedirect.com/science/article/pii/S2772431X25000504
[15]
Berbudi, A., Rahmadika, N., Tjahjadi, A.I. and Ruslami, R. (2020) Type 2 Diabetes and Its Impact on the Immune System. Current Diabetes Reviews, 16, 442-449. https://doi.org/10.2174/1573399815666191024085838
[16]
Savelkoel, J., Zimmermann, R., Tjon, A.N.C., Dzebisasjvili, T., Lanzl, M., Matamoros, S., et al. (2025) Detection of Burkholderiathailandensis in Soil Samples, Suriname. Emerging Infectious Diseases, 31, 2057-2059. https://doi.org/10.3201/eid3110.251114
[17]
Rolim, D.B., Lima, R.X.R., Ribeiro, A.K.C., Colares, R.M., Lima, L.D.Q., Rodríguez-Morales, A.J., et al. (2018) Melioidosis in South America. Tropical Medicine and Infectious Disease, 3, Article 60. https://doi.org/10.3390/tropicalmed3020060
[18]
Amoureux, L., Bador, J., Fardeheb, S., Mabille, C., Couchot, C., Massip, C., et al. (2013) Detection of Achromobacter Xylosoxidans in Hospital, Domestic, and Outdoor Environmental Samples and Comparison with Human Clinical Isolates. Applied and Environmental Microbiology, 79, 7142-7149. https://doi.org/10.1128/aem.02293-13
[19]
Patil, S. and Gondhali, G. (2021) Pulmonary Melioidosis Masquerading as Tuberculosis: A Case Report. Electronic Journal of General Medicine, 18, em310. https://doi.org/10.29333/ejgm/11064
Semenza, J.C., Rocklöv, J. and Ebi, K.L. (2022) Climate Change and Cascading Risks from Infectious Disease. Infectious Diseases and Therapy, 11, 1371-1390. https://doi.org/10.1007/s40121-022-00647-3
