Fatal hemophagocytic lymphohistiocytosis-induced multiorgan dysfunction secondary to Burkholderia pseudomallei sepsis: A case report

Clinical and Microbiological Insights Into Burkholderia Infections: A Retrospective Study From a Tertiary Care Hospital

Background Opportunistic pathogens such as Burkholderia cepacia and B. pseudomallei  within the genus Burkholderia are significant causes of morbidity and mortality, especially in immunocompromised individuals. Despite their clinical importance, these infections are often underreported in resource-poor settings due to diagnostic challenges. This study investigates the prevalence, clinical profiles, and antibiotic resistance patterns seen in Burkholderia infections in a tertiary care hospital in India. Methods This retrospective study analyzed 56 hospitalized patients with Burkholderia infections diagnosed between June 2022 and June 2024. Positive cultures were identified using biochemical and morphological criteria. Demographic, clinical, and laboratory data, as well as antibiotic susceptibility profiles, were reviewed. Statistical analysis included descriptive measures and comparisons between B. cepacia and B. pseudomallei. Results The study included 56 patients, predominantly male (66.10%), with a mean age of 50.10 years. Comorbidities such as diabetes (39.30%) and hypertension (35.70%) were common. Blood cultures were the most frequent sample type, yielding positive results, with B. cepacia isolated in 67.60% of cases and B. pseudomallei  in 32.40%. Patients with B. pseudomallei  exhibited a stronger systemic inflammatory response, reflected by significantly elevated procalcitonin levels (p = 0.035) compared to B. cepacia. While C-reactive protein levels were also higher in B. pseudomallei, the difference was not statistically significant (p = 0.066). Both species demonstrated sensitivity to carbapenems and beta-lactam/beta-lactamase inhibitors, but notable resistance to aminoglycosides and cephalosporins was observed. B. pseudomallei  showed high resistance to amikacin (41.20%) and cefepime (41.20%) while B. cepacia exhibited resistance to piperacillin/tazobactam (30.8%) and aztreonam (30.80%). Conclusion This study highlights distinct clinical and microbiological characteristics of B. cepacia and B. pseudomallei with distinct inflammatory markers and resistance patterns that underscore the need for precise diagnostic tools and tailored antibiotic therapy. Carbapenems and beta-lactam/beta-lactamase inhibitors remain effective treatment options, but emerging resistance necessitates effective antimicrobial stewardship for combating antimicrobial resistance and ensuring optimal patient outcomes. Further multicentric studies are essential to validate these findings and optimize management strategies for Burkholderia infections.

The Evolving Global Epidemiology of Human Melioidosis: A Narrative Review

Endemic in over 45 countries globally, recent reports of locally acquired melioidosis in novel geographical areas, such as the Southern US, have highlighted the expanding geographical range of Burkholderia pseudomallei. Climate change and severe weather events have been linked to an increase in cases of melioidosis, which follows environmental exposure to the bacterium. Healthcare professionals should be aware of the possibility of the disease, with its diverse and often delayed presentations, even in areas not previously known to have risk. Over 200 cases of travel-associated melioidosis have been reported in the literature, highlighting the need to consider this disease in non-endemic areas, as diagnostic delays of up to 18 months have been identified. The review updates the global epidemiology of melioidosis, focusing on new geographical areas where cases have been diagnosed and imported cases, unusual clinical presentations and co-infections, and less frequent modes of transmission (laboratory exposures and the risk of acquisition due to imported infected animals and contaminated products).