Melioidosis in a patient with type 1 diabetes mellitus on an insulin pump

Area of Science:

• Infectious Diseases
• Microbiology
• Endocrinology

Background:

• Melioidosis, caused by Burkholderia pseudomallei, is endemic in tropical regions.
• Diabetes mellitus is a known, significant risk factor for melioidosis.
• Geographic location (northern Australia) and patient comorbidities (type 1 diabetes) are key factors.

Purpose of the Study:

• To present a diagnostic challenge of melioidosis in a patient with type 1 diabetes.
• To emphasize the importance of considering melioidosis in febrile patients with diabetes, even with negative initial cultures.
• To highlight atypical presentations and potential infection routes.

Main Methods:

• Case report of a febrile patient from northern Australia with type 1 diabetes.
• Initial presentation with negative blood cultures and undifferentiated abdominal pain.
• Diagnostic imaging (MRI spine) revealing a psoas abscess.
• Abscess drainage and culture confirming Burkholderia pseudomallei.
• Treatment with intravenous and oral antibiotics (ceftazidime, trimethoprim/sulphamethoxazole).

Main Results:

• The patient presented with prolonged fever and abdominal pain, initially without a clear diagnosis.
• MRI identified a psoas abscess, leading to the isolation of Burkholderia pseudomallei.
• Successful treatment was achieved with a prolonged course of antibiotics.
• The likely infection route was skin inoculation, possibly related to insulin pump sites.

Conclusions:

• Diabetes mellitus is the primary risk factor for melioidosis.
• Melioidosis should be considered in febrile diabetic patients, irrespective of initial negative blood cultures.
• Clinical presentations of melioidosis are diverse, depending on organ involvement.
• Travel history to endemic areas (northern Australia, Southeast Asia) is crucial for diagnosis.