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Published on: February 24, 2023
Atypical Presentations in Melioidosis: A Case-Based Review from Endemic Regions
Saurav Jyoti Patgiri1, Anukalpa Saikia1, Sushmita Yadav1
1ICMR Regional Medical Research Centre North East, Dibrugarh 786001, India.
Background:
Melioidosis, caused by Burkholderia pseudomallei, is a severe and often underdiagnosed infection endemic to South Asia, Southeast Asia, and northern Australia. While pneumonia and sepsis are the classical presentations, the disease is increasingly recognized for its diverse and atypical clinical manifestations.
Objective:
The objective is to improve diagnostic accuracy and increase clinical awareness in both endemic and non-endemic settings by reviewing and classifying atypical presentations of melioidosis that have been documented in the literature.
Methods:
A narrative, case-based review was conducted using 238 published case reports and series from endemic and transitional regions during the period from 2000 to 2025. Cases with non-respiratory presentations or anatomical locations not commonly linked to melioidosis were classified as atypical. Clinical syndromes were used to classify the extracted cases, and common patterns in presentation, diagnosis, and outcome were examined.
Results:
One hundred and sixty published articles were included after a full text review. The most frequent atypical presentations included neurological involvement (e.g., brain abscess, encephalomyelitis), musculoskeletal infections (osteomyelitis, myositis), thyroid abscess, tubo-ovarian abscess, and dermatologic manifestations such as erythema nodosum. Imported and pediatric cases were also found. Numerous cases were misidentified as cancer, fungal infections, or tuberculosis. Among risk factors, diabetes mellitus was the most prevalent. Non-specific symptoms, a lack of laboratory capacity, and incorrect pathogen identification frequently resulted in delays in diagnosis.
Conclusions:
In endemic areas, melioidosis should be taken into account when making a differential diagnosis of a variety of clinical syndromes, especially in patients who have diabetes or have had relevant environmental exposure. Poor outcomes and diagnostic delays are greatly exacerbated by atypical presentations. Improving diagnostic capabilities and raising awareness are crucial to lessening the worldwide burden of this often ignored but potentially deadly infection.
Insights
Melioidosis, a severe infection caused by Burkholderia pseudomallei, often presents atypically, leading to diagnostic delays. Recognizing diverse clinical syndromes, especially in diabetic patients, is crucial for timely diagnosis and improved outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a severe infection endemic to South and Southeast Asia and northern Australia.
- While pneumonia and sepsis are common, melioidosis presents with diverse and atypical clinical manifestations, often leading to underdiagnosis.
Purpose of the Study:
- To enhance diagnostic accuracy and clinical awareness of melioidosis.
- To review and classify atypical presentations of melioidosis documented in scientific literature.
- To improve recognition in both endemic and non-endemic regions.
Main Methods:
- A narrative, case-based review of 238 published case reports and series (2000-2025).
- Cases with non-respiratory or uncommon anatomical presentations were classified as atypical.
- Analysis of clinical syndromes, presentation patterns, diagnosis, and outcomes.
Main Results:
- 160 articles were included, detailing frequent atypical presentations: neurological, musculoskeletal, thyroid, tubo-ovarian abscesses, and dermatologic signs.
- Common misdiagnoses included cancer, fungal infections, and tuberculosis.
- Diabetes mellitus was the most prevalent risk factor; diagnostic delays were linked to non-specific symptoms and laboratory limitations.
Conclusions:
- Melioidosis should be considered in differential diagnoses for various syndromes in endemic areas, particularly in patients with diabetes or environmental exposure.
- Atypical presentations significantly worsen outcomes and diagnostic delays.
- Enhanced diagnostic capabilities and increased awareness are vital to reduce the global burden of melioidosis.
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The first classification is based on the development of the disease, and it includes the following categories: