Human infections caused by pathogenic Burkholderia: current clinical challenges and future perspectives

The genus Burkholderia comprises diverse environmental bacteria, although only a limited number of species are clinically significant. Among these, Burkholderia mallei, Burkholderia pseudomallei, and the Burkholderia cepacia complex (Bcc) are the primary human pathogens associated with severe infections. This review aims to synthesize current knowledge on these species, focusing on their epidemiology, pathogenicity, diagnostic approaches, and treatment challenges, while identifying key gaps and future research directions.

A narrative synthesis of the literature was conducted, integrating findings from microbiological, clinical, and genomic studies addressing major pathogenic Burkholderia species and their management.

B. mallei causes glanders, a zoonotic infection transmitted through contact with infected animals. B. pseudomallei, an environmental organism endemic to tropical and subtropical regions, causes melioidosis, particularly in individuals with risk factors such as diabetes. The Bcc, comprising over 20 species, poses significant risks in patients with cystic fibrosis and chronic granulomatous disease, where it may lead to severe outcomes including "cepacia syndrome" and nosocomial outbreaks linked to contaminated medical products. Pathogenic Burkholderia species exhibit highly dynamic genomes shaped by horizontal gene transfer, contributing to virulence and intrinsic resistance to multiple antimicrobials, including polymyxins and many β-lactams. Advances in laboratory diagnosis include the use of molecular techniques, mass spectrometry, and whole-genome sequencing alongside conventional methods. Treatment remains challenging due to multidrug resistance, often requiring prolonged and intensive therapeutic regimens.

Clinically significant Burkholderia species present substantial diagnostic and therapeutic challenges due to their virulence and intrinsic antimicrobial resistance. Improved diagnostic strategies, optimized treatment protocols, and further research into prevention and control measures are essential to mitigate their clinical impact.