First culture-confirmed melioidosis case in Mozambique: a wakeup call for better diagnostics and clinical awareness

Melioidosis is a disease caused by Burkholderia pseudomallei and is an underrecognised cause of severe infection in sub-Saharan Africa. In Mozambique, where infectious diseases are prevalent, and laboratory capacity remains limited, it has not previously been reported. We report the first culture-confirmed case of melioidosis in a 37-year-old man living with advanced HIV. He presented with fever, diffuse ulcerative skin lesions, and pulmonary infiltrates, and was empirically treated for sepsis. He died on day 15 of hospitalisation before culture results were available. The isolate was identified as B. pseudomallei susceptible (increased exposure) to ceftazidime and susceptible to meropenem. The identification of melioidosis represents a sentinel case that suggests melioidosis is likely underdiagnosed in Mozambique. Increasing clinical awareness, strengthening diagnostic capacity, and integrating B. pseudomallei into differential diagnoses of refractory sepsis, tuberculosis-like illness, and ulcerative skin disease in immunocompromised patients should be a priority.