Maxillary sinusitis due to Burkholderia cepacia mimicking fungal sinusitis

Chronic maxillary sinusitis is a frequently encountered condition in otorhinolaryngology practice, with bacterial pathogens playing a critical role. The most commonly isolated pathogens include Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa. Isolation of Burkholderia cepacia complex (Bcc) from sinonasal infections is rare, particularly in immunocompetent individuals. It comprises a group of genetically distinct, aerobic, non-fermenting Gram-negative bacilli that are widely distributed in soil and water environments. Over the past few decades, Bcc has emerged as an opportunistic pathogen, particularly noted for causing severe infections in patients with cystic fibrosis (CF), chronic granulomatous disease, and other compromised immune states. In patients with CF, chronic pulmonary colonization by Bcc is strongly correlated with a rapid decline in lung function and increased mortality. In contrast to Burkholderia pseudomallei, which is known to cause life-threatening melioidosis, the major challenge of Bcc is its intrinsic resistance to multiple antimicrobial agents, including aminoglycosides, quinolones, polymyxins, and several beta-lactams, through various mechanisms, including active efflux pumps, reduced outer membrane permeability, and robust biofilm formation. Consequently, eradicating Bcc infections is notoriously difficult, often requiring culture-directed systemic therapy in combination with definitive surgical intervention.