Clinicians should maintain a high index of suspicion in patients presenting with severe pneumonia or sepsis, particularly during the rainy season and among individuals with diabetes mellitus or chronic liver disease, and strengthening conventional microbiological capacity remains essential for improving diagnosis and patient outcomes in geographically isolated settings.
Abstract
Melioidosis, caused by
Burkholderia pseudomallei
, is an important but frequently under-recognized cause of severe infection in tropical regions, including Vietnam. Although cases have been reported from several parts of the country, published clinical data from remote island settings remain scarce. To our knowledge, no clinical case series of melioidosis from Phu Quoc Island has been previously reported. This study describes the clinical presentations, underlying comorbidities, management, and outcomes of patients diagnosed with melioidosis at a tertiary hospital on Phu Quoc Island, Vietnam.
We retrospectively reviewed all patients with culture-confirmed melioidosis admitted to Vinmec Phu Quoc General Hospital between July 2022 and February 2026. Archived isolates underwent molecular confirmation using a TTS1-targeted quantitative polymerase chain reaction (qPCR) assay, followed by recA gene sequencing. Nine patients were included. Clinical, laboratory, microbiological, radiological, treatment, and outcome data were extracted from medical records.
Pneumonia was the predominant manifestation, occurring in seven patients, and eight patients presented with bacteremic disease. Diabetes mellitus was the most common underlying condition (7/9), followed by chronic liver disease and previous tuberculosis. Most patients were admitted with sepsis, including four cases complicated by septic shock. Two patients developed rapidly progressive pulmonary melioidosis with acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) and died despite intensive antimicrobial and supportive therapy, including one previously healthy individual. The remaining seven patients survived. TTS1 qPCR confirmed all available isolates, while recA sequencing demonstrated the presence of at least two closely related sequence variants among circulating isolates. Antimicrobial susceptibility testing by broth microdilution showed preserved susceptibility to amoxicillin/clavulanic acid, ceftazidime, imipenem, and trimethoprim/sulfamethoxazole in all tested isolates.
This report represents, to our knowledge, the first published clinical case series of melioidosis from Phu Quoc Island. The findings highlight the broad clinical spectrum of melioidosis and its potential for rapid progression to life-threatening pneumonia, septic shock, and multiorgan failure. Clinicians should maintain a high index of suspicion in patients presenting with severe pneumonia or sepsis, particularly during the rainy season and among individuals with diabetes mellitus or chronic liver disease. Strengthening conventional microbiological capacity, including timely blood culture, accurate organism identification, and standardized antimicrobial susceptibility testing, remains essential for improving diagnosis and patient outcomes in geographically isolated settings.
This case series aimed to increase physicians' awareness of melioidosis in high-risk patients presenting with diverse clinical symptoms, thereby improving diagnostic accuracy and ensuring timely and appropriate treatment.
Arulananthi Venkataraman Arumugham, Sabarinathan Thiyagarajan, S. Ali et al.· 0 citations
OBJECTIVES
Melioidosis is an infectious disease endemic to southeast Asia and northern Australia. Although rare, central nervous system (CNS) melioidosis carries a high mortality. This study aims to determine its clinical characteristics and provide insights facilitating its diagnosis and management.
METHODS
We performed a multicenter retrospective analysis of CNS melioidosis cases at six hospitals in Hainan, China, between 2010 and 2025. Demographic and clinical data were collected and analyzed. Antimicrobial susceptibility testing was performed, and comparative statistics were calculated between survivors and non-survivors.
RESULTS
Mortality reached 31.0% (13/42) among CNS melioidosis cases. Intracranial involvement was most common (76.2%, 32/42). Diabetes (59.5%, 25/42) was predominant risk factor. Common presentations included fever (76.2%, 32/42), headache (52.4%, 22/42), localizing neurologic signs (47.6%, 20/42), and altered consciousness (42.9%, 18/42). Bacteremia was confirmed in 59.5% (25/42) of the enrolled cases All tested isolates were susceptible to most common antibiotics. Surgical intervention and treatment with ceftazidime or trimethoprim-sulfamethoxazole were associated with lower mortality, whereas altered consciousness and diabetes were linked to poorer overall survival.
CONCLUSIONS
CNS melioidosis in Hainan predominantly affects diabetic males and frequently presents with nonspecific neurologic symptoms mimicking stroke, contributing to delayed diagnosis and high mortality. High clinical vigilance, cultures of multiple specimens, and timely antibiotics plus surgical treatment are critical for improving prognoses.
Hua Wu, Yujuan Long, Qinlei Cai et al.· International Journal of Inf...· 0 citations
BACKGROUND
Pediatric melioidosis is an under-recognised but potentially severe infection caused by Burkholderia pseudomallei. Evidence is largely fragmented across case reports and small series, limiting understanding of disease patterns, severity, and outcomes in children.
METHODS
A scoping review was conducted in accordance with PRISMA-ScR 2020 guidelines. PubMed and Google Scholar were searched up to December 2025 for studies reporting culture-confirmed melioidosis in children (≤18 years). Case reports, case series, and observational studies were included. Given the heterogeneity of available data, findings were synthesised narratively with emphasis on clinical patterns and outcome determinants.
RESULTS
A total of 140 studies comprising 1,058 pediatric cases were included. Most cases were reported after 2000 and originated from Southeast Asia and northern Australia. Pediatric melioidosis demonstrated a broad clinical spectrum, ranging from localized infections (predominantly parotid, lymphatic, and skin involvement) to severe disseminated disease with bacteraemia and pneumonia. Overall mortality was 22.4% (229/1024). Mortality was markedly lower in localized melioidosis (0.7%; 4/557) than in disseminated disease (46.2%; 226/489) and was highest in neonatal (56.0%) and neurologic melioidosis (51.7%). Diagnostic delay ranged from 1 to 420 days and was frequently associated with severe and fatal outcomes, suggesting progression from initially localized infection to disseminated disease.
CONCLUSIONS
Pediatric melioidosis follows a phenotype-severity continuum, with outcomes strongly influenced by disease pattern and timeliness of diagnosis. Early recognition of localized disease and prompt microbiological confirmation are critical to preventing progression and reducing mortality. This review provides a consolidated framework for understanding pediatric melioidosis and highlights key priorities for clinical practice and future research.
G. Vithiya, S. Ponnusamy, V. Mangayarkarasi et al.· Indian Journal of Medical Mi...· 0 citations
Histoplasmosis is a systemic fungal infection caused by inhalation of spores of
Histoplasma capsulatum
. The disease is endemic in several geographical regions worldwide, including parts of India such as West Bengal, Assam, and selected areas of southern and northern India. Sporadic cases have also been reported from Gujarat and Rajasthan. However, being tropical countries with lots of other infections, histoplasmosis becomes a relatively rare infection and is often missed in routine clinical practice. In patients presenting with pyrexia of unknown origin, delayed diagnosis of disseminated histoplasmosis may result in catastrophic consequences. We report the case of a 29-year-old male, grain merchant by occupation, presented with a fever of 1-month duration. He had previously received empirical broad-spectrum antimicrobial therapy at another hospital without clinical improvement. At presentation, the patient was ill-appearing and hemodynamically unstable. On physical examination, mild splenomegaly was present, and the chest was clear on auscultation. Laboratory evaluation demonstrated bicytopenia, raising suspicion for hematological malignancy or overwhelming systemic infection. Fluorodeoxyglucose (FDG)-positron emission tomography computed tomography demonstrated diffuse marrow hypermetabolism and FDG-avid hepatosplenomegaly, further increasing suspicion for malignancy. Bone marrow aspiration and biopsy were planned, but due to hemodynamic instability could not be performed; however, peripheral blood smear examination revealed intra- and extracellular small oval yeast-like organisms morphologically suggestive of
H. capsulatum
. The patient was treated with an induction therapy dose of Liposomal amphotericin B 3 mg/kg/day for 7 days. Fever subsided within 24 h of therapy, accompanied by rapid clinical and hemodynamic improvement. Following induction therapy, maintenance treatment with oral itraconazole was initiated with a loading dose of 200 mg thrice daily for 3 days, followed by 200 mg twice daily, planned for 1 year. Disseminated histoplasmosis should be considered in patients with prolonged unexplained fever, even in the absence of apparent immunodeficiency. Peripheral blood smear examination may provide an important diagnostic clue and, in selected cases, may help avoid invasive procedures such as bone marrow examination. Early recognition and prompt initiation of antifungal therapy can result in rapid clinical improvement and may be lifesaving.
Nikunj Mehta, Amar Chapla, Dhaval Nathwani et al.· Journal of Hematology and Al...· 0 citations
BACKGROUND
Human brucellosis remains a significant public health concern in northeastern Türkiye and is among the leading causes of visits to infectious disease clinics. In this study, we aimed to describe the clinical characteristics and laboratory findings of patients with brucellosis in high-burden regions, with a particular focus on identifying diagnostic indicators of complicated disease.
METHODS
We conducted a retrospective study of patients with positive serology for brucellosis who were admitted to Harakani State Hospital in Kars between September 2022 and December 2023. Patients were grouped based on whether they had complicated or uncomplicated brucellosis. Potential diagnostic indicators of complicated brucellosis were identified using univariate and multivariate logistic regression.
RESULTS
The study included 97 patients with a median age of 42 years; 41.2% were female. Rose Bengal and Brucellacapt/Coombs Wright (BC/CW) tests were positive in 94.8% and 98.9% of patients, respectively. Cases were classified as acute (55.7%), subacute (28.9%), and chronic (15.5%). Complicated brucellosis was identified in 33 patients (34%). In univariate analyses, complicated brucellosis was associated with thrombocytopenia (OR: 5.53; 95% CI: 1.01-30.29), elevated C-reactive protein (CRP) (OR: 5.9; 95% CI: 2.31-15.15), elevated erythrocyte sedimentation rate (ESR) (OR: 3.23; 95% CI: 1.14-9.18), and a BC/CW titer >1:320 (OR: 2.76; 95% CI: 1.13-6.72). Elevated CRP levels were observed in 43.3% of patients and remained independently associated with complicated brucellosis in multivariable analysis (adjusted OR: 4.36; 95% CI: 1.60-11.87). Relapse occurred in 13 patients (13.4%) within six months.
CONCLUSIONS
The presence of thrombocytopenia, high CRP and ESR levels, and high BC/CW titers was a diagnostic indicator of complicated brucellosis. Early identification of high-risk patients using combined clinical and laboratory parameters may improve follow-up strategies and clinical outcomes.
Peru carries the highest burden of cystic echinococcosis (CE) in South America, yet major geographic gaps persist in understanding the distribution and intensity of the disease. The Arequipa region in southern Peru has historically been considered nonendemic, with no previous systematic clinical characterization of CE, despite increasing reports. Clinical records of 129 of 177 CE surgical cases treated between December 2011 and November 2013 at a government-funded CE surgical unit at a major referral hospital were analyzed. This represents the first structured clinical assessment of CE in Arequipa. Sociodemographic, epidemiological, and clinical data were extracted, and cases were mapped at a provincial level. Statistical analysis was conducted using appropriate nonparametric and exact tests. Half of Arequipa's provinces of origin (4/8) had case rates of 7.8 to 20 per 100,000, substantially exceeding the national average. Notably, 40.3% of CE surgical cases were autochthonous to Arequipa, suggesting local transmission years before treatment, consistent with CE's prolonged incubation period. Patients had a median age of 26 years (interquartile range: 16-45 years), 55% were male, and 69% were students (35%), farmers (18%), or homemakers (16%). Pulmonary involvement predominated, accounting for 70% of cases. Comparison of patient- and cyst-level characteristics between Arequipa and established CE-endemic regions revealed no significant differences. These findings reveal a substantial and previously underrecognized clinical CE burden in Arequipa, providing foundational baseline evidence for a region newly recognized as endemic. Evidence of local transmission underscores the urgent need for sustained political support, specialized surgical units, and systematic surveillance to strengthen CE control in southern Peru.
R. Castillo-Neyra, Wilfredo Victor Gutiérrez Zarate, M. P. Requena-Herrera et al.· American Journal of Tropical...· 0 citations