SHM Converge Scientific Abstract ePoster Gallery-A Case Report of Travel-Associated Melioidosis Infection Wisconsin, United States

Pdf Summary

This case report describes two travel-associated melioidosis infections diagnosed in Wisconsin, both ultimately caused by <strong>Burkholderia pseudomallei</strong>, a rare but potentially life-threatening pathogen endemic to Southeast Asia and northern Australia.

<strong>Case 1</strong> involved a 70-year-old Hmong man from Wisconsin with weeks of dry cough, shortness of breath, gray sputum, and poor oral intake. He had recently traveled to Laos. Initial treatment for presumed community-acquired pneumonia did not help, and chest CT showed a <strong>right upper lobe cavitary lesion</strong>. Routine testing was negative for other common infections. A culture initially suggested <em>Burkholderia thailandensis</em>, but state laboratory confirmation identified <strong>B. pseudomallei</strong>. He was treated with <strong>2 weeks of IV ceftazidime</strong> followed by <strong>90 days of trimethoprim-sulfamethoxazole (TMP-SMX)</strong>, with clinical and radiographic improvement.

<strong>Case 2</strong> involved a 58-year-old Nepalese man who recently arrived in the U.S. He presented with fever, worsening back pain, fatigue, diarrhea, abdominal pain, and a tender left flank mass. CT imaging revealed a <strong>very large multiloculated retroperitoneal mass</strong>, and drainage yielded purulent fluid. Cultures again were initially identified as <em>B. thailandensis</em> but were confirmed by the state lab as <strong>B. pseudomallei</strong>. He first received piperacillin-tazobactam, then was switched to <strong>ceftazidime</strong>, and later completed <strong>3 months of oral TMP-SMX</strong> because of social barriers to prolonged IV therapy, with full resolution.

The report emphasizes that <strong>melioidosis can mimic pneumonia, abscesses, TB, fungal disease, or malignancy</strong>, making travel and exposure history essential. Because <strong>B. pseudomallei is a Tier 1 select agent</strong>, suspected cases should be promptly communicated to the laboratory. Recommended treatment includes an <strong>initial intensive phase</strong> with ceftazidime or meropenem, followed by a prolonged <strong>eradication phase</strong> with TMP-SMX.

Asset Subtitle

Ginger Kwak

Meta Tag

Author List Alex Rosiejka, Ginger Kwak, Njeri Wainaina, Oscar Villarreal Espinosa, Pinky Jha, Shivum Patel

Category Clinical Vignettes

Concept Melioidosis

Concept Burkholderia pseudomallei

Concept Ceftazidime

Concept Meropenem

Concept Trimethoprim-sulfamethoxazole

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Ginger Kwak

Track Adult

Keywords

melioidosis

Burkholderia pseudomallei

travel-associated infection

Wisconsin case report

cavitary lung lesion

retroperitoneal mass

ceftazidime

trimethoprim-sulfamethoxazole

select agent

Southeast Asia travel

Melioidosis

Burkholderia pseudomallei

Ceftazidime

Meropenem

Trimethoprim-sulfamethoxazole