Burkholderia pseudomallei causing urinary tract infection and cellulitis: A case report

Introduction: Burkholderia pseudomallei causes protean manifestations. Though infection caused by this organism is rare, infection can be fatal. We present a case of urinary tract infection and cellulitis caused by Burkholderia pseudomallei who was admitted at a tertiary care hospital. The case is presented to highlight the identification of this rare pathogenic organism in the laboratory from the samples collected and to start the treatment early for better prognosis since the mortality is high without treatment. Case presentation: 68 Year old male presented to medicine Department with symptoms of urinary tract infection and also inflammation of the skin on the upper part of medial aspect of the left thigh. On examination patient had cellulitis on the medial side of the left thigh and also suspected urinary tract infection. Samples of urine, blood and pus collected using sterile swabs from the discharge of cellulitis was sent to microbiology laboratory for culture and antimicrobial susceptibility testing. Microbiological culture and identification revealed the etiologic agent to be Burkholderia pseudomallei. The organism was susceptible to amoxicillin-clavulanic acid (20μg/10 μg), ceftazidime(30μg), trimethoprim/sulfamethoxazole(1.25/23.75 μg). The strain was resistant to amikacillin(30 μg), and colistin(10 μg ). His fasting blood glucose was 223mg/dl. Patient was started with ceftazidime (intravenous route) for two weeks followed by trimethoprim/sulfamethoxazole for twelve weeks. Pus at cellulitis area was also drained.He was put on antidiabetic therapy. Second sample of urine and blood collected after a week was negative for culture. Conclusion: Urinary tract infection is common in diabetics, and in a diabetic patient B. pseudomallei, a rare pathogen can cause infection. This organism can be overlooked in routine cultures as contaminant especially if the bacterial growth on the culture plate is polymicrobial. Identification requires a great deal of clinical suspicion as well as alertness on the part of laboratory personnel. Melioidosis caused by should be considered in the differential diagnosis in diabetic men with urinary tract infection, especially if they come from areas where melioidosis is prevalent. Appropriate treatment must be initiated to prevent complications.