Melioidosis, caused by the bacterium Burkholderia pseudomallei, is a disease of the tropics that rarely occurs in the United States. Disease may occur years or decades after exposure and can appear in acute, chronic, relapsing or reactivated forms, which makes diagnosis more problematic. We report on the clinical aspects of a case of reactivated melioidosis, diagnosed approximately 36 years after initial exposure and after a recently published case with a purported latency of 62 years. Our case patient highlights the clinically complex picture often presented by melioidosis patients, the difficulties in laboratory identification of the causative pathogen, and challenges in provision of appropriate antibiotic therapy for a prolonged period. We survey the current literature with regard to melioidosis epidemiology, diagnosis, and treatment, and report on several cases of reactivation melioidosis not included in previous reviews. We also discuss the clinical and public health aspects of Burkholderia pseudomallei as a Category B agent with potential for use as biological weapon and the importance of physicians immediately reporting any suspect cases to public health officials to facilitate more rapid assessment and response.
From the *Bureau of Epidemiology, Michigan Department of Community Health, Lansing; †Infectious Diseases, University of Michigan Hospitals/VA Medical Center, Ann Arbor, MI; ‡Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA; §Microbiology Section, Bureau of Laboratories, Michigan Department of Community Health, Lansing; and ∥Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
Correspondence to: Eden V. Wells, MD, MPH, Bureau of Epidemiology, 5th Floor CVB, Michigan Department of Community Health, 201 Townsend, PO Box 30195, Lansing, MI 48913. E-mail: firstname.lastname@example.org.
The authors have no funding or conflicts of interest to disclose.
Our case presentation, with a disease latency of approximately 36 years, illustrates the importance of clinical awareness of melioidosis epidemiology, identification, treatment, and the need to report a suspected case immediately to public health authorities.