Melioidosis in kidney transplant recipients: A report of two cases

Abstract

Rationale: Melioidosis is a serious opportunistic infection caused by Burkholderia (B.) pseudomallei, primarily affecting immunocompromised individuals, particularly in endemic regions. Timely diagnosis and appropriate treatment are crucial to prevent fatal outcomes.

Patient concerns: Case 1 was a 34-year-old male kidney transplant recipient who presented with a 15-day history of intermittent fever, accompanied by liver and spleen abscesses. Case 2 was a 37-year- old female kidney transplant recipient who presented with acute febrile illness and developed leucopenia. Blood cultures for both patients grew B. pseudomallei.

Diagnosis: Both patients were diagnosed with melioidosis caused by B. pseudomallei, with the diagnosis confirmed through pus culture from the liver abscess in Case 1 and blood culture in Case 2.

Interventions: Both patients were treated with an intensive regimen of meropenem (renal-adjusted doses), followed by a 3-month course of oral cotrimoxazole for eradication therapy.

Outcomes: Case 1 experienced resolution of liver and spleen abscesses after 3 months of treatment and continued to recover well. In Case 2, blood cultures became sterile after 4 weeks, with no further complications observed.

Lessons: Melioidosis should be suspected in immunocompromised patients, especially kidney transplant recipients, who present with unexplained fever and sepsis-like symptoms. Early diagnosis through aspiration of abscesses and prompt treatment are critical for preventing relapses and improving patient outcomes.

Keywords

Kidney transplant / Melioidosis / Deep seated abscess / Disseminated infection / Meropenem / Cotrimoxazole

Conflict of interest statement

The authors declare that they have no conflict of interest.

Ethical approval and patients’ consent

Written informed consents were obtained from the patients for publication of this case report and any accompanying images.

Funding

The authors received no extramural funding for the study.

Authors’ contributions

CR: Conceptualization, methodology, case analysis, data collection, writing original draft; JV: Provided radiological images and explanation for images; UM: Literature review, data analysis, and manuscript revision; JJE: Patient care and management, clinical data collection, and manuscript revision; AT&EEJ: Data interpretation, and manuscript revision; ATV: Reviewing, and editing the manuscript; SA: Supervision of clinical aspects and case formulation; VGD: Contribution to the case discussion and interpretation of results; JSM: Provided microbilogical aspects of melioidosis; SV: Final manuscript approval and critical review of the work.

Publisher’s note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1] Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, et al. Increasing incidence of human melioidosis in Northeast Thailand. Am J Trop Med Hyg 2010; 82(6): 1113-1117. doi: 10.4269/ajtmh.2010.10-0038.

[2] Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med 2012; 367: 1035-1044.

[3] John TG, Jesudason MV, Lalitha MK, Ganesh A, Mohandas V, Cherian T, et al. Melioidosis in India: The tip of the iceberg ? Indian J Med Res 1996; 103: 62.

[4] Suputtamongkol Y, Chaowagul W, Chetchotisakd P, Lertpatanasuwun N, Intaranongpai S, Ruchutrakool T, et al. Risk factors for melioidosis and bacteremic melioidosis. Clin Infect Dis 1999; 29: 408-413.

[5] Mardhiah K, Wan-Arfah N, Naing NN, Hassan MRA, Chan HK. Comparison of Cox proportional hazards model, Cox proportional hazards with time-varying coefficients model, and lognormal accelerated failure time model: Application in time to event analysis of melioidosis patients. Asian Pac J Trop Med 2022; 15(3): 128-134.

[6] Malczewski AB, Oman KM, Norton RE, Ketheesan N. Clinical presentation of melioidosis in Queensland, Australia. Trans R Soc Trop Med Hyg 2005; 99: 856-860.

[7] Varughese S, Mohapatra A, Sahni R, Balaji V, Tamilarasi V. Renal allograft recipient with melioidosis of the urinary tract. Transpl Infect Dis 2011; 13: 95-96.

[8] Sullivan RP, Marshall CS, Anstey NM, Ward L, Currie BJ. 2020 Review and revision of the 2015 Darwin melioidosis treatment guideline; paradigm drift not shift. PLoS Negl Trop Dis 2020; 14(9): e0008659.

[9] Raj S, Sistla S, Sadanandan DM, Kathirvan T, Rameesh BM, Amalnath D. Clinical profile and predictors of mortality among patients with melioidosis. J Global Infect Dis 2023; 15: 72-78.

[10] Dance D. Treatment and prophylaxis of melioidosis. Int J Antimicrob Agents 2014; 43: 310-318.