Severe Disseminated Melioidosis with Pulmonary, Cutaneous, and Osteoarticular Involvement in the Peruvian Amazon.

Abstract

Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Although well described in Southeast Asia and northern Australia, its burden in South America remains poorly characterized and likely underestimated. A case of severe disseminated melioidosis in a 35-year-old man with poorly controlled diabetes mellitus residing in the Peruvian Amazon is reported here. The patient presented multifocal pneumonia, bacteremia, and septic shock requiring mechanical ventilation and vasopressor support. During hospitalization, he developed cutaneous microabscesses and septic arthritis of the left knee. Burkholderia pseudomallei was isolated from both blood cultures and synovial fluid, confirming hematogenous dissemination. This case highlights the presence of severe melioidosis in the Peruvian Amazon and underscores the need to consider this pathogen in patients presenting with severe sepsis in tropical regions with high environmental exposure and metabolic risk factors. Strengthening microbiological diagnostic capacity is essential to improve detection of this emerging infection in South America.