Carbapenem-resistant disseminated melioidosis with pulmonary, cardiac and cutaneous involvement: a case report

Abstract

Introduction: Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a Gram-negative bacterium found in soil and water in tropical regions of the world, especially in Southeast Asia and Northern Australia.  Report: This case report describes a patient with disseminated melioidosis caused by Burkholderia pseudomallei, with pulmonary, cardiac and cutaneous manifestations. The infection showed resistance to carbapenems, making therapeutic management difficult. The diagnosis was challenging due to the nonspecific clinical presentation and the rarity of the disease in non-endemic regions. Laboratory confirmation allowed the institution of targeted antimicrobial treatment, with favorable clinical evolution and significant improvement of the condition. Discussion: Melioidosis is a serious infectious disease, often underdiagnosed outside of endemic areas such as Southeast Asia and Northern Australia. In Brazil, it has already been identified in several states, especially Ceará, where cases have increased and generally evolve to a severe form. Its nonspecific symptoms make diagnosis difficult, as they can mimic other infections. The causative bacterium, Burkholderia pseudomallei, shows increasing resistance to antibiotics, such as carbapenems, which complicates treatment. The disease can affect multiple organs and, although rare, can cause endocarditis. This scenario reinforces the need for greater epidemiological surveillance, early diagnosis, identification of antimicrobial resistance and training of health professionals, even in regions outside the traditionally affected areas. Conclusion: This case highlights the importance of clinical suspicion of melioidosis in patients with multiple infectious foci, especially in tropical areas, and reinforces the need for agile diagnostic protocols and knowledge about emerging bacterial resistance.