Burkholderia Infections in Diabetic Section Patients Emerging as a Challenge for Physicians: A Case Series

Abstract

The genus Burkholderia comprises more than 40 species. Medically important members of this genus are Burkholderia cepacia (B.cepacia), Burkholderia pseudomallei (B.pseudomallei) and Burkholderia mallei (B.mallei). Burkholderia cepacia complex (Bcc) can cause Cepacia syndrome which includes necrotising pneumonia, respiratory failure and bacteremia in Cystic Fibrosis (CF) patients and can be fatal. B.cepacia can be potentially pathogenic in individuals with impaired host defences and can cause pneumonia, bronchiectasis, pyopneumothorax and cavitatory lesions. The clinical manifestations of Melioidosis range from localised infection to overwhelming sepsis and death with Pneumonia being the most common presentation. The most significant risk factor for Melioidosis is diabetes. Musculoskeletal Melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. In the present two cases of Melioidosis in diabetics who presented with septic arthritis treated with surgical debridement followed by antibiotics and two cases of Cepacia syndrome in diabetics whose hospital course was complicated by pneumothorax and Acute Respiratory Distress Syndrome (ARDS). These reports raise the concern regarding the potential severity of Burkholderia infections and prompts early diagnosis by physicians to prevent morbidity and mortality.

Keywords

• cepacia syndrome
• cystic fibrosis
• melioidosis
• pyopneumothorax