{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:14:42Z","timestamp":1759335282728,"version":"3.44.0"},"reference-count":31,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,5,22]]},"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>Melioidosis is an emerging infectious disease with highest predominance in Southeast Asia, but it has a significantly lower incidence across other parts of the globe. The most common systemic involvement seen in melioidosis is pulmonary, followed by multiple visceral and cutaneous abscesses. Infrequently, melioidosis manifests with atypical presentations such as spontaneous bacterial peritonitis (SBP), acute pyogenic meningitis or septic arthritis. Our primary case discusses an extremely rare presentation of melioidosis with SBP. There have not been any cases of SBP reported secondary to melioidosis infection. The second case exhibits development of acute pyogenic meningitis from haematogenous dissemination of this organism, while the final case demonstrates musculoskeletal melioidosis as an uncommon presentation. Of note, this case series also discusses the guidelines of management of melioidosis and illustrates the tremendous impact of appropriate and timely antibiotic therapy on mortality and morbidity secondary to melioidosis.<\/jats:p>","DOI":"10.1136\/bcr-2022-249417","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T11:25:19Z","timestamp":1654514719000},"page":"e249417","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Critical approach to atypical spectrum of melioidosis: a case-series based literature review"],"prefix":"10.1136","volume":"15","author":[{"given":"Akhya","family":"Sharma","sequence":"first","affiliation":[{"name":"Internal Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zubin","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Internal Medicine, Loyola Medicine MacNeal Hospital, Berwyn, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2821-3473","authenticated-orcid":false,"given":"Sharath P","family":"Madhyastha","sequence":"additional","affiliation":[{"name":"Internal Medicine, Manipal Academy of Higher Education, Kasturba Medical College Manipal, Manipal, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0617-9753","authenticated-orcid":false,"given":"Vishal","family":"Mehta","sequence":"additional","affiliation":[{"name":"Internal Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2022,6,6]]},"reference":[{"key":"2025082712274251000_15.6.e249417.1","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1016\/S0035-9203(08)70002-6","article-title":"The global distribution of Burkholderia pseudomallei and melioidosis: an update","volume":"102(Suppl 1)","author":"Currie","year":"2008","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2025082712274251000_15.6.e249417.2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.18.2.383-416.2005"},{"key":"2025082712274251000_15.6.e249417.3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0000900"},{"key":"2025082712274251000_15.6.e249417.4","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/S1473-3099(21)00022-0","article-title":"The Darwin prospective melioidosis study: a 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2025082712274251000_15.6.e249417.5","article-title":"Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan)","volume":"3","author":"Mukhopadhyay","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"2025082712274251000_15.6.e249417.6","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir808"},{"key":"2025082712274251000_15.6.e249417.7","doi-asserted-by":"crossref","unstructured":"Limmathurotsakul D , Golding N , Dance DAB , et al . Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 2016;1.doi:10.1038\/nmicrobiol.2015.8","DOI":"10.1038\/nmicrobiol.2015.8"},{"key":"2025082712274251000_15.6.e249417.8","first-page":"1209","article-title":"Tuberculosis mimicked by melioidosis","volume":"12","author":"Vidyalakshmi","year":"2008","journal-title":"Int J Tuberc Lung Dis"},{"key":"2025082712274251000_15.6.e249417.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61951-0"},{"key":"2025082712274251000_15.6.e249417.10","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.3390\/ph3051296","article-title":"The treatment of melioidosis","volume":"3","author":"Inglis","year":"2010","journal-title":"Pharmaceuticals"},{"key":"2025082712274251000_15.6.e249417.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1204699"},{"key":"2025082712274251000_15.6.e249417.12","doi-asserted-by":"crossref","first-page":"17107","DOI":"10.1038\/nrdp.2017.107","article-title":"Melioidosis","volume":"4","author":"Wiersinga","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"2025082712274251000_15.6.e249417.13","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1086\/520223","article-title":"Risk factors for melioidosis and bacteremic melioidosis","volume":"29","author":"Suputtamongkol","year":"1999","journal-title":"Clin Infect Dis"},{"key":"2025082712274251000_15.6.e249417.14","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/23.5.1082"},{"key":"2025082712274251000_15.6.e249417.15","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/23.5.1082"},{"key":"2025082712274251000_15.6.e249417.16","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.113-a734"},{"key":"2025082712274251000_15.6.e249417.17","doi-asserted-by":"publisher","DOI":"10.1086\/432942"},{"key":"2025082712274251000_15.6.e249417.18","doi-asserted-by":"publisher","DOI":"10.3201\/eid1110.050740"},{"key":"2025082712274251000_15.6.e249417.19","doi-asserted-by":"crossref","unstructured":"Chakravorty A , Heath CH . Melioidosis: an updated review. Aust J Gen Pract 2019:327\u201332.doi:10.31128\/AJGP-04-18-4558","DOI":"10.31128\/AJGP-04-18-4558"},{"key":"2025082712274251000_15.6.e249417.20","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-233498","article-title":"Melioidosis of the nervous system: atypical presentation of a rare disease in a 48-year-old man","volume":"13","author":"Hamdoon","year":"2020","journal-title":"BMJ Case Rep"},{"key":"2025082712274251000_15.6.e249417.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(98)94639-4"},{"key":"2025082712274251000_15.6.e249417.22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0007320"},{"key":"2025082712274251000_15.6.e249417.23","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2015-211001","article-title":"Central and peripheral nervous system involvement in neuromelioidosis","volume":"2015","author":"Arif","year":"2015","journal-title":"BMJ Case Rep"},{"key":"2025082712274251000_15.6.e249417.24","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1177\/0300060516685967","article-title":"Neuromelioidosis: a series of seven cases in Hainan Province, China","volume":"45","author":"Zhan","year":"2017","journal-title":"J Int Med Res"},{"key":"2025082712274251000_15.6.e249417.25","first-page":"242","article-title":"Dural sinus thrombosis in melioidosis: the first case report","volume":"89","author":"Niyasom","year":"2006","journal-title":"J Med Assoc Thai"},{"key":"2025082712274251000_15.6.e249417.26","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000503021","article-title":"Melioidosis of the musculoskeletal system","volume":"29","author":"Perumal","year":"2020","journal-title":"Med Princ Pract"},{"key":"2025082712274251000_15.6.e249417.27","doi-asserted-by":"crossref","DOI":"10.3389\/fcimb.2021.654745","article-title":"Osteomyelitis and septic arthritis due to Burkholderia pseudomallei: a 10-year retrospective melioidosis study from South China","volume":"11","author":"Wu","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"2025082712274251000_15.6.e249417.28","first-page":"179","article-title":"Melioidosis and peritoneal dialysis related peritonitis","volume":"68","author":"Wong","year":"2013","journal-title":"Med J Malaysia"},{"key":"2025082712274251000_15.6.e249417.29","doi-asserted-by":"publisher","DOI":"10.3747\/pdi.2015.00269"},{"key":"2025082712274251000_15.6.e249417.30","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1089\/sur.2012.140","article-title":"Melioidosis presenting as pseudomyxoma peritonei: yet another pretense of the great mimicker: an unreported entity","volume":"14","author":"Sugi Subramaniam","year":"2013","journal-title":"Surg Infect"},{"key":"2025082712274251000_15.6.e249417.31","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0003586"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-249417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T19:27:50Z","timestamp":1756322870000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-249417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2022,6,6]]},"published-print":{"date-parts":[[2022,6]]}},"alternative-id":["10.1136\/bcr-2022-249417"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-249417","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2022,6]]}}}