{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:46:05Z","timestamp":1791873965681,"version":"4.3.4"},"reference-count":122,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T00:00:00Z","timestamp":1766620800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Travel-associated melioidosis, caused by Burkholderia pseudomallei, is increasingly reported in non-endemic countries due to rising global travel. Understanding demographic, clinical, and outcome patterns of imported cases is important to improve recognition and management in settings where melioidosis is uncommon. Methods: We systematically searched PubMed, Embase, and Scopus (last search: 24 September 2025) for case reports and case series of melioidosis diagnosed outside endemic regions and linked to travel exposure. Data were extracted on demographics, comorbidities, clinical manifestations, and outcomes. We performed descriptive analyses, subgroup analyses, and Firth\u2019s penalized logistic regression to explore predictors of death. The protocol was registered in PROSPERO (CRD420251154559). Results: A total of 104 studies, encompassing 143 individual cases, were included. Most diagnoses occurred in non-endemic, high-income countries, especially the Netherlands (21%), France (10%), the United States (9%), and South Korea (7%). Infections were predominantly acquired in Southeast Asia, particularly Thailand (39%). The mean patient age was 50.6 years, with a male predominance (78%). Diabetes mellitus was the most frequent comorbidity (28%). Clinical presentations included pulmonary (33%), sepsis (27%), cutaneous (13%), abdominal (4%), and osteoarticular disease (1%). Overall mortality was 12.6% and relapse occurred in 7%. In penalized regression analyses, no baseline characteristic was statistically significantly associated with mortality; septic presentation showed an elevated point estimate for odds of death, but with imprecise estimates. Conclusions: Travel-associated melioidosis is a rare but clinically significant imported infection. Most cases followed exposure in Southeast Asia, and pulmonary disease and sepsis were the most frequent presentations. Mortality remained substantial (12.6%), and relapse was reported in 7%, underscoring the need for early recognition, appropriate therapy, and follow-up in non-endemic settings.<\/jats:p>","DOI":"10.3390\/ijerph23010036","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T02:07:58Z","timestamp":1766714878000},"page":"36","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Travel-Associated Melioidosis in Non-Endemic Regions: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-4542-8980","authenticated-orcid":false,"given":"Jongkonnee","family":"Thanasai","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Mahasarakham University, Mahasarakham 44000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atthaphong","family":"Phongphithakchai","sequence":"additional","affiliation":[{"name":"Nephrology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3264-1155","authenticated-orcid":false,"given":"Moragot","family":"Chatatikun","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand"},{"name":"Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9312-903X","authenticated-orcid":false,"given":"Sa-ngob","family":"Laklaeng","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4768-7829","authenticated-orcid":false,"given":"Jitbanjong","family":"Tangpong","sequence":"additional","affiliation":[{"name":"School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand"},{"name":"Research Excellence Center for Innovation and Health Products (RECIHP), Walailak University, Nakhon Si Thammarat 80160, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pakpoom","family":"Wongyikul","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Biomedical Informatics and Clinical Epidemiology (BioCE), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8543-6254","authenticated-orcid":false,"given":"Phichayut","family":"Phinyo","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"},{"name":"Department of Biomedical Informatics and Clinical Epidemiology (BioCE), Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Supphachoke","family":"Khemla","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Nakhon Phanom Hospital, Nakhon Phanom 48000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anchalee","family":"Chittamma","sequence":"additional","affiliation":[{"name":"Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5247-166X","authenticated-orcid":false,"given":"Wiyada Kwanhian","family":"Klangbud","sequence":"additional","affiliation":[{"name":"Medical Technology Program, Faculty of Science, Nakhon Phanom University, Nakhon Phanom 48000, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gassiep, I., Armstrong, M., and Norton, R. (2020). Human melioidosis. Clin. Microbiol. Rev., 33.","DOI":"10.1128\/CMR.00006-19"},{"key":"ref_2","first-page":"706","article-title":"Burkholderia pseudomallei and melioidosis","volume":"21","author":"Meumann","year":"2023","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_3","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":"ref_4","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1097\/QCO.0000000000000869","article-title":"Melioidosis and Burkholderia pseudomallei: Progress in epidemiology, diagnosis, treatment and vaccination","volume":"35","author":"Currie","year":"2022","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/s40121-023-00768-3","article-title":"Risk factors for melioidosis mortality and epidemics: A multicentre, 10-year retrospective cohort study in northern Hainan","volume":"12","author":"Zheng","year":"2023","journal-title":"Infect. Dis. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s10096-019-03548-5","article-title":"A review of melioidosis cases imported into Europe","volume":"38","author":"Montana","year":"2019","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.7861\/clinmed.2022-0014","article-title":"Melioidosis: Clinical aspects","volume":"22","author":"Karunanayake","year":"2022","journal-title":"Clin. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1093\/infdis\/168.5.1181","article-title":"Relapse in melioidosis: Incidence and risk factors","volume":"168","author":"Chaowagul","year":"1993","journal-title":"J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.3201\/eid2911.230951","article-title":"Clinical manifestations and genomic evaluation of melioidosis outbreak among children after sporting event, Australia","volume":"29","author":"Smith","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12941-023-00620-z","article-title":"Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review","volume":"22","author":"Keragala","year":"2023","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/j.phrp.2015.10.014","article-title":"Imported melioidosis in South Korea: A case series with a literature review","volume":"6","author":"Kim","year":"2015","journal-title":"Osong. Public Health Res. Perspect."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Norman, F., and Chen, L.H. (2023). Travel-associated melioidosis: A narrative review. J. Travel Med., 30.","DOI":"10.1093\/jtm\/taad039"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"8154810","DOI":"10.1155\/2021\/8154810","article-title":"Risk factors for mortality in melioidosis: A single-centre, 10-year retrospective cohort study","volume":"2021","author":"Menon","year":"2021","journal-title":"Sci. World J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., Shamseer, L., Tetzlaff, J.M., Akl, E.A., and Brennan, S.E. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372.","DOI":"10.1136\/bmj.n71"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1017\/S0950268805004103","article-title":"Changing epidemiology of melioidosis? A case of acute pulmonary melioidosis with fatal outcome imported from Brazil","volume":"133","author":"Aardema","year":"2005","journal-title":"Epidemiol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.jiph.2020.01.310","article-title":"Melioidosis: Case reports of confirmed Burkholderia pseudomallei in Saudi Arabia","volume":"13","author":"Alhatmi","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_17","first-page":"807","article-title":"Melioidosis: A cause of pneumonia to suspect in travellers back from Oceania","volume":"19","author":"Allen","year":"2002","journal-title":"Rev. Mal. Respir."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1378\/chest.13-3000","article-title":"A 42-year-old farmer from Bangladesh with respiratory failure, septic arthritis, and multiple cavitating consolidations","volume":"146","author":"AlShati","year":"2014","journal-title":"Chest"},{"key":"ref_19","first-page":"154","article-title":"Chronic melioidosis: A report of the first case in Japan","volume":"67","author":"Arakawa","year":"1993","journal-title":"J. Jpn. Assoc. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Arya, A., Shaikh, H., Weber, D., Pettengill, M., and Moss, S. (2021). Fever in a returning traveler: A case and literature review of melioidosis. IDCases, 26.","DOI":"10.1016\/j.idcr.2021.e01340"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Auvens, C., Neuwirth, C., Piroth, L., and Blot, M. (2019). Infected aneurysm after returning from Southeast Asia: Think Burkholderia pseudomallei!. BMJ Case Rep., 12.","DOI":"10.1136\/bcr-2018-228856"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"445","DOI":"10.3109\/00365540903582467","article-title":"Imported melioidosis in Danish travellers: A diagnostic challenge","volume":"42","author":"Badran","year":"2010","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Barry, M., Dada, H., Barry, M., Almohaya, A., and Aldrees, A. (2020). Unusual presentation of melioidosis in a returning traveler. IDCases, 20.","DOI":"10.1016\/j.idcr.2020.e00809"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/S0300-2977(98)00129-6","article-title":"Melioidosis","volume":"54","author":"Beeker","year":"1999","journal-title":"Neth. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"101461","DOI":"10.1016\/j.tmaid.2019.07.017","article-title":"Melioidosis in travelers: An analysis of Dutch melioidosis registry data 1985\u20132018","volume":"32","author":"Birnie","year":"2019","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Bodilsen, J., Vammen, S., Fuursted, K., and Hjort, U. (2014). Mycotic aneurysm caused by Burkholderia pseudomallei in a previously healthy returning traveller. BMJ Case Rep., 2014.","DOI":"10.1136\/bcr-2013-202824"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1708-8305.2006.00050.x","article-title":"Melioidosis: An Imported Case from Madagascar","volume":"13","author":"Borgherini","year":"2006","journal-title":"J. Travel Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1007\/BF02013291","article-title":"Septic melioidosis after a visit to Southeast Asia","volume":"5","author":"Bouvy","year":"1986","journal-title":"Eur. J. Clin. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"271","DOI":"10.3109\/inf.1982.14.issue-4.05","article-title":"Microbiological and Immunological Studies in a Case of Human Melioidosis Diagnosed in Denmark","volume":"14","author":"Bremmelgaard","year":"1982","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_30","first-page":"987","article-title":"Sensitivity of radionuclide isotope brain scan in cerebral melioidosis: Case report","volume":"18","author":"Brill","year":"1977","journal-title":"J. Nucl. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1809","DOI":"10.3201\/eid1511.090038","article-title":"Imported melioidosis, Israel, 2008","volume":"15","author":"Cahn","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/00365540050164308","article-title":"Melioidosis presenting as urinary tract infection in a previously healthy tourist","volume":"32","author":"Carlson","year":"2000","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1155\/2014\/158323","article-title":"Melioidosis in a returned traveller","volume":"25","author":"Chagla","year":"2014","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_34","first-page":"1365","article-title":"Pleuropulmonary melioidosis in a Cambodian refugee","volume":"131","author":"Chan","year":"1984","journal-title":"Can. Med. Assoc. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2142","DOI":"10.1001\/jama.2012.33634","article-title":"Neck mass in a returning traveler","volume":"308","author":"Christini","year":"2012","journal-title":"JAMA"},{"key":"ref_36","first-page":"237","article-title":"Burkholderia pseudomallei infection in a cystic fibrosis patient from the Caribbean: A case report","volume":"15","author":"Corral","year":"2008","journal-title":"Can. Respir. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"282","DOI":"10.4269\/ajtmh.2011.11-0207","article-title":"Case report: Melioidosis imported from West Africa to Europe","volume":"85","author":"Cuadros","year":"2011","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"108","DOI":"10.2310\/7060.2005.12208","article-title":"Suppurative epididymo-orchitis and chronic prostatitis caused by Burkholderia pseudomallei: A case report and review","volume":"12","author":"Demar","year":"2005","journal-title":"J. Travel Med."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Demas, A., Labb\u00e9, F., Vandendriessche, A., and Langlois, V. (2023). Focal pachymeningitis in a returning traveler: Don\u2019t forget melioidosis. IDCases, 33.","DOI":"10.1016\/j.idcr.2023.e01834"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"ofz005","DOI":"10.1093\/ofid\/ofz005","article-title":"CNS melioidosis in a traveler returning from Cabo, Mexico","volume":"6","author":"Donahue","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/j.1708-8305.2008.00277.x","article-title":"Melioidosis masquerading as community-acquired pneumonia: A case report demonstrating efficacy of intrapleural fibrinolytic therapy","volume":"16","author":"Duplessis","year":"2009","journal-title":"J. Travel Med."},{"key":"ref_42","first-page":"22","article-title":"Imported melioidosis with an isolated cutaneous presentation in a 90-year-old traveller from Bangladesh","volume":"100","author":"Ezzedine","year":"2007","journal-title":"Bull. Soc. Pathol. Exot."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"S40","DOI":"10.1016\/S0035-9203(08)70011-7","article-title":"\u2018Imported\u2019 melioidosis in Germany: Relapse after 10 years","volume":"102","author":"Frangoulidis","year":"2008","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1017\/S0022215110000381","article-title":"Melioidosis and the vacuum-assisted closure device: A rare cause of a discharging neck wound, and a new approach to management","volume":"124","author":"Garas","year":"2010","journal-title":"J. Laryngol. Otol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.3201\/eid2209.160169","article-title":"Melioidosis in Travelers Returning from Vietnam to France","volume":"22","author":"Gauthier","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_46","first-page":"19758","article-title":"Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010","volume":"16","author":"Abbas","year":"2011","journal-title":"EuroSurveill"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.1007\/s15010-024-02253-6","article-title":"A case of pulmonary melioidosis in Germany: A rare differential diagnosis in returning travelers from South-East Asia","volume":"52","author":"Gottschalk","year":"2024","journal-title":"Infection"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Guilleminault, L., Holstein, A., Azzouz, M., Favelle, O., Lanotte, P., and Diot, P. (2010). Tropical pneumonia: Pulmonary melioidosis. (Une pneumonie exotique \u00e0 ne pas m\u00e9connaitre: La m\u00e9lio\u00efdose pulmonaire.). Rev. Med. Interne, 31.","DOI":"10.1016\/j.revmed.2009.07.019"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.4269\/ajtmh.21-0689","article-title":"Case Report: A Fatal Case of Latent Melioidosis Activated by COVID-19","volume":"106","author":"Gulati","year":"2022","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.eimc.2014.06.003","article-title":"Melioidosis imported from Colombia to Spain. (Melioidosis importada desde Colombia a Espa\u00f1a)","volume":"33","author":"Salas","year":"2015","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_51","first-page":"1","article-title":"[Melioidosis, an important diagnosis in the severely ill traveler] (Melioidos \u2013 en viktig diagnos vid sv\u00e5r sjukdom efter utlandsresa.)","volume":"114","author":"Gylfe","year":"2017","journal-title":"Lakartidningen"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1046\/j.1464-5491.2003.00863.x","article-title":"An unusual cause of diabetic ketoacidosis and fulminant septicaemia","volume":"20","author":"Hassanein","year":"2003","journal-title":"Diabet. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1111\/j.1708-8305.2011.00550.x","article-title":"Two Norwegian patients with melioidosis presenting with bacteraemia and splenic and prostatic abscesses","volume":"18","author":"Hesstvedt","year":"2011","journal-title":"J. Travel Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s15010-002-2112-3","article-title":"A case of imported melioidosis presenting as prostatitis","volume":"31","author":"Heyse","year":"2003","journal-title":"Infection"},{"key":"ref_55","first-page":"7","article-title":"A Case of Prostatic Abscess due to Burkholderia pseudomallei","volume":"81","author":"Hong","year":"2011","journal-title":"Korean J. Med."},{"key":"ref_56","first-page":"246","article-title":"Fatal melioidosis in a tourist returning from Cambodia","volume":"77","year":"2009","journal-title":"Korean J. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"E40","DOI":"10.1111\/tid.12047","article-title":"Expect the unexpected: Pleuro-pulmonary melioidosis in a renal transplant recipient","volume":"15","author":"Jabbar","year":"2013","journal-title":"Transpl. Infect. Dis."},{"key":"ref_58","first-page":"141","article-title":"Burkholderia pseudomallei osteomyelitis: An unusual cause of fever in a returned traveller","volume":"5","author":"Jane","year":"2012","journal-title":"Australas. Med. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/0163-4453(90)91935-7","article-title":"Imported melioidosis in a British native","volume":"21","author":"Jenkins","year":"1990","journal-title":"J. Infect."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.jiac.2016.08.017","article-title":"A fatal case of melioidosis with pancytopenia in a traveler from Indonesia","volume":"23","author":"Katanami","year":"2017","journal-title":"J. Infect. Chemother."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1055\/s-2008-1047585","article-title":"Acute septic course of mellioidosis (Pseud. pseudomallei infection) after a visit to Thailand","volume":"122","author":"Koch","year":"1997","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.tmaid.2015.12.010","article-title":"Melioidosis acquired by a traveler from Papua New Guinea","volume":"14","author":"Kong","year":"2016","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_63","first-page":"2","article-title":"Uw diagnose?","volume":"13","author":"Kraaijenbrink","year":"2018","journal-title":"Tijdschr. Infect."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.2169\/naika.88.1101","article-title":"Case of melioidosis associated with acute empyema and cellulitis of the leg","volume":"88","author":"Kunishima","year":"1999","journal-title":"Nihon Naika Gakkai Zasshi J. Jpn. Soc. Intern. Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"34","DOI":"10.4269\/ajtmh.1999.61.34","article-title":"Melioidosis with adrenal gland abscess","volume":"61","author":"Lee","year":"1999","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"139","DOI":"10.3346\/jkms.2005.20.1.139","article-title":"A case of melioidosis presenting as migrating pulmonary infiltration: The first case in Korea","volume":"20","author":"Lee","year":"2005","journal-title":"J. Korean Med. Sci."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/S0929-6646(09)60171-6","article-title":"Pyogenic Liver Abscess Caused by Burkhoderia pseudomallei in Taiwan","volume":"105","author":"Lee","year":"2006","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_68","first-page":"3","article-title":"Melioidosis","volume":"146","author":"Leeuwenburgh","year":"2002","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_69","first-page":"V12120748","article-title":"Melioidosis in a Danish tourist returning from North-eastern Thailand","volume":"176","author":"Leth","year":"2014","journal-title":"Ugeskr. Laeger"},{"key":"ref_70","first-page":"614","article-title":"Enhancing Diagnosis and Treatment Adjustments for Travelers Infected with Burkholderia pseudomallei: A Case Report\u2014Beijing Municipality, China, June 2023","volume":"6","author":"Li","year":"2024","journal-title":"China CDC Wkly."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"taaa187","DOI":"10.1093\/jtm\/taaa187","article-title":"Cerebral melioidosis in an immunocompromised traveller: An argument for prevention","volume":"28","author":"Lim","year":"2021","journal-title":"J. Travel Med."},{"key":"ref_72","first-page":"920352","article-title":"Sinonasal melioidosis in a returned traveller presenting with nasal cellulitis and sinusitis","volume":"2013","author":"Lim","year":"2013","journal-title":"Case Rep. Otolaryngol."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1179\/joc.2004.16.4.404","article-title":"Melioidosis in a traveller from Thailand: Case report","volume":"16","author":"Maccanti","year":"2004","journal-title":"J. Chemother."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.medmal.2004.10.011","article-title":"Infection \u00e0 Burkholderia pseudomalle\u00ef au retour d\u2019un voyage dans le Sud-est asiatique","volume":"35","author":"Mandjee","year":"2005","journal-title":"M\u00e9d. Mal. Infect."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1097\/QAD.0000000000002205","article-title":"Burkholderia pseudomallei: Prostatic abscesses in an AIDS patient back from Cameroon","volume":"33","author":"Gominet","year":"2019","journal-title":"Aids"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"359","DOI":"10.3201\/eid1802.111603","article-title":"Cutaneous melioidosis in adolescent returning from Guadeloupe","volume":"18","author":"Meckenstock","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Meraj, S., Rodenberg, B., Thannum, S., Sheley, J., and Foreman, J. (2019). Persistent Burkholderia pseudomallei bacteremia in a Filipino immigrant to the United States: A case report. Trop. Med. Infect. Dis., 4.","DOI":"10.3390\/tropicalmed4010020"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.jinf.2011.12.016","article-title":"Melioidosis breast abscesses","volume":"64","author":"Mickail","year":"2012","journal-title":"J. Infect."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0924-8579(99)00071-0","article-title":"Imipenem for the treatment of melioidosis","volume":"12","author":"Minassian","year":"1999","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_80","first-page":"296","article-title":"Melioidosis and renal failure in a Dutch man after a trip to Gambia","volume":"73","author":"Morelli","year":"2015","journal-title":"Neth. J. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.3201\/eid1910.121785","article-title":"Melioidosis in traveler from Africa to Spain","volume":"19","author":"Morosini","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_82","doi-asserted-by":"crossref","unstructured":"Nieminen, T., and Vaara, M. (2005). Burkholderia pseudomallei infections in Finnish tourists injured by the December 2004 tsunami in Thailand. EuroSurveill, 10.","DOI":"10.2807\/esw.10.09.02656-en"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1378\/chest.10-3336","article-title":"Burkholderia pseudomallei infection in a child with cystic fibrosis: Acquisition in the western hemisphere","volume":"140","author":"Torres","year":"2011","journal-title":"Chest"},{"key":"ref_84","first-page":"6206395","article-title":"Burkholderia Aortic Aneurysm: A Case Report and Review of the Literature","volume":"2017","author":"Panginikkod","year":"2017","journal-title":"Case Rep. Infect. Dis."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"315","DOI":"10.3947\/ic.2012.44.4.315","article-title":"Septicemic Melioidosis Presenting as Head and Neck Abscesses","volume":"44","author":"Park","year":"2012","journal-title":"Infect. Chemother."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Patil, C., Mangalagiri, N., Ajmera, P., Kumar Ks, P., and Reddy, H. (2024). A Case Report of Whitmore\u2019s Disease: A True Masquerader. Cureus, 16.","DOI":"10.7759\/cureus.52409"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1086\/517247","article-title":"Melioidosis Brain and Lung Abscess After Travel to Sri Lanka","volume":"28","author":"Peetermans","year":"1999","journal-title":"Clin. Infect. Dis."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.idcr.2016.01.004","article-title":"Burkholderia pseudomallei: First case of melioidosis in Portugal","volume":"3","author":"Pelerito","year":"2016","journal-title":"IDCases"},{"key":"ref_89","first-page":"499","article-title":"Pulmonary melioidosis in a German Southeast Asia tourist: History and clinical findings","volume":"51","author":"Riecke","year":"1997","journal-title":"Pneumologie"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"503","DOI":"10.3201\/eid1903.121329","article-title":"Melioidosis and hairy cell leukemia in 2 travelers returning from Thailand","volume":"19","author":"Rossi","year":"2013","journal-title":"Emerg. Infect. Dis."},{"key":"ref_91","first-page":"859","article-title":"Chronic skin ulcer in a 24-year-old man after a journey to Southeast Asia","volume":"58","author":"Slesak","year":"2017","journal-title":"Internist"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.tmaid.2015.08.007","article-title":"Melioidosis as a travel-associated infection: Case report and review of the literature","volume":"13","author":"Griffiths","year":"2015","journal-title":"Travel Med. Infect. Dis."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.3201\/eid1707.110502","article-title":"Melioidosis acquired by traveler to Nigeria","volume":"17","author":"Salam","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1378\/chest.101.2.555","article-title":"Ceftazidime Monotherapy for Pulmonary Melioidosis in a Traveler Returning from Thailand","volume":"101","author":"Sauerwein","year":"1992","journal-title":"Chest"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1067\/mva.2002.118592","article-title":"Melioidosis presenting as an infected intrathoracic subclavian artery pseudoaneurysm treated with femoral vein interposition graft","volume":"35","author":"Schindler","year":"2002","journal-title":"J. Vasc. Surg."},{"key":"ref_96","doi-asserted-by":"crossref","unstructured":"Schultze, D., M\u00fcller, B., Bruderer, T., Dollenmaier, G., Riehm, J.M., and Boggian, K. (2012). A traveller presenting with severe melioidosis complicated by a pericardial effusion: A case report. BMC Infect. Dis., 12.","DOI":"10.1186\/1471-2334-12-242"},{"key":"ref_97","first-page":"892","article-title":"Fulminant septic melioidosis after a vacation in Thailand","volume":"112","author":"Schwarzmaier","year":"2000","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_98","first-page":"114","article-title":"A case of septicemia and septic pneumonia due to Burkholderia pseudomallei","volume":"36","author":"Seok","year":"2004","journal-title":"Infect. Chemother."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"20","DOI":"10.4103\/2231-0770.127418","article-title":"Reactivation of latent melioidosis presenting with acute pyelonephritis and bacteremia","volume":"4","author":"Shaaban","year":"2014","journal-title":"Avicenna J. Med."},{"key":"ref_100","doi-asserted-by":"crossref","unstructured":"Shrestha, N., Adhikari, M., Pant, V., Baral, S., Shrestha, A., Basnyat, B., Sharma, S., and Sherchand, J.B. (2019). Melioidosis: Misdiagnosed in Nepal. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3793-x"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"199","DOI":"10.3109\/00365549709035886","article-title":"Two patients with recurrent melioidosis after prolonged antibiotic therapy","volume":"29","author":"Silbermann","year":"1997","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/20009666.2017.1348875","article-title":"Melioidosis: The great mimicker","volume":"7","author":"Singh","year":"2017","journal-title":"J. Community Hosp. Intern. Med. Perspect."},{"key":"ref_103","first-page":"A279","article-title":"Melioidosis: The importance of a detailed medical history, including recent travels","volume":"154","author":"Snijders","year":"2010","journal-title":"Ned. Tijdschr. Voor Geneeskd."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"P103","DOI":"10.1055\/s-0034-1367858","article-title":"Case Report: Eine Melioidose in Berlin","volume":"68","author":"Starzacher","year":"2014","journal-title":"Pneumologie"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"e781","DOI":"10.1016\/j.ijid.2013.01.029","article-title":"Melioidosis in a European traveler without comorbidities: A case report and literature review","volume":"17","author":"Subran","year":"2013","journal-title":"Int. J. Infect. Dis."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1080\/00365540500264738","article-title":"Cutaneous melioidosis in a Swedish tourist after the tsunami in 2004","volume":"38","author":"Svensson","year":"2006","journal-title":"Scand J. Infect. Dis"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"62","DOI":"10.5001\/omj.2017.11","article-title":"Imported Case of Melioidosis in Oman: Case Report","volume":"32","author":"Tamtami","year":"2017","journal-title":"Oman Med. J."},{"key":"ref_108","doi-asserted-by":"crossref","unstructured":"Tan Boun, K., Biron, F., Chidiac, C., and Ferry, T. (2012). Imported melioidosis in France revealed by a cracking abdominal mycotic aortic aneurysm in a 61-year-old man. BMJ Case Rep., 2012.","DOI":"10.1136\/bcr-2012-006839"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1111\/j.1468-3083.2006.01785.x","article-title":"Cutaneous melioidosis","volume":"20","author":"Teo","year":"2006","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1016","DOI":"10.1016\/S0140-6736(05)70729-7","article-title":"A deadly thorn: A case of imported melioidosis","volume":"353","author":"Torrens","year":"1999","journal-title":"Lancet"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1086\/317528","article-title":"Travel-associated Burkholderia pseudomallei infection (Melioidosis) in a patient with cystic fibrosis: A case report","volume":"32","author":"Visca","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/infdis\/152.2.424a","article-title":"A case of melioidosis in West Africa","volume":"152","author":"Wall","year":"1985","journal-title":"J. Infect. Dis."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1799","DOI":"10.3201\/eid1511.081719","article-title":"Burkholderia pseudomallei misidentified by automated system","volume":"15","author":"Weissert","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S0163-4453(94)95222-1","article-title":"Fatal melioidosis in a tourist returning from Thailand","volume":"29","author":"Wilks","year":"1994","journal-title":"J. Infect."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00124743-200108000-00010","article-title":"Septic arthritis caused by Burkholderia pseudomallei: Case report and review of the literature","volume":"7","author":"Wooten","year":"2001","journal-title":"J. Clin. Rheumatol."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"53","DOI":"10.2310\/7060.2002.23954","article-title":"Melioidotic Osteomyelitis of the Femur Occurring in a Traveler","volume":"9","author":"Yazdanpanah","year":"2002","journal-title":"J. Travel Med."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1099\/jmm.0.041525-0","article-title":"Misidentification of Burkholderia pseudomallei as Burkholderia cepacia by the VITEK 2 system","volume":"61","author":"Zong","year":"2012","journal-title":"J. Med. Microbiol."},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Pennino, F., Fiorilla, C., Sorrentino, M., Armonia, U., Parisi, A., Mirizzi, P.D., Di Lillo, M., De Silva, O., Montuori, P., and Triassi, M. (2023). Investigating Awareness Regarding Travel-Related Infectious Disease Prevention in a Metropolitan Area. Trop. Med. Infect. Dis., 8.","DOI":"10.3390\/tropicalmed8100476"},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Hinjoy, S., Hantrakun, V., Kongyu, S., Kaewrakmuk, J., Wangrangsimakul, T., Jitsuronk, S., Saengchun, W., Bhengsri, S., Akarachotpong, T., and Thamthitiwat, S. (2018). Melioidosis in Thailand: Present and Future. Trop. Med. Infect. Dis., 3.","DOI":"10.3390\/tropicalmed3020038"},{"key":"ref_120","first-page":"113","article-title":"Thailand as a World Top Tourism Destination: Balancing Growth with Environmental and Cultural Preservation","volume":"9","author":"Sriwapee","year":"2025","journal-title":"Int. J. Multidiscip. Manag. Tour."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"15008","DOI":"10.1038\/nmicrobiol.2015.8","article-title":"Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis","volume":"1","author":"Limmathurotsakul","year":"2016","journal-title":"Nat. Microbiol."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1007\/s13577-023-00905-7","article-title":"Neutrophil (dys) function due to altered immuno-metabolic axis in type 2 diabetes: Implications in combating infections","volume":"36","author":"Thimmappa","year":"2023","journal-title":"Hum. 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