{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T15:39:52Z","timestamp":1792510792968,"version":"4.5.0"},"reference-count":27,"publisher":"American Society of Tropical Medicine and Hygiene","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,20]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Melioidosis, caused by\n                    <jats:italic>Burkholderia pseudomallei<\/jats:italic>\n                    , is endemic in Southeast Asia. Over 90% of cases present acutely. The reactivation of latent melioidosis in endemic regions is difficult to diagnose, and the incidence is unknown. We report two previously healthy middle-age women from Limbang, Malaysian Borneo, who were newly diagnosed with systemic lupus erythematosus. They developed fulminant sepsis due to culture-confirmed melioidosis 4 to 8 weeks after starting immunosuppressive therapy. They had pneumonia and multiorgan microabscesses. One patient survived, whereas the other succumbed to illness. Diagnosing the reactivation of latent melioidosis in endemic regions is impeded by substantial gaps in clinical evaluation and laboratory diagnostic capacity, particularly within resource-limited health care systems. Maintaining high clinical vigilance for reactivation, promptly identifying disseminated disease, and initiating targeted therapy early are critical during the initiation and administration of immunosuppressive treatment. Pre-immunosuppression risk assessment and potential prophylactic strategies in high-risk individuals may help reduce the associated morbidity and mortality.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0316","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:50:48Z","timestamp":1792507848000},"source":"Crossref","is-referenced-by-count":0,"title":["Latent Melioidosis Reactivation Following Immunosuppression in Malaysia: A Report of Two Cases"],"prefix":"10.4269","author":[{"given":"Tonnii","family":"Sia","sequence":"first","affiliation":[{"name":"Department of Medicine, Miri Hospital, Miri, Sarawak, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teik Yiap","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Miri Hospital, Miri, Sarawak, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guat-Yee","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Medicine, Limbang Hospital, Limbang, Sarawak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wun-Khang","family":"Chong","sequence":"additional","affiliation":[{"name":"Department of Medicine, Limbang Hospital, Limbang, Sarawak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Front Public Health","first-page":"1423420","article-title":"Shared challenges to the control of complex intracellular neglected pathogens","volume":"12","author":"Perez","year":"2024"},{"key":"b2","series-title":"Nat Microbiol","first-page":"15008","article-title":"Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis","volume":"1","author":"Limmathurotsakul","year":"2016"},{"issue":"1","key":"b3","series-title":"CMI 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2015\u20132019","volume":"38","author":"Hadi","year":"2021"},{"issue":"7","key":"b20","series-title":"Emerg Infect Dis","first-page":"e2","article-title":"Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei.","volume":"14","author":"Peacock","year":"2008"},{"issue":"1","key":"b21","series-title":"Kidney Int Rep","first-page":"160","article-title":"Trimethoprim+sulfamethoxazole reduces rates of melioidosis in high-risk hemodialysis patients","volume":"3","author":"Majoni","year":"2018"},{"issue":"11","key":"b22","series-title":"Pathogens","first-page":"943","article-title":"The incidence, aetiology and clinical course of serious infections complicating biological and targeted synthetic disease-modifying antirheumatic drug therapy in patients with rheumatoid arthritis in tropical Australia","volume":"13","author":"Price","year":"2024"},{"issue":"4","key":"b23","series-title":"Commun Dis Intell Q Rep","first-page":"526","article-title":"Prevention of 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