Fatal urosepsis due to delayed diagnosis of genitourinary melioidosis

Abstract

Background: Two months after a vacation in Thailand, a 54-year-old alcohol-addicted diabetes patient was admitted to hospital presenting with a febrile, therapy-refractory urinary tract infection. Burkholderia pseudomallei was cultured from urine but misidentified as Burkholderia cepacia. Application of inappropriate chemotherapy provoked systemic spread of bacteria from urinary tract abscesses. Septic shock and respiratory failure resulted in a fatal outcome. Results: Correct identification at the species level was achieved by 16S rRNA gene sequencing. Postmortem, B. pseudomallei was additionally detected in prostatic tissue by PCR and fluorescence in situ hybridization. Conclusions: Biochemical differentiation of bacteria of the genus Burkholderia is not reliable at the species level. Molecular approaches should be added if an infection with B. pseudomallei is probable according to clinical anamnesis. The recommended dosage of antibiotic drugs should be at the upper limit if abscess formation is likely.