Diabetic foot osteomyelitis caused by Burkholderia pseudomallei: first case report from Türkiye and a review of literature

Abstract

Introduction: Burkholderia pseudomalleiis a non-fermenting, motile, Gram-negative, saprophytic bacillus that causes melioidosis. It is typically found as an endemic agent in South-eastern Asia and northern Australia. The primary transmission route is most likely percutaneous inoculation from wet soils or contaminated water. B. pseudomallei can cause a wide range of human diseases, including bacteremia, abscesses, osteomyelitis, and septic arthritis. Diabetes mellitus, renal disease, alcoholism, liver cirrhosis, and thalassemia are known predisposing factors. Mortality from melioidosis depends on clinical presentation, ranging from 2% (skin and soft tissue infections) to 21% (neurological disease).

Case Report: We reported a patient with a diabetic foot infection whose wound drainage yielded B. pseudomallei as the infecting agent. Due to the organism’s rarity in our country, we searched with the keywords “melioidosis” and “osteomyelitis” in Pubmed on 09.07.2024. Among the 88 results displayed, there is a variety of case reports about septic arthritis, osteomyelitis, foot and splenic abscesses, acute cholangitis, pneumonia, pericarditis, and even cerebritis and subdural collections in patients with B. pseudomallei infections. These reports and studies mostly come from Middle Eastern and South Asian countries. There are also two previous reports of this microorganism from our country, but to our knowledge, this case is the first B. pseudomallei diabetic foot infection from Türkiye.

Conclusions: This case signifies the appropriate sample collection practices for diabetic foot infections are important even in outpatient settings.