{ "abstract": "Burkholderia pseudomallei, the causative agent of melioidosis, is a gram-negative bacterium historically endemic to Southeast Asia and Northern Australia. However, recent environmental detection along the Gulf Coast and an increasing number of reported cases in non-travelers have raised questions regarding potential endemicity and environmental establishment in the Southern United States. We report a case of putatively locally acquired pulmonary melioidosis in a Florida resident with no recent international travel history, illustrating the diagnostic and therapeutic challenges posed by this rare pathogen. The patient presented with fever, pleuritic chest pain, and hypoxia following a period of severe weather. Computed tomography (CT) of the chest revealed multiple solid pulmonary nodules with ground-glass opacities and mediastinal lymphadenopathy. Given his underlying stage 3b chronic kidney disease (CKD), the patient was treated with an intensive course of intravenous ceftazidime followed by oral doxycycline monotherapy, achieving full clinical recovery. Follow-up imaging at 3 months demonstrated complete resolution of the pulmonary nodules. This case emphasizes the importance of considering melioidosis in the differential diagnosis for non-resolving community-acquired pneumonia or significant pulmonary nodules in the Southern United States, even in the absence of international travel. Risk factors such as diabetes mellitus and severe weather events are key clinical clues. While trimethoprim-sulfamethoxazole remains the preferred eradication therapy, doxycycline may serve as a potential alternative for patients with renal impairment when first-line therapy is contraindicated. Author summary: We describe a case of melioidosis, a serious infection caused by the bacterium Burkholderia pseudomallei, in a Florida resident who had not traveled internationally. Historically, this disease was only found in tropical regions like Southeast Asia and Northern Australia. However, this case adds to a small number of reported infections in individuals without travel history, highlighting the need to remain vigilant for possible local exposures in the Southern United States. Our patient, a 70-year-old man with diabetes and chronic kidney disease, developed severe pneumonia with multiple lung nodules and swollen lymph nodes following a period of heavy rainfall and hurricanes. These weather events can make it easier for individuals to breathe in the bacteria. Because this disease is rare in the United States, it is often misidentified or overlooked, which can be dangerous and lead to delays in treatment. We successfully treated our patient with a long course of antibiotics, including ceftazidime and doxycycline, resulting in complete clinical recovery and total resolution of his lung nodules. This case demonstrates that even when the standard drug, trimethoprim-sulfamethoxazole, cannot be used due to kidney issues, alternative treatments, such as doxycycline, may be considered as potential treatment options. Ultimately, this case serves as a vital reminder for healthcare providers along the Gulf Coast to consider melioidosis in patients with lung infections, even if they have never left the US.", "abstract_shown": true, "affiliations": [ "Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, United States of America.", "Miller School of Medicine, University of Miami, Miami, Florida, United States of America.", "Department of Infectious Diseases, University of Florida, Gainesville, Florida, United States of America.", "Department of Internal Medicine, Baptist Health South Florida, Boca Raton, Florida, United States of America." ], "article_type": "Research Article", "arxiv": null, "author_total": 8, "authors": [ { "affs": [ 0 ], "name": "Rodrigo Garcia-Santisteban" }, { "affs": [ 1 ], "name": "Maria Kaufman", "orcid": "0009-0006-1192-3742" }, { "affs": [ 2 ], "name": "Hac-Tu Jacqueline Chung" }, { "affs": [ 0 ], "name": "Raphael Khella" }, { "affs": [ 0 ], "name": "Angel Pousa" }, { "affs": [ 0 ], "name": "Winy Kujundzic" }, { "affs": [ 3 ], "name": "Ines Mbaga" }, { "affs": [ 3 ], "name": "Vlad Voin" } ], "bibtex": "https://research.draconitic.com/paper/drs5cjxvkyaar.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014790", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014790", "id": "drs5cjxvkyaar", "issns": [ "1935-2735", "1935-2727" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014790", "language": "eng", "licence": "CC-BY", "licence_label": "CC BY", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2713|Burkholderia infections and melioidosis" ], [ "plos", "/Biology and life sciences/Anatomy/Lymphatic system/Lymph nodes" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Bacterial pathogens/Burkholderia/Burkholderia pseudomallei" ], [ "plos", "/Biology and life sciences/Microbiology/Microbial control/Antimicrobials/Antibiotics/Doxycycline" ], [ "plos", "/Biology and life sciences/Neuroscience/Neuroimaging/Computed axial tomography" ], [ "plos", "/Biology and life sciences/Organisms/Bacteria/Burkholderia/Burkholderia pseudomallei" ], [ "plos", "/Medicine and health sciences/Anatomy/Lymphatic system/Lymph nodes" ], [ "plos", "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Medicine and health sciences/Endocrinology/Endocrine disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Bacterial diseases/Melioidosis" ], [ "plos", "/Medicine and health sciences/Medical conditions/Metabolic disorders/Diabetes mellitus" ], [ "plos", "/Medicine and health sciences/Nephrology/Renal diseases/Chronic kidney disease" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Bacterial pathogens/Burkholderia/Burkholderia pseudomallei" ], [ "plos", "/Medicine and health sciences/Pharmacology/Drugs/Antimalarials/Doxycycline" ], [ "plos", "/Medicine and health sciences/Pharmacology/Drugs/Antimicrobials/Antibiotics/Doxycycline" ], [ "plos", "/Medicine and health sciences/Pulmonology/Pneumonia" ], [ "plos", "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Tomography/Computed axial tomography" ], [ "plos", "/Research and analysis methods/Imaging techniques/Neuroimaging/Computed axial tomography" ] ], "openalex": "W7221546541", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014790&type=printable", "pmcid": "PMC13674857", "pmid": "42862852", "published": "2026-10-12", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/drs5cjxvkyaar.ris", "sources": [ { "first_seen": "2026-10-30T12:17:30Z", "native_id": "10.1371/journal.pntd.0014790", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014790" }, { "first_seen": "2026-10-30T12:19:00Z", "native_id": "MED:42862852", "source": "europepmc", "url": "https://europepmc.org/article/MED/42862852" } ], "subjects": [ { "field": "biology", "origin": "plos:microbiology", "subfield": "microbiology" }, { "field": "medicine", "origin": "plos:diagnostic radiology", "subfield": "imaging" }, { "field": "medicine", "origin": "plos:anatomy", "subfield": "physiology" } ], "title": "Brought with the wind: A case of melioidosis acquired in the United States presenting with multiple pulmonary nodules", "title_text": "Brought with the wind: A case of melioidosis acquired in the United States presenting with multiple pulmonary nodules", "type": "peer-reviewed", "updated_at": "2026-10-30T12:19:00Z", "url": "https://research.draconitic.com/paper/drs5cjxvkyaar", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }