Brought with the wind: A case of melioidosis acquired in the United States presenting with multiple pulmonary nodules
4 affiliations
- 1Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida, United States of America.
- 2Miller School of Medicine, University of Miami, Miami, Florida, United States of America.
- 3Department of Infectious Diseases, University of Florida, Gainesville, Florida, United States of America.
- 4Department of Internal Medicine, Baptist Health South Florida, Boca Raton, Florida, United States of America.
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.
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BibTeX
@article{garciasantisteban2026brought,
title = {{Brought with the wind: A case of melioidosis acquired in the United States presenting with multiple pulmonary nodules}},
author = {Rodrigo Garcia-Santisteban and Maria Kaufman and Hac-Tu Jacqueline Chung and Raphael Khella and Angel Pousa and Winy Kujundzic and Ines Mbaga and Vlad Voin},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = oct,
doi = {10.1371/journal.pntd.0014790},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014790},
note = {CC BY},
}
RIS
TY - JOUR
TI - Brought with the wind: A case of melioidosis acquired in the United States presenting with multiple pulmonary nodules
AU - Rodrigo Garcia-Santisteban
AU - Maria Kaufman
AU - Hac-Tu Jacqueline Chung
AU - Raphael Khella
AU - Angel Pousa
AU - Winy Kujundzic
AU - Ines Mbaga
AU - Vlad Voin
PY - 2026
DA - 2026/10/12
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014790
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014790
AB - 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.
SN - 1935-2735
SN - 1935-2727
ER -