Melioidosis: Burkholderia pseudomallei technical challenges in identification and susceptibility testing in a non-endemic area

We report the isolation Burkholderia pseudomallei from a 69-year-old of Thai descent who presented in our hospital in central Sydney, Ausralia. This case highlights the technical challenges of identifying melioidosis in a non-endemic region. In our case confirming the diagnosis of melioidosis was difficult due to the misreporting of this isolate with a MALDI-TOF high score as B. thailandensis by MALDI-TOF-MS without the proper laboratory Maldi-Biotyper Security-Relevant library database software. The initial diagnosis of melioidosis was founded on suspicion from the clinical microbiologists based on history and an understanding of the mis-categorisation of B. pseudomallei as B. thailandensis. While EUCAST have antibiotic susceptibility testing for B. pseudomallei isolates, correctly reading the inhibition zone especially for trimethoprim/sulfamethoxazole, is important to ensure AST is appropriately reported, since this is the antibiotic used for the eradication phase of treatment for melioidosis.