Severe Hepatosplenic Abscesses and Septicemia Caused by Burkholderia thailandensis in a Hemodialysis Patient

Severe Hepatosplenic Abscesses and Septicemia Caused by Burkholderia thailandensis in a Hemodialysis Patient | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Severe Hepatosplenic Abscesses and Septicemia Caused by Burkholderia thailandensis in a Hemodialysis Patient Sirachat Nitchaphanit, Chutchawan Ungthammakhun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7393216/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Burkholderia thailandensis , an environmental saprophyte closely related to B. pseudomallei , is generally considered non-pathogenic but can rarely causes human disease. We report a case of B. thailandensis septicemia with hepatosplenic abscesses in a 58-year-old Thai male with end-stage kidney disease undergoing long term hemodialysis. The patient presented with prolonged fever following freshwater exposure. CT scan of chest and abdomen revealed hepatosplenic abscesses along with cavitary lung nodules. Blood culture grew B. thailandensis , confirmed by MALDI-TOF MS and 16S rRNA sequencing. This case highlights the potential of B. thailandensis to cause life-threatening infections in immunocompromised patients. It also emphasizes the importance of advance microbiological diagnostic to distinguish it from B. pseudomallei , due to their clinical and microbiological similarities but differing pathogenicity and epidemiological implication Burkholderia thailandensis hepatosplenic abscess end stage kidney disease Figures Figure 1 Figure 2 Figure 3 Introduction Burkholderia thailandensis is a gram-negative, non-fermentative bacillus closely related to B. pseudomallei , the causative agent of melioidosis. Although B. thailandensis shares over 99% sequence identity with B. pseudomallei [ 1 ], it is generally regarded as non-pathogenic to humans due to the absence of several key virulence determinants [ 2 , 3 ]. Nevertheless, sporadic cases of human infections have been reported, particularly in Southeast Asia and among immunocompromised individuals. The clinical significance of B. thailandensis remains poorly understood and may be underdiagnosed due to its phenotypic and biochemical similarities with B. pseudomallei . Advanced diagnostics, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), species-specific PCR [ 4 ], or gene sequencing [ 5 ] are essential for accurate species identification. Here, we describe a rare and severe case of disseminated B. thailandensis infection in a patient with end-stage kidney disease (ESKD) on hemodialysis, who presented with septic shock, hepatosplenic abscesses, and bacteremia. Case presentation A 58-year-old Thai male presented with a 3-week history of intermittent fever and worsening fatigue. He was a taxi driver with a known history of ESKD due to diabetic nephropathy, receiving hemodialysis via a tunnel-cuffed right internal jugular vein catheter twice weekly for the past four months. Additional comorbidities included poorly controlled type 2 diabetes mellitus (HbA1c 12.6%) and hypertension. Approximately one month prior to symptom onset, he traveled to Chachoengsao province, where he visited a rural area and participated in recreational activities involving full-body immersion in a freshwater pond, during which he caught freshwater shrimp. Notably, the exit site of his catheter was also submerged in the pond water during this exposure. Three weeks before admission, he developed low-grade fever without specific symptoms. He remained functionally independent until one week prior to admission, when he began experiencing daily high-grade fevers with chills, fatigue, and anorexia. Two days before admission, the symptoms worsened following a routine dialysis session. One day before hospitalization, he was found by family members to be febrile, weak, and mostly bedbound, prompting hospital referral. On physical examination, the patient appeared acutely ill. His vital signs revealed a temperature of 38.0°C, heart rate of 85 beats per minute, blood pressure of 80/40 mmHg, respiratory rate of 24 breaths per minute and oxygen saturation of 98% on room air. Abdominal examination revealed tenderness in both the right and left upper quadrants, with positive splenic dullness. Initial laboratory investigations showed: hemoglobin 9.2 g/dL, MCV 66.5 fL, WBC 8,600/mm³ (96.4% neutrophils), platelets count of 57,000/mm³. Liver enzymes were markedly elevated: AST 1,399 U/L, ALT 302 U/L, ALP 469 U/L, with total/direct bilirubin 2.21/2.13 mg/dL. Electrolytes and acid-base studies revealed hyponatremia (Na 128.2 mEq/L), hyperkalemia (K 5.18 mEq/L), severe metabolic acidosis (HCO 3 4.9 mEq/L), and markedly elevated lactate (15.2 mmol/L). Coagulation studies revealed prolonged INR (3.05), elevated APTT ratio (2.18), and markedly elevated D-dimer (36,346 ng/mL). A contrast-enhanced CT scan of the abdomen demonstrated multiple small hypodense lesions in the liver suggestive of microabscesses (up to 1.3 cm) located in the subcapsular region of hepatic segment 2. A large multiloculated splenic abscess (4.5 x 7.4 x 6.3 cm) at lower pole of spleen. Additionally multiple enlarged non-necrotic and necrotic lymph nodes at paraaortic, aortocaval and retrocaval regions, along with mild ascites (Figs. 1 ). Blood cultures obtained on admission became positive within 24 hours. Specifically, the culture from the hemodialysis catheter flagged positive at 24 hours and 29 minutes, while the peripheral blood sample became positive at 26 hours and 38 minutes. Gram stain revealed gram-negative bacilli (Figs. 2 and 3 ). Biochemical testing demonstrated triple sugar iron (TSI) K/K reaction, oxidase positivity, and positive arabinose assimilation (Ara+). MALDI-TOF MS (Bruker MALDI Biotyper, database version 13) identified the isolate as Burkholderia thailandensis with a score of 1.95. Although the MALDI-TOF MS score of 1.95 was below the typical confidence threshold, species-level identification, the diagnosis was supported by the positive arabinose assimilation and clinical correlation. Antimicrobial susceptibility testing by automated broth microdilution (ARIS 2X AST System) demonstrated that the isolate was susceptible to ceftazidime (MIC = 4 µg/mL), imipenem (MIC ≤ 0.5 µg/mL), amoxicillin-clavulanate (MIC ≤ 4/2 µg/mL), and trimethoprim-sulfamethoxazole (MIC ≤ 1/19 µg/mL). Interestingly, 16S rRNA gene sequencing (700 base pairs) from splenic abscess tissue obtained during splenectomy yielded a result consistent with B. pseudomallei . Given the high degree of sequence similarity between these species, this discordance reflects a known limitation of 16S rRNA sequencing in distinguishing B. thailandensis from B. pseudomallei . Due to high genetic similarity, the 16S rRNA sequence matched B. pseudomallei with 99% identity but could not resolve species-level differences. Consequently, the isolate was ultimately confirmed as B. thailandensis through concordant MALDI-TOF MS identification and a positive arabinose assimilation test, which is characteristic of B. thailandensis but negative in B. pseudomallei . The patient was diagnosed with disseminated Burkholderia thailandensis infection, presenting with septic shock, hepatosplenic abscesses and bacteremia. Initial treatment included intravenous meropenem combined with trimethoprim-sulfamethoxazole. Due to ongoing sepsis and poor clinical response, a total splenectomy was performed. After clinical improvement, the antibiotic regimen was de-escalated to ceftazidime. Despite initial improvement, the patient developed multiple episodes of nosocomial infections during hospitalization and ultimately died due to complications related to his illness. Discussion Burkholderia thailandensis is a saprophytic, aerobic gram-negative bacillus endemic to Southeast Asia [ 6 ]. Although genetically similar to B. pseudomallei , it lacks the capsular polysaccharide synthesis genes required for full virulence [ 2 , 3 ]. Its identification is complicated by its phenotypic similarity to B. pseudomallei , especially in resource-limited settings. In this patient’s exposure to freshwater which is known reservoirs for environmental Burkholderia spp. that provides a plausible route of infection. Multiple risk factors including ESKD, hemodialysis, diabetes, and recent environmental exposure likely predisposed the patients to invasive infection. Previous reports of B. thailandensis infection have included wound infection [ 7 – 9 ], skin abscesses [ 10 , 11 ], mediastinal lymphadenitis [ 12 ], and pneumonia [ 1 , 12 , 13 ] However, this case represent one of the first to describe disseminated infection with hepatosplenic abscesses and septicemia. Given the similarity of B. thailandensis to B. pseudomallei , accurate differentiation is crucial for understanding epidemiology and guiding treatment. Conventional biochemical tests may be insufficient. Advance techniques such as MALDI-TOF MS, Burkholderia species specific PCR [ 10 ] and, gene sequencing offers greater specificity. (Table 1 ) Clinicians should suspect B. thailandensis in patients with compatible clinical picture and environmental exposure, particularly when the clinical course appears less aggressive than typical melioidosis. In this patients, the infection’s severity was likely modulated by host factors despite the typically low virulence of the organism. While specific susceptibility data are limited, B. thailandensis is often sensitive to ceftazidime, meropenem, and trimethoprim-sulfamethoxazole [ 14 ]. Table 1 Previous reported cases of infections caused by B. thailandensis Author Patient Characteristic Diagnosis Diagnostic method Treatment and Prognosis Vannachone S et al. (2024) [ 10 ] Male, 44 years old, Laos Foot abscess Burkholderia species specific PCR Ceftazidime; recovered Asawaplungkul J (2022) [ 12 ] Male, 49 years old Monk, Thailand Mediastinal lymphadenopathy and pneumonia MALDI-TOF MS, Biochemical test (API-20NE), Ara+ Ceftazidime + trimethoprim-sulfamethoxazole for 5 weeks; recovered Li J et al. (2024) [ 7 ] Male, 61 years old, China (Farmer), diabetes mellitus Infected wound of the foot with osteomyelitis Biochemical test (API-20NE), Ara+ Meropenem; died Gee JE et al. (2018) [ 15 ] Female, 29 years old, USA, diabetes mellitus Surgical site infection of open bone forearm fracture MALDI-TOF MS Ceftazidime for 6 weeks; recovered Zueter AR et al. (2016) [ 11 ] Male, 42 years old, Malaysia Foot abscess with ankle cellulitis Biochemical test (API NE), Ara+ Ceftazidime; recovered Chang K et al. (2017) [ 13 ] Male, 67 years old, China Pneumonia Biochemical test (API-20NE), Ara+ Meropenem; died Glass MB et al. (2006) [ 1 ] Male, 2 years old, USA Pneumonia and septicemia Biochemical test, Ara+ Ceftazidime + trimethoprim-sulfamethoxazole 4 weeks, then ciprofloxacin + trimethoprim-sulfamethoxazole for 18 weeks; recovered Lertpatanasuwan N et al. (1999) [ 8 ] Male, 16 years old, Thailand Infected wound of the leg Biochemical test (API-20NE), Ara+ Ceftazidime then cefoperazone/sulbactam 17 days then trimethoprim-sulfamethoxazole + doxycycline 20 weeks; recovered Conclusion This case illustrates the pathogenic potential of Burkholderia thailandensis in ESKD receiving hemodialysis individuals and emphasizes the need for accurate diagnostic tools that mimic melioidosis. Although B. thailandensis and B. pseudomallei share overlapping phenotypic and clinical characteristics, reliable differentiation requires specialized techniques such as MALDI-TOF MS, arabinose assimilation testing, or other advanced biochemical and molecular methods. Awareness of B. thailandensis as an emerging pathogen is important for clinicians in endemic areas. While treatment regimens for B. thailandensis and B. pseudomallei are generally similar, precise species identification remains essential for epidemiological surveillance, infection control, and improved understanding of the clinical disease spectrum of B. thailandensis infection. Declarations Authorship statement All authors meet the ICMJE authorship criteria. All authors participated in the diagnosis, management, and/or care of the patient. All authors wrote the draft and revised the manuscript for important intellectual content. All authors were responsible for patient care and supervised the writing of the manuscript. All authors read and approved the final manuscript. Declaration of competing interest The authors declare they have no potential conflict of interest relevant to this article. Patient declaration of consent statement The patient has provided written informed consent for the publication of this report and the accompanying images. Funding This manuscript received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. References Glass MB, Gee JE, Steigerwalt AG, Cavuoti D, Barton T, Hardy RD, et al. Pneumonia and septicemia caused by Burkholderia thailandensis in the United States. J Clin Microbiol 2006;44:4601–4. https://doi.org/10.1128/JCM.01585-06. Hantrakun V, Thaipadungpanit J, Rongkard P, Srilohasin P, Amornchai P, Langla S, et al. Presence of B. thailandensis and B. thailandensis expressing B. pseudomallei-like capsular polysaccharide in Thailand, and their associations with serological response to B. pseudomallei. PLoS Negl Trop Dis 2018;12. https://doi.org/10.1371/journal.pntd.0006193. DeShazer D. Virulence of clinical and environmental isolates of Burkholderia oklahomensis and Burkholderia thailandensis in hamsters and mice. FEMS Microbiol Lett 2007;277:64–9. https://doi.org/10.1111/j.1574-6968.2007.00946.x. Novak RT, Glass MB, Gee JE, Gal D, Mayo MJ, Currie BJ, et al. Development and Evaluation of a Real-Time PCR Assay Targeting the Type III Secretion System of Burkholderia pseudomallei. J Clin Microbiol 2006;44:85–90. https://doi.org/10.1128/JCM.44.1.85-90.2006. Woo PCY, Woo GKS, Lau SKP, Wong SSY, Yuen K. Single gene target bacterial identification: groEL gene sequencing for discriminating clinical isolates of Burkholderia pseudomallei and Burkholderia thailandensis. Diagn Microbiol Infect Dis 2002;44:143–9. https://doi.org/10.1016/S0732-8893(02)00439-X. Hantrakun V, Thaipadungpanit J, Rongkard P, Srilohasin P, Amornchai P, Langla S, et al. Presence of B. thailandensis and B. thailandensis expressing B. pseudomallei-like capsular polysaccharide in Thailand, and their associations with serological response to B. pseudomallei. PLoS Negl Trop Dis 2018;12. https://doi.org/10.1371/journal.pntd.0006193. Li J, Tan J, Xiong X, Zhong Q, Lu W. Burkholderia thailandensis Isolated from Infected Wound, Southwest China, 2022. Emerg Infect Dis 2024;30. https://doi.org/10.3201/eid3005.230743. Lertpatanasuwan N, Sermsri K, Petkaseam A, Trakulsomboon S, Thamlikitkul V, Suputtamongkol Y. Arabinose‐Positive Burkholderia pseudomallei Infection in Humans: Case Report. Clinical Infectious Diseases 1999;28:927–8. https://doi.org/10.1086/517253. Glass MB, Steigerwalt AG, Jordan JG, Wilkins PP, Gee JE. Burkholderia oklahomensis sp. nov., a Burkholderia pseudomallei-like species formerly known as the Oklahoma strain of Pseudomonas pseudomallei. Int J Syst Evol Microbiol 2006;56:2171–6. https://doi.org/10.1099/ijs.0.63991-0. Vannachone S, Luangraj M, Dance D, Chantratita N, Saiprom N, Seng R, et al. Case Report: Soft tissue infection with Burkholderia thailandensis capsular variant: case report from the Lao PDR. Wellcome Open Res 2024;9. https://doi.org/10.12688/wellcomeopenres.22706.1. Zueter A. Skin infection caused by Burkholderia thailandensis: Case report with review. Journal of Microbiology and Infectious Diseases 2016:92–5. https://doi.org/10.5799/ahinjs.02.2016.02.0224. Asawaplungkul J. A case report: Mediastinal lymph node infection caused by Burkholderia thailandensis in a Thai monk. Dis Control J. 2022;48(4). n.d. https://doi.org/10.14456/dcj.2022.78. Chang K, Luo J, Xu H, Li M, Zhang F, Li J, et al. Human Infection with Burkholderia thailandensis , China, 2013. Emerg Infect Dis 2017;23:1416–8. https://doi.org/10.3201/eid2308.170048. Wuthiekanun V, Smith MD, Dance DAB, Walsh AL, Pitt TL, White NJ. Biochemical characteristics of clinical and environmental isolates of Burkholderia pseudomallei. J Med Microbiol 1996;45:408–12. https://doi.org/10.1099/00222615-45-6-408. Gee JE, Elrod MG, Gulvik CA, Haselow DT, Waters C, Liu L, et al. Burkholderia thailandensis isolated from infected wound, Arkansas, USA. Emerg Infect Dis 2018;24:2091–4. https://doi.org/10.3201/eid2411.180821. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7393216","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":501594989,"identity":"5859c580-a13d-427f-aa2c-9f44dd727c3d","order_by":0,"name":"Sirachat Nitchaphanit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAt0lEQVRIiWNgGAWjYBAC+wYGBgkgLQcXMSCkxeAARIsxTECCaC2JDcRrOd578HZBzbb07eynExh+1DDUmRPSYt9zLtl6xrHbuTt7cjcw9hxjkLBsIKDFQCLHTJq34Xbuhhu8Gxh4G4AOO0CklnQDoBbGv6RoSQBpYSbOFp4zxiC/GIL8cljmmITkBoJa2HsMgSF2W96c/ezGh29qbPgJ2gICzGC9QHwAEkekaBkFo2AUjIJRgBUAAF83PzBgbH1UAAAAAElFTkSuQmCC","orcid":"","institution":"Phramongkutklao Hospital and College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Sirachat","middleName":"","lastName":"Nitchaphanit","suffix":""},{"id":501594990,"identity":"5b560d44-98db-4122-8be8-c2e7c2827b66","order_by":1,"name":"Chutchawan Ungthammakhun","email":"","orcid":"","institution":"Phramongkutklao Hospital and College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Chutchawan","middleName":"","lastName":"Ungthammakhun","suffix":""}],"badges":[],"createdAt":"2025-08-17 15:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7393216/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7393216/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":89389673,"identity":"8d400a09-6a8d-4a93-a9dc-ecbde4936a11","added_by":"auto","created_at":"2025-08-19 12:49:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":187958,"visible":true,"origin":"","legend":"\u003cp\u003eContrast-enhanced abdominal CT showing multiloculated splenic abscess\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7393216/v1/baa6cd0ec8db3d45c638f25c.png"},{"id":89389672,"identity":"8aeabeeb-d8ff-490a-86f3-4032f58c5e26","added_by":"auto","created_at":"2025-08-19 12:49:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":169721,"visible":true,"origin":"","legend":"\u003cp\u003eWrinkled colonies of \u003cem\u003eBurkholderia thailandensis\u003c/em\u003e on blood agar\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7393216/v1/c6950ae7985a6b50f7207f3c.png"},{"id":89389674,"identity":"e6307e51-be11-4528-8ccb-221e3851abef","added_by":"auto","created_at":"2025-08-19 12:49:57","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":146516,"visible":true,"origin":"","legend":"\u003cp\u003eGram stain from positive blood culture showing gram-negative bacilli (X1000 magnification)\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7393216/v1/033f6302e73a04c93922d308.png"},{"id":89781965,"identity":"7b2e0a99-1bf4-402f-9243-83f41da8723a","added_by":"auto","created_at":"2025-08-25 02:38:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":907299,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7393216/v1/951078e5-5724-4647-9403-841ada990179.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Severe Hepatosplenic Abscesses and Septicemia Caused by Burkholderia thailandensis in a Hemodialysis Patient","fulltext":[{"header":"Introduction","content":"\u003cp\u003e\u003cem\u003eBurkholderia thailandensis\u003c/em\u003e is a gram-negative, non-fermentative bacillus closely related to \u003cem\u003eB. pseudomallei\u003c/em\u003e, the causative agent of melioidosis. Although \u003cem\u003eB. thailandensis\u003c/em\u003e shares over 99% sequence identity with \u003cem\u003eB. pseudomallei\u003c/em\u003e [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], it is generally regarded as non-pathogenic to humans due to the absence of several key virulence determinants [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Nevertheless, sporadic cases of human infections have been reported, particularly in Southeast Asia and among immunocompromised individuals.\u003c/p\u003e\u003cp\u003eThe clinical significance of \u003cem\u003eB. thailandensis\u003c/em\u003e remains poorly understood and may be underdiagnosed due to its phenotypic and biochemical similarities with \u003cem\u003eB. pseudomallei\u003c/em\u003e. Advanced diagnostics, such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), species-specific PCR [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], or gene sequencing [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] are essential for accurate species identification. Here, we describe a rare and severe case of disseminated \u003cem\u003eB. thailandensis\u003c/em\u003e infection in a patient with end-stage kidney disease (ESKD) on hemodialysis, who presented with septic shock, hepatosplenic abscesses, and bacteremia.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 58-year-old Thai male presented with a 3-week history of intermittent fever and worsening fatigue. He was a taxi driver with a known history of ESKD due to diabetic nephropathy, receiving hemodialysis via a tunnel-cuffed right internal jugular vein catheter twice weekly for the past four months. Additional comorbidities included poorly controlled type 2 diabetes mellitus (HbA1c 12.6%) and hypertension.\u003c/p\u003e\u003cp\u003eApproximately one month prior to symptom onset, he traveled to Chachoengsao province, where he visited a rural area and participated in recreational activities involving full-body immersion in a freshwater pond, during which he caught freshwater shrimp. Notably, the exit site of his catheter was also submerged in the pond water during this exposure. Three weeks before admission, he developed low-grade fever without specific symptoms. He remained functionally independent until one week prior to admission, when he began experiencing daily high-grade fevers with chills, fatigue, and anorexia. Two days before admission, the symptoms worsened following a routine dialysis session. One day before hospitalization, he was found by family members to be febrile, weak, and mostly bedbound, prompting hospital referral.\u003c/p\u003e\u003cp\u003eOn physical examination, the patient appeared acutely ill. His vital signs revealed a temperature of 38.0\u0026deg;C, heart rate of 85 beats per minute, blood pressure of 80/40 mmHg, respiratory rate of 24 breaths per minute and oxygen saturation of 98% on room air. Abdominal examination revealed tenderness in both the right and left upper quadrants, with positive splenic dullness.\u003c/p\u003e\u003cp\u003eInitial laboratory investigations showed: hemoglobin 9.2 g/dL, MCV 66.5 fL, WBC 8,600/mm\u0026sup3; (96.4% neutrophils), platelets count of 57,000/mm\u0026sup3;. Liver enzymes were markedly elevated: AST 1,399 U/L, ALT 302 U/L, ALP 469 U/L, with total/direct bilirubin 2.21/2.13 mg/dL. Electrolytes and acid-base studies revealed hyponatremia (Na 128.2 mEq/L), hyperkalemia (K 5.18 mEq/L), severe metabolic acidosis (HCO\u003csub\u003e3\u003c/sub\u003e 4.9 mEq/L), and markedly elevated lactate (15.2 mmol/L). Coagulation studies revealed prolonged INR (3.05), elevated APTT ratio (2.18), and markedly elevated D-dimer (36,346 ng/mL).\u003c/p\u003e\u003cp\u003eA contrast-enhanced CT scan of the abdomen demonstrated multiple small hypodense lesions in the liver suggestive of microabscesses (up to 1.3 cm) located in the subcapsular region of hepatic segment 2. A large multiloculated splenic abscess (4.5 x 7.4 x 6.3 cm) at lower pole of spleen. Additionally multiple enlarged non-necrotic and necrotic lymph nodes at paraaortic, aortocaval and retrocaval regions, along with mild ascites (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eBlood cultures obtained on admission became positive within 24 hours. Specifically, the culture from the hemodialysis catheter flagged positive at 24 hours and 29 minutes, while the peripheral blood sample became positive at 26 hours and 38 minutes. Gram stain revealed gram-negative bacilli (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Biochemical testing demonstrated triple sugar iron (TSI) K/K reaction, oxidase positivity, and positive arabinose assimilation (Ara+). MALDI-TOF MS (Bruker MALDI Biotyper, database version 13) identified the isolate as \u003cem\u003eBurkholderia thailandensis\u003c/em\u003e with a score of 1.95. Although the MALDI-TOF MS score of 1.95 was below the typical confidence threshold, species-level identification, the diagnosis was supported by the positive arabinose assimilation and clinical correlation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eAntimicrobial susceptibility testing by automated broth microdilution (ARIS 2X AST System) demonstrated that the isolate was susceptible to ceftazidime (MIC\u0026thinsp;=\u0026thinsp;4 \u0026micro;g/mL), imipenem (MIC\u0026thinsp;\u0026le;\u0026thinsp;0.5 \u0026micro;g/mL), amoxicillin-clavulanate (MIC\u0026thinsp;\u0026le;\u0026thinsp;4/2 \u0026micro;g/mL), and trimethoprim-sulfamethoxazole (MIC\u0026thinsp;\u0026le;\u0026thinsp;1/19 \u0026micro;g/mL). Interestingly, 16S rRNA gene sequencing (700 base pairs) from splenic abscess tissue obtained during splenectomy yielded a result consistent with \u003cem\u003eB. pseudomallei\u003c/em\u003e. Given the high degree of sequence similarity between these species, this discordance reflects a known limitation of 16S rRNA sequencing in distinguishing \u003cem\u003eB. thailandensis\u003c/em\u003e from \u003cem\u003eB. pseudomallei\u003c/em\u003e. Due to high genetic similarity, the 16S rRNA sequence matched \u003cem\u003eB. pseudomallei\u003c/em\u003e with 99% identity but could not resolve species-level differences. Consequently, the isolate was ultimately confirmed as \u003cem\u003eB. thailandensis\u003c/em\u003e through concordant MALDI-TOF MS identification and a positive arabinose assimilation test, which is characteristic of \u003cem\u003eB. thailandensis\u003c/em\u003e but negative in \u003cem\u003eB. pseudomallei\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eThe patient was diagnosed with disseminated \u003cem\u003eBurkholderia thailandensis\u003c/em\u003e infection, presenting with septic shock, hepatosplenic abscesses and bacteremia. Initial treatment included intravenous meropenem combined with trimethoprim-sulfamethoxazole. Due to ongoing sepsis and poor clinical response, a total splenectomy was performed. After clinical improvement, the antibiotic regimen was de-escalated to ceftazidime. Despite initial improvement, the patient developed multiple episodes of nosocomial infections during hospitalization and ultimately died due to complications related to his illness.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e\u003cem\u003eBurkholderia thailandensis\u003c/em\u003e is a saprophytic, aerobic gram-negative bacillus endemic to Southeast Asia [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although genetically similar to \u003cem\u003eB. pseudomallei\u003c/em\u003e, it lacks the capsular polysaccharide synthesis genes required for full virulence [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Its identification is complicated by its phenotypic similarity to \u003cem\u003eB. pseudomallei\u003c/em\u003e, especially in resource-limited settings. In this patient\u0026rsquo;s exposure to freshwater which is known reservoirs for environmental \u003cem\u003eBurkholderia\u003c/em\u003e spp. that provides a plausible route of infection. Multiple risk factors including ESKD, hemodialysis, diabetes, and recent environmental exposure likely predisposed the patients to invasive infection.\u003c/p\u003e\u003cp\u003ePrevious reports of \u003cem\u003eB. thailandensis\u003c/em\u003e infection have included wound infection [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], skin abscesses [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], mediastinal lymphadenitis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and pneumonia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] However, this case represent one of the first to describe disseminated infection with hepatosplenic abscesses and septicemia. Given the similarity of \u003cem\u003eB. thailandensis\u003c/em\u003e to \u003cem\u003eB. pseudomallei\u003c/em\u003e, accurate differentiation is crucial for understanding epidemiology and guiding treatment. Conventional biochemical tests may be insufficient. Advance techniques such as MALDI-TOF MS, \u003cem\u003eBurkholderia\u003c/em\u003e species specific PCR [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and, gene sequencing offers greater specificity. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eClinicians should suspect \u003cem\u003eB. thailandensis\u003c/em\u003e in patients with compatible clinical picture and environmental exposure, particularly when the clinical course appears less aggressive than typical melioidosis. In this patients, the infection\u0026rsquo;s severity was likely modulated by host factors despite the typically low virulence of the organism. While specific susceptibility data are limited, \u003cem\u003eB. thailandensis\u003c/em\u003e is often sensitive to ceftazidime, meropenem, and trimethoprim-sulfamethoxazole [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevious reported cases of infections caused by \u003cem\u003eB. thailandensis\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Characteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDiagnosis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDiagnostic method\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTreatment and Prognosis\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVannachone S et al. (2024) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 44 years old, Laos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFoot abscess\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eBurkholderia\u003c/em\u003e species specific PCR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCeftazidime; recovered\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsawaplungkul J (2022) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 49 years old Monk, Thailand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMediastinal lymphadenopathy and pneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMALDI-TOF MS, Biochemical test (API-20NE), Ara+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCeftazidime\u0026thinsp;+\u0026thinsp;trimethoprim-sulfamethoxazole for 5 weeks; recovered\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLi J et al. (2024) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 61 years old, China (Farmer), diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInfected wound of the foot with osteomyelitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBiochemical test (API-20NE), Ara+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMeropenem; died\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGee JE et al. (2018) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale, 29 years old, USA, diabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSurgical site infection of open bone forearm fracture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMALDI-TOF MS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCeftazidime for 6 weeks; recovered\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eZueter AR et al. (2016) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 42 years old, Malaysia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFoot abscess with ankle cellulitis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBiochemical test (API NE), Ara+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCeftazidime; recovered\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChang K et al. (2017) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 67 years old, China\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePneumonia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBiochemical test (API-20NE), Ara+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMeropenem; died\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlass MB et al. (2006) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 2 years old, USA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePneumonia and septicemia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBiochemical test, Ara+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCeftazidime\u0026thinsp;+\u0026thinsp;trimethoprim-sulfamethoxazole 4 weeks, then ciprofloxacin\u0026thinsp;+\u0026thinsp;trimethoprim-sulfamethoxazole for 18 weeks; recovered\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLertpatanasuwan N et al. (1999) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale, 16 years old, Thailand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInfected wound of the leg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBiochemical test (API-20NE), Ara+\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCeftazidime then cefoperazone/sulbactam 17 days then trimethoprim-sulfamethoxazole\u0026thinsp;+\u0026thinsp;doxycycline 20 weeks; recovered\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case illustrates the pathogenic potential of \u003cem\u003eBurkholderia thailandensis\u003c/em\u003e in ESKD receiving hemodialysis individuals and emphasizes the need for accurate diagnostic tools that mimic melioidosis. Although \u003cem\u003eB. thailandensis\u003c/em\u003e and \u003cem\u003eB. pseudomallei\u003c/em\u003e share overlapping phenotypic and clinical characteristics, reliable differentiation requires specialized techniques such as MALDI-TOF MS, arabinose assimilation testing, or other advanced biochemical and molecular methods. Awareness of \u003cem\u003eB. thailandensis\u003c/em\u003e as an emerging pathogen is important for clinicians in endemic areas. While treatment regimens for \u003cem\u003eB. thailandensis\u003c/em\u003e and \u003cem\u003eB. pseudomallei\u003c/em\u003e are generally similar, precise species identification remains essential for epidemiological surveillance, infection control, and improved understanding of the clinical disease spectrum of \u003cem\u003eB. thailandensis\u003c/em\u003e infection.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors meet the ICMJE authorship criteria. All authors participated in the diagnosis, management, and/or care of the patient. All authors wrote the draft and revised the manuscript for important intellectual content. All authors were responsible for patient care and supervised the writing of the manuscript. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare they have no potential conflict of interest relevant to this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient declaration of consent statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient has provided written informed consent for the publication of this report and the accompanying images.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGlass MB, Gee JE, Steigerwalt AG, Cavuoti D, Barton T, Hardy RD, et al. Pneumonia and septicemia caused by Burkholderia thailandensis in the United States. J Clin Microbiol 2006;44:4601\u0026ndash;4. https://doi.org/10.1128/JCM.01585-06.\u003c/li\u003e\n\u003cli\u003eHantrakun V, Thaipadungpanit J, Rongkard P, Srilohasin P, Amornchai P, Langla S, et al. Presence of B. thailandensis and B. thailandensis expressing B. pseudomallei-like capsular polysaccharide in Thailand, and their associations with serological response to B. pseudomallei. PLoS Negl Trop Dis 2018;12. https://doi.org/10.1371/journal.pntd.0006193.\u003c/li\u003e\n\u003cli\u003eDeShazer D. Virulence of clinical and environmental isolates of Burkholderia oklahomensis and Burkholderia thailandensis in hamsters and mice. FEMS Microbiol Lett 2007;277:64\u0026ndash;9. https://doi.org/10.1111/j.1574-6968.2007.00946.x.\u003c/li\u003e\n\u003cli\u003eNovak RT, Glass MB, Gee JE, Gal D, Mayo MJ, Currie BJ, et al. Development and Evaluation of a Real-Time PCR Assay Targeting the Type III Secretion System of Burkholderia pseudomallei. J Clin Microbiol 2006;44:85\u0026ndash;90. https://doi.org/10.1128/JCM.44.1.85-90.2006.\u003c/li\u003e\n\u003cli\u003eWoo PCY, Woo GKS, Lau SKP, Wong SSY, Yuen K. Single gene target bacterial identification: groEL gene sequencing for discriminating clinical isolates of Burkholderia pseudomallei and Burkholderia thailandensis. Diagn Microbiol Infect Dis 2002;44:143\u0026ndash;9. https://doi.org/10.1016/S0732-8893(02)00439-X.\u003c/li\u003e\n\u003cli\u003eHantrakun V, Thaipadungpanit J, Rongkard P, Srilohasin P, Amornchai P, Langla S, et al. Presence of B. thailandensis and B. thailandensis expressing B. pseudomallei-like capsular polysaccharide in Thailand, and their associations with serological response to B. pseudomallei. PLoS Negl Trop Dis 2018;12. https://doi.org/10.1371/journal.pntd.0006193.\u003c/li\u003e\n\u003cli\u003eLi J, Tan J, Xiong X, Zhong Q, Lu W. Burkholderia thailandensis Isolated from Infected Wound, Southwest China, 2022. Emerg Infect Dis 2024;30. https://doi.org/10.3201/eid3005.230743.\u003c/li\u003e\n\u003cli\u003eLertpatanasuwan N, Sermsri K, Petkaseam A, Trakulsomboon S, Thamlikitkul V, Suputtamongkol Y. Arabinose‐Positive Burkholderia pseudomallei Infection in Humans: Case Report. Clinical Infectious Diseases 1999;28:927\u0026ndash;8. https://doi.org/10.1086/517253.\u003c/li\u003e\n\u003cli\u003eGlass MB, Steigerwalt AG, Jordan JG, Wilkins PP, Gee JE. Burkholderia oklahomensis sp. nov., a Burkholderia pseudomallei-like species formerly known as the Oklahoma strain of Pseudomonas pseudomallei. Int J Syst Evol Microbiol 2006;56:2171\u0026ndash;6. https://doi.org/10.1099/ijs.0.63991-0.\u003c/li\u003e\n\u003cli\u003eVannachone S, Luangraj M, Dance D, Chantratita N, Saiprom N, Seng R, et al. Case Report: Soft tissue infection with Burkholderia thailandensis capsular variant: case report from the Lao PDR. Wellcome Open Res 2024;9. https://doi.org/10.12688/wellcomeopenres.22706.1.\u003c/li\u003e\n\u003cli\u003eZueter A. Skin infection caused by Burkholderia thailandensis: Case report with review. Journal of Microbiology and Infectious Diseases 2016:92\u0026ndash;5. https://doi.org/10.5799/ahinjs.02.2016.02.0224.\u003c/li\u003e\n\u003cli\u003eAsawaplungkul J. A case report: Mediastinal lymph node infection caused by Burkholderia thailandensis in a Thai monk. Dis Control J. 2022;48(4). n.d. https://doi.org/10.14456/dcj.2022.78.\u003c/li\u003e\n\u003cli\u003eChang K, Luo J, Xu H, Li M, Zhang F, Li J, et al. Human Infection with Burkholderia thailandensis , China, 2013. Emerg Infect Dis 2017;23:1416\u0026ndash;8. https://doi.org/10.3201/eid2308.170048.\u003c/li\u003e\n\u003cli\u003eWuthiekanun V, Smith MD, Dance DAB, Walsh AL, Pitt TL, White NJ. Biochemical characteristics of clinical and environmental isolates of Burkholderia pseudomallei. J Med Microbiol 1996;45:408\u0026ndash;12. https://doi.org/10.1099/00222615-45-6-408.\u003c/li\u003e\n\u003cli\u003eGee JE, Elrod MG, Gulvik CA, Haselow DT, Waters C, Liu L, et al. Burkholderia thailandensis isolated from infected wound, Arkansas, USA. Emerg Infect Dis 2018;24:2091\u0026ndash;4. https://doi.org/10.3201/eid2411.180821.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Burkholderia thailandensis, hepatosplenic abscess, end stage kidney disease","lastPublishedDoi":"10.21203/rs.3.rs-7393216/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7393216/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003eBurkholderia thailandensis\u003c/em\u003e, an environmental saprophyte closely related to \u003cem\u003eB. pseudomallei\u003c/em\u003e, is generally considered non-pathogenic but can rarely causes human disease. We report a case of \u003cem\u003eB. thailandensis\u003c/em\u003e septicemia with hepatosplenic abscesses in a 58-year-old Thai male with end-stage kidney disease undergoing long term hemodialysis. The patient presented with prolonged fever following freshwater exposure. CT scan of chest and abdomen revealed hepatosplenic abscesses along with cavitary lung nodules. Blood culture grew \u003cem\u003eB. thailandensis\u003c/em\u003e, confirmed by MALDI-TOF MS and 16S rRNA sequencing. This case highlights the potential of \u003cem\u003eB. thailandensis\u003c/em\u003e to cause life-threatening infections in immunocompromised patients. It also emphasizes the importance of advance microbiological diagnostic to distinguish it from \u003cem\u003eB. pseudomallei\u003c/em\u003e, due to their clinical and microbiological similarities but differing pathogenicity and epidemiological implication\u003c/p\u003e","manuscriptTitle":"Severe Hepatosplenic Abscesses and Septicemia Caused by Burkholderia thailandensis in a Hemodialysis Patient","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-19 12:41:52","doi":"10.21203/rs.3.rs-7393216/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"77a0ce31-5f48-404c-9d1b-931a990c2c3c","owner":[],"postedDate":"August 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-25T02:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-19 12:41:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7393216","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7393216","identity":"rs-7393216","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}