Melioidosis in patients with suspected tuberculosis in Cambodia: a single-center cross-sectional study

SETTING: Melioidosis-Burkholderia pseudomallei infection-is increasingly recognized in Cambodia, a country with a high incidence of tuberculosis (TB). Melioidosis and TB can be clinically indistinguishable. OBJECTIVE: To quantify the proportion of patients with clinically suspected TB who had melioidosis by testing sputum for B. pseudomallei. DESIGN: This was a prospective, 6-month cross-sectional single-center study at a Cambodian provincial referral hospital among patients with suspicion of TB who provided sputum specimens for testing. TB was diagnosed using sputum Xpert (R) MTB/RIF molecular assay or culture; melioidosis was diagnosed using sputum culture for B. pseudomallei. RESULTS: Of 404 patients evaluated for possible TB, 52 (12.9%, 95% CI 9.8-16.5) had TB. Four patients (1.0%, 95% CI 0.3-2.5) had melioidosis; none had concurrent TB or an existing medical risk factor for melioidosis, although two were farmers, an occupational risk factor. CONCLUSION: One per cent of patients being evaluated for TB at a Cambodian provincial referral hospital had culture-proven respiratory melioidosis, a highly lethal infection. None had previously recognized medical conditions that would increase their risk of melioidosis. Testing for melioidosis should be considered in patients presenting with suspected TB in Cambodia.