Chenliang Fan,1 Xiaosi Li,1 Baizhi Pi,2 Jiasheng Wu,3 Heping Shen,3 Yumiao Guo,3 Xiaoyan Wu1 

1Department of Laboratory Medicine, the Second Affiliated Hospital of Jiaxing University, Jiaxing, 314001, People’s Republic of China; 2Department of Intensive Care, the Second Affiliated Hospital of Jiaxing University, Jiaxing, 314001, People’s Republic of China; 3Department of Infectious Diseases, the Second Affiliated Hospital of Jiaxing University, Jiaxing, 314001, People’s Republic of China

Correspondence: Yumiao Guo, Department of Infectious Diseases, the Second Affiliated Hospital of Jiaxing University, Jiaxing, 314001, People’s Republic of China, Email guoym0328@163.com Xiaoyan Wu, Department of Laboratory Medicine, the Second Affiliated Hospital of Jiaxing University, Jiaxing, 314001, People’s Republic of China, Email wxy87751@163.com

Abstract: Melioidosis is prevalent in Southeast Asia, acquired via breathing or skin contact with water or soil contaminated by Burkholderia pseudomallei. This article reports a 42-year-old male melioidosis patient without underlying diseases or travel history to epidemic areas, discussing its significance for epidemiology, diagnosis and treatment in non-epidemic areas. The patient’s clinical manifestations, disease progression, previous treatment, admission examination, diagnostic process, treatment and follow-up results were retrospectively analyzed. tNGS, microbial culture and WGS were used for sample and pathogen identification and genetic analysis. The patient had recurrent fever with erythema nodosum on the left lower limb. Misdiagnosed and treated ineffectively in other hospitals, he was diagnosed with melioidosis in the Second Affiliated Hospital of Jiaxing University. The strain was identified as Burkholderia pseudomallei, type ST46. Appropriate antibiotic treatment was selected based on drug sensitivity test results. After 6 months of follow-up, most lesions were absorbed, laboratory indicators normalized and the clinical effect was good. Epidemiological investigations suggested ST46 might be transmitted via non-traditional routes related to the fact that 15 days before the onset of the disease, the patient had purchased live turtles and the soil for raising them online which were sourced from Yunnan, indicating the possibility of geographical transmission. This case enriches understanding of melioidosis’ non-traditional transmission, strain transmission, clinical diagnosis and treatment, highlighting the importance of considering the disease in non-endemic areas’ differential diagnosis and the need for further epidemiological surveillance and research.

Keywords: melioidosis, targeted next-generation sequencing, non-endemic areas, non-traditional transmission