Pan-drug-resistant and biofilm-producing strain of Burkholderia pseudomallei: first report of melioidosis from a diabetic patient in Yogyakarta, Indonesia [Letter]

We are writing, on behalf of the International Melioidosis Society Committee, as a group of researchers and clinicians with longstanding experience of melioidosis and Burkholderia pseudomallei as we have some concerns about the above paper that was published in your journal recently.1 Although we believe that melioidosis is undoubtedly being under-diagnosed in Indonesia,2,3 we are not convinced that the isolate in this case is B.pseudomallei based on the information provided by the authors. Although it is difficult to be certain from the photographs in Figure 2, the colonies do not appear typical of the species to the microbiologists amongst us, who have seen several thousand isolates of B.pseudomallei over the past 30 years. Furthermore, the authors do not report whether the isolate was oxidase positive or negative. We believe that more comprehensive methods of confirming the identity, particularly genomic analysis, should have been undertaken before publishing the case.4 Unfortunately, the postamplification 16s analysis described in the paper might not have been able to distinguish between B.pseudomallei and other Burkholderia species (particularly B.thailandensis and several as-yet-uncharacterized Burkholderia spp.), and we would have recommended additional testing, for example, multilocus sequence typing and PCR for the TTS1 gene at least.