Melioidosis Acquired by Traveler to Nigeria

We describe melioidosis associated with travel to Nigeria in a woman with diabetes, a major predisposing factor for this infection.With the prevalence of diabetes projected to increase dramatically in many developing countries, the global reach of melioidosis may expand. The PatientA 46-year-old woman sought treatment in the emergency department of St Thomas' Hospital, London, UK.She described a 2-day history of frontal headache, fever, and painful swelling in the right postauricular region.She had received a diagnosis of type 2 diabetes mellitus 5 months before admission, for which she took metformin (500 mg 2×/d).She did not smoke or drink alcohol.She was born in Ogun State, Nigeria, and had moved to the United Kingdom at the age of 31 years.She recently had visited relatives in Sagamu City, Ogun State, and returned to the United Kingdom 6 weeks before onset of her illness.She had no history of travel outside the United Kingdom or Nigeria.Examination at admission indicated a temperature of 39.5°C, a heart rate of 108 beats per minute, and a blood pressure level of 132/84 mm Hg.Other examination fi ndings were unremarkable, apart from a tender, fi rm, erythematous, and hot swollen area (4 cm × 3 cm) in the right postauricular region.Initial investigations found a leukocyte count of 6.1 × 10 9 cells/L (neutrophils 4.4 × 10 9 cells/L) and a C-reactive protein level of 406 mg/L; renal and liver profi les were normal.Results of a hemoglobin A1c blood test for diabetes were 13%, which is consistent with poorly controlled diabetes, and results of an HIV test and malaria screen were both negative.Ultrasonography of the swollen area showed localized, superfi cial, enlarged