case_images: PMC11279980_01
case_images: Chest X-ray and high resolution computed tomography (HRCT) of the chest: Chest X-ray (left): multifocal confluent consolidations of the left upper and middle zones and faint consolidation in the right upper zone. HRCT of the chest (right): axial and coronal images of the chest showing bilateral multifocal confluent dense consolidations, generalized ground-glass density of the lung parenchyma on background of mild emphysema (images a, b, and c), and focal area of bronchiectasis at the right apex (image d).
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case_images: PMC11279980_01_gr1.jpg
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case_images: A chest x-ray and a high-resolution computed tomography (HRCT) of the chest were performed (Fig. 1).
case_images: (a): Direct Gram-stain from positive blood culture bottle demonstrating Gram-negative bacilli with bipolar-staining (indicated by yellow circles) typical of Burkholderia pseudomallei. (b): non-lactose fermenting colonies at 24 h of incubation on cysteine lysine electrolyte deficient (CLED) agar. (c): wrinkled colonies (shown by yellow circles) on blood agar after 48 h of incubation.
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case_images: Within four hours, the first blood culture set flagged positive from aerobic bottle (BD Bactec ) showing regular-sized Gram-negative bacilli with the characteristic bipolar staining (Fig. 2A) which was preliminarily identified by standard library MALDI-TOF Biotyper  (Bruker Daltonics) as Burkholderia thailandensis with a score of 1.81. Subculture plates of both sets of blood culture showed colonies that were shiny, wet, non-lactose fermenting, and growing well on all standard media (Fig. 2B & C).