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Background  Infections due to  Mycobacterium tuberculosis, Burkholderia pseudomallei  and non-typhoidal  Salmonella  cause significant morbidity and mortality throughout the world. These intracellular pathogens share some common predisposing factors and clinical features. Co-infection with two of these organisms has been reported previously but, to our knowledge, this is the first time that infection with all three has been reported in one person.    Case presentation  In September 2010, a 58-year-old diabetic Malaysian male presented with fever and a fluctuant mass on the right side of his neck.  B. pseudomallei  was isolated from an aspirate of this lesion and there was radiological evidence of disseminated infection in the liver and spleen. The recurrence of clinical symptoms over ensuing months prompted further aspiration and biopsy of a cervical abscess and underlying lymph nodes.  Salmonella enterica  serovar Stanley and then  M. tuberculosis  were identified from these specimens by culture and molecular methods. The patient responded to targeted medical management of each of these infections.    Conclusion  In endemic settings, a high index of suspicion and adequate tissue sampling are imperative in identifying these pathogenic organisms. Diabetes was identified as a predisposing factor in this case while our understanding of other potential risk factors is evolving.

bmc infectious diseases

Cervical abscesses due to co-infection with Burkholderia pseudomallei, Salmonella enterica serovar Stanley and Mycobacterium tuberculosisin a patient with diabetes mellitus