Melioidosis is an emerging, potentially fatal disease caused byBurkholderia pseudomallei, which requires prolonged antibiotic
treatment to prevent disease relapse. However, difficulties in laboratory diagnosis of melioidosis may delay treatment and affect
disease outcomes. Isolation ofB. pseudomalleifrom clinical specimens has been improved with the use of selective media.
However, even with positive cultures, identification ofB. pseudomalleican be difficult in clinical microbiology laboratories, especially in non-endemic areas where clinical suspicion is low. Commercial identification systems may fail to distinguish between
B. pseudomalleiand closely related species such asBurkholderia thailandensis. Genotypic identification of suspected isolates can
be achieved by sequencing of gene targets such asgroELwhich offer higher discriminative power than 16S rRNA. Specific PCRbased identification ofB. pseudomalleihas also been developed usingB. pseudomallei-specific gene targets such as Type III
secretion system and Tat-domain protein. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry, a revolutionary technique for pathogen identification, has been shown to be potentially useful for rapid identification of B. pseudomallei,
although existing databases require optimization by adding reference spectra forB. pseudomallei. Despite these advances in
bacterial identification, diagnostic problems encountered in culture-negative cases remain largely unresolved. Although various
serological tests have been developed, they are generally unstandardized ‘‘in house’’ assays and have low sensitivities and
specificities. Although specific PCR assays have been applied to direct clinical and environmental specimens, the sensitivities
for diagnosis remain to be evaluated. Metabolomics is an uprising tool for studying infectious diseases and may offer a novel
approach for exploring potential diagnostic biomarkers. The metabolomics profiles ofB. pseudomalleiculture supernatants can
be potentially distinguished from those of related bacterial species includingB. thailandensis.Further studies using bacterial
cultures and direct patient samples are required to evaluate the potential of metabolomics for improving diagnosis of melioidosis.