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Melioidosis

Melioidosis, also known as pseudoglanders and Whitmore's disease (after Capt Alfred Whitmore) is an uncommon infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water. It exists in acute and chronic forms. more...

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Medicines

The causative organism, Burkholderia pseudomallei, was thought to be a member of the Pseudomonas genus and was previously known as Pseudomonas pseudomallei. This organism is phylogenetically related closely to Burkholderia mallei, the organism that causes glanders. Another closely-related but less virulent bacterium is found in Thailand and is called Burkholderia thailandensis.

Melioidosis is endemic in parts of south east Asia and northern Australia. Its true extent has not been completely defined but it has been noted before in Africa, India, parts of the Middle East and Central and South America. It affects humans as well as other animals such as goats, sheep, horses and cattle. The mode of infection is usually either through an infected laceration or burn or through inhalation of aerosolized B. pseudomallei.

There has also been interest in melioidosis because it has the potential to be developed as a biological weapon.

Symptoms and signs

Patients with chronic or latent melioidosis may be symptom free for decades.

A patient with active melioidosis usually presents with fever. There may be pains in multiple sites around his/her body due to bacteremia and abscess formation. Patients with melioidosis usually have risk factors for disease, such as diabetes, thalassemia or renal disease. However, otherwise healthy patients, including children, may also get melioidosis.

If there is pulmonary involvement, there may be signs and symptoms of pneumonia.

If hepatic or splenic abscesses are present, the patient may present with abdominal pain. If there are brain abscesses present, the patient may present with neurological signs and symptoms. An encephalomyelitis syndrome is recognised in northern Australia.

Melioidosis may also cause osteomyelitis and present with bony pain.

In Thailand, parotid abscesses in children are common.

Diagnosis

A definite history of contact with soil or animals may not be elicited as melioidosis can be dormant for many years before becoming acute. Attention should be paid to a history of travel to endemic areas in returned travellers. Patients with diabetes mellitus often have a more serious presentation of melioidosis.

A definitive diagnosis can be made by growing B. pseudomallei from blood cultures or from pus aspirated from an abscess. Culture mediums may need to have additional agents added to facilitate the growth of B. pseudomallei.

There is also a serological test for melioidosis, but this is not commercially available in some countries. A high background titre may complicate diagnosis.

If clinically indicated, CT scans (or, in some cases, ultrasound scans) of the thorax and abdomen are useful to investigate for the presence of abscesses and to rule out other diseases.

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Melioidosis
From Gale Encyclopedia of Medicine, 4/6/01 by Rebecca J. Frey

Definition

Melioidosis is an infectious disease of humans and animals caused by a gram-negative bacillus found in soil and water. It has both acute and chronic forms.

Description

Melioidosis, which is sometimes called Pseudomonas pseudomallei infection, is endemic (occurring naturally and consistently) in Southeast Asia, Australia, and parts of Africa. It was rare in the United States prior to recent immigration from Southeast Asia. Melioidosis is presently a public health concern because it is most common in AIDS patients and intravenous drug users.

Causes & symptoms

Melioidosis is caused by Pseudomonas pseudomallei, a bacillus that can cause disease in sheep, goats, pigs, horses, and other animals, as well as in humans. The organism enters the body through skin abrasions, burns, or wounds infected by contaminated soil; inhalation of dust; or by eating food contaminated with P. pseudomallei. Person-to-person transmission is unusual. Drug addicts acquire the disease from shared needles. The incubation period is two to three days.

Chronic melioidosis is characterized by osteomyelitis (inflammation of the bone) and pus-filled abscesses in the skin, lungs, or other organs. Acute melioidosis takes one of three forms: a localized skin infection that may spread to nearby lymph nodes; an infection of the lungs associated with high fever (102°F/38.9°C), headache, chest pain, and coughing; and septicemia (blood poisoning) characterized by disorientation, difficulty breathing, severe headache, and an eruption of pimples on the head or trunk. The third form is most common among drug addicts and may be rapidly fatal.

Diagnosis

Melioidosis is usually suspected based on the patient's history, especially travel, occupational exposure to infected animals, or a history of intravenous drug. Diagnosis must then be confirmed through laboratory tests. P. pseudomallei can be cultured from samples of the patient's sputum, blood, or tissue fluid from abscesses. Blood tests, including complement fixation (CF) tests and hemagglutination tests, also help to confirm the diagnosis. In acute infections, chest x rays and liver function tests are usually abnormal.

Treatment

Patients with mild or moderate infections are given a course of trimethoprim-sulfamethoxazole (TMP/SMX) and ceftazidime by mouth. Patients with acute melioidosis are given a lengthy course of ceftazidime followed by TMP/SMX. In patients with acute septicemia, a combination of antibiotics is administered intravenously, usually tetracycline, chloramphenicol, and TMP/SMX.

Prognosis

The mortality rate in acute cases of pulmonary melioidosis is about 10%; the mortality rate for the septicemic form is significantly higher (slightly above 50%). The prognosis for recovery from mild infections is excellent.

Prevention

There is no form of immunization for melioidosis. Prevention requires prompt cleansing of scrapes, burns, or other open wounds in areas where the disease is common and avoidance of needle sharing among drug addicts.

Key Terms

Osteomyelitis
An inflammation of bone or bone marrow, often caused by bacterial infections. Chronic melioidosis may cause osteomyelitis.
Septicemia
Bacterial infection of the bloodstream. One form of melioidosis is an acute septicemic infection.

Further Reading

For Your Information

    Books

  • "Bacterial Diseases: Melioidosis." In The Merck Manual of Diagnosis and Therapy, vol. I, edited by Robert Berkow, et al. Rahway, NJ: Merck Research Laboratories, 1992.
  • "Ceftazidime." In Nurses Drug Guide 1995, edited by Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.
  • Pollock, Matthew. "Infections Due to Pseudomonas Species and Related Organisms." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.
  • "Trimethoprim-sulfamethoxazole." In Nurses Drug Guide 1995, edited by Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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