Melioidosis

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Retrieved

2021-01-23

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Orphanet

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A rare infectious disease caused by the Gram-negative bacillus Burkholderia (pseudomonas) pseudomallei, also called Whitmore bacillus. The infection can be acute, subacute, or chronic and affects the skin, the lungs, or the whole body.

Epidemiology

The disease is endemic in Southeast Asia and North Australia but cases are seen across the tropics. A rising number of cases are being reported in Europe. Men are predominantly affected (sex ratio: 1.4:1).

Clinical description

Melioidosis may occur in any age group, but is more frequent between 40 and 60 years of age. The incubation period varies from two days to months or years. The acute form of the disease is characterized by respiratory infections (necrotizing pneumonia) and septicemia (with high fever, severe headaches, diarrhea, vomiting, skin lesions, and abscesses). The subacute and chronic forms are characterized by local abscesses and suppurative lesions, most commonly affecting the lung (tuberculosis-like lesions), liver, intestine, and spleen, as well as the skin, lymph nodes, brain and bones.

Etiology

.Melioidosis is caused by Burkholderia pseudomallei, an environmental saprophyte found in wet soil, mud, pooled surface water and rice paddies. Infection may occur through direct contact of skin abrasions, wounds and burns with contaminated soil or water, or through ingestion or inhalation. Diabetes, renal failure, thalassemia, and heavy alcohol consumption are often independent risk factors for melioidosis.

Diagnostic methods

The diagnosis is based on analysis of cultures and identification of the pathogen. Other diagnostic methods include hemagglutination (IHA), direct immunofluorescence, enzyme-linked immunosorbent assays (ELISAs), complement fixation tests or PCR assays. These methods can also help to estimate the prevalence of the infection in a given population. Imaging exams are performed to assess the full extent of disease.

Differential diagnosis

Differential diagnosis includes tuberculosis, pneumonia, and other infectious diseases such as plague, typhoid fever and syphilis.

Management and treatment

The pathogen is sensitive to a range of antibiotics. Treatment consists of an intensive phase of at least two weeks with intravenous ceftazidime or meropenem (imipenem is also used) followed by a couple of months of oral antibiotics, e.g. with co-trimoxazole.

Prognosis

Reported mortality varies between 15%-40% of cases depending on among others the resources available to treat patients across different regions in the world. Early recognition and adequate treatment is key. Relapses can occur.