melioidosis

Melioidosis 

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 and 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.

Resources

Books

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, 1997.

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.

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melioidosis /me·li·oi·do·sis/ (mel″e-oi-do´sis) a glanders-like disease of rodents, transmissible to humans, and caused by Pseudomonas pseudomallei.

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mel·i·oi·do·sis (ml-oi-dss)

n.

An infectious disease, primarily affecting rodents in India and Southeast Asia but also communicable to humans, that is caused by the bacterium Pseudomonas pseudomallei; it produces a characteristic caseous nodule that breaks down into an abscess.

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melioidosis

[mel′ē·oidō′sis]

Etymology: Gk, melis, distemper, eidos, form, osis, condition

an infection caused by the gram-negative bacillus Burkholderia pseudomallei. Acute melioidosis is fulminant and usually characterized by pneumonia, empyema, lung abscess, septicemia, and liver or spleen involvement. Chronic melioidosis is associated with osteomyelitis, multiple abscesses of the internal organs, and development of fistulas from the abscesses. The disease, most commonly seen in China and Southeast Asia, is acquired by direct contact with infected animals. Human-to-human transmission is unlikely. Treatment using chloramphenicol, sulfonamides, or tetracycline for several months is usually successful.

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melioidosis

a glanders-like disease of rodents, transmissible to humans, and caused by Burkholderia pseudomallei. Minor outbreaks, some with heavy mortalities have been recorded in all animal species. The syndromes seen vary widely and may include lymphangitis, meningoencephalitis, ocular and nasal discharge and pneumonia.

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melioidosis

Pseudoglanders A tropical infection primarily of rats by Pseudomonas pseudomallei, an aerobic gram-negative bacillus found in wells and stagnant waters; epizootic infection occurs in sheep, goats, pigs; human infection is water-borne, transmitted via the skin or by inhalation, most commonly in Southeast Asia; Clinical Asymptomatic to fulminant sepsis with multiple abscesses in liver, spleen, lungs, resolving as granulomas–mortality without antibiotics, 90%; with antibiotics 50%, high fever, chills, tachypnea, myalgia; chronic form has a ±10% mortality and is characterized by an intermittent, TB-like pneumonia, lung cavitation, chronic drainage Treatment 3^rd-generation cephalosporins, ceftazadime, also tetracycline, chloramphenicol, aminoglycosides