melioidosis


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Related to melioidosis: Burkholderia pseudomallei

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.

melioidosis

 [mel″e-oi-do´sis]
a glanderslike disease of rodents, caused by Pseudomonas pseudomallei and occasionally transmitted to humans; it is most commonly seen in China and Southeast Asia. Two forms are noted in humans: the acute form is characterized by pulmonary, liver, and spleen involvement with septicemia; and the chronic form leads to osteomyelitis and formation of abscesses and fistulas.

mel·i·oi·do·sis

(mel'ē-oy-dō'sis),
An infectious disease of rodents in India and Southeast Asia that is caused by Pseudomonas pseudomallei and is communicable to humans. The characteristic lesion is a small caseous nodule, found generally throughout the body, which breaks down into an abscess; symptoms vary according to the tracts or organs involved.
[G. mēlis, a distemper of asses, + eidos, resemblance, + -osis, condition]

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.

melioidosis

(mĕl′ē-oi-dō′sĭs)
n.
An infectious disease caused by the bacterium Burkholderia pseudomallei, occurring in a wide range of animals chiefly in Southeast Asia and presenting in humans with a focal infection, usually of the lungs, bones, or skin, that can become chronic.

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.

melioidosis

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 and pigs; human infection is water-borne, transmitted via the skin or by inhalation, most commonly in Southeast Asia. The latency period is long, lasting up to 26 years; it is estimated that 225,000 veterans of the Vietnam conflict have subclinical melioidosis.
 
Clinical findings
Asymptomatic to fulminant sepsis with multiple abscesses in liver, spleen and lungs, resolving as granulomas. Mortality without antibiotics, 90%; with antibiotics 50%. High fever, chills, tachypnoea, myalgia; chronic form has a ±10% mortality and is characterised by an intermittent, TB-like pneumonia, lung cavitation and chronic drainage. 

Management
Third-generation cephalosporins, ceftazadime; also tetracycline, chloramphenicol and aminoglycosides.

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 3rd-generation cephalosporins, ceftazadime, also tetracycline, chloramphenicol, aminoglycosides

melioidosis

A severe infection caused by Pseudomonas pseudomallei acquired through skin abrasions. The disease features high fever, prostration and multiple abscesses in the liver, lungs and spleen with PNEUMONIA and other severe effects. Early treatment with large doses of TETRACYCLINE antibiotics and CHLORAMPHENICOL may save life, but treatment must be continued for weeks or months.

Whitmore,

Alfred, English surgeon, 1876-1946.
Whitmore bacillus - a species found in cases of melioidosis in humans and other animals and in soil and water in tropical regions. Synonym(s): Pseudomonas pseudomallei
Whitmore disease - an infectious disease of rodents in India and Southeast Asia that is caused by Pseudomonas pseudomallei and is communicable to humans. Synonym(s): melioidosis

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.
References in periodicals archive ?
A case of acute pulmonary melioidosis with fatal outcome imported from Brazil.
As bacteria enter the blood, the localized forms may progress to hematogenous melioidosis involving many organs (most frequently the lungs, liver, and spleen).
Las manifestaciones clinicas de la melioidosis son muy diversas y pueden variar desde la presentacion asintomatica y la enfermedad subaguda con supuracion y abscesos, hasta la septicemia con neumonia y el fallo sistemico de multiples organos.
There are hardly any reported cases of melioidosis presenting as polyserositis.
Professor Bart Currie, who works in the infectious diseases department at Royal Darwin Hospital and is the Melioidosis project manager at Menzies School of Health Research, said interest in the bacteria from countries outside the endemic regions had grown dramatically in the past 10 years, particularly since the 2001 anthrax attacks in the US.
2) Fortunately, all workers were provided antibiotic prophylaxis within 48 hours of exposure with no patients developing melioidosis.
The picture was quite different from the panlobular microvesicular steatosis of Reye's syndrome (22) or that of viral hepatitis or infectious diseases involving the liver, such as melioidosis, typhoid fever or malaria.
In 2005, two cases of melioidosis (one in August, one in October) were reported to the Florida Department of Health, the first cases since reporting the disease became mandatory in Florida in 2003.
The Soviet Union had focused on smallpox, plague, Q-fever, Marburg hemorrhagic fever, melioidosis, and typhus (4).
Analysis of the major threat areas in the biodefense market including - anthrax, plague, tularemia, small pox viral hemorrhagic fevers, botulism, ricin, staphylococcal enterotoxins, brucella, glanders, melioidosis and Q fever.
Endemic Melioidosis in Residents of Desert Region after Atypically Intense Rainfall in Central Australia, 2011