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

(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

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
References in periodicals archive ?
Melioidosis predominantly affects adults with risk factors such as farming, diabetes mellitus and chronic renal and liver disease.
Although rare, laboratory acquisition of melioidosis through unknowing exposure to B.
Melioidosis patients pretreated with glibenclamide showed lower accumulation of IL-1[beta] and IL-18 and better outcomes, which was mediated by the inhibition of NLRP3 inflammasome [12].
Melioidosis occurs more frequently in patients with underlying diseases, such as diabetes, chronic renal failure, alcoholism, malignancy, and hematological diseases, including immunosuppression.
Melioidosis, also known as Whitmore's disease, is an infection caused by the gram-negative bacteria B.
Melioidosis is an endemic communicable disease caused by Burkholderia pseudomallei and a prevalent amphixenosis in tropical and subtropical regions.
Global Markets Direct's, 'Burkholderia pseudomallei Infections (Melioidosis) - Pipeline Review, H1 2016', provides an overview of the Burkholderia pseudomallei Infections (Melioidosis) pipeline landscape.
Necrotising lymphadenitis may be seen in bubonic plague, tularaemia, anthrax, typhoid fever, melioidosis and Kikuchi's lymphadenitis.
[USPRwire, Thu Feb 04 2016] Global Markets Direct's, 'Burkholderia pseudomallei Infections (Melioidosis) - Pipeline Review, H2 2015', provides an overview of the Burkholderia pseudomallei Infections (Melioidosis)'s therapeutic pipeline.