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Melioidosis (Burkholderia pseudomallei)
⚠️ High mortality from septicaemic melioidosis is seen in South India, Thailand, and Northern Australia. ⏳ Incubation can be prolonged – even years after exposure.
📖 About
- 🦠 Caused by Burkholderia pseudomallei (formerly Pseudomonas) found in soil and rice paddies.
- 🌏 Endemic in northeast Thailand and northern Australia; cases also reported in South Asia.
- 🔁 Recurrence possible → requires prolonged treatment, especially in immunocompromised patients.
- 😶 Many infections are subclinical.
🧬 Aetiology
- Gram-negative, motile, aerobic bacillus.
- Reservoir: soil and fresh surface water (e.g., rice fields in endemic areas).
- Produces a heat-stable endotoxin with classic toxic activity.
🩺 Clinical Features
- ⏳ Incubation may be years (up to 26 years reported).
- 🩹 Entry: through skin abrasions/ulcers from contact with contaminated water.
- 💨 Inhalation → pneumonia with cavitation, mimicking TB.
- ⚡ Septic shock often fatal.
- 🫀 Liver/splenic abscess (may mimic amoebic abscess).
- 🧠 Melioidosis encephalomyelitis (rare but severe).
- 🔁 Reactivation can occur decades later, similar to TB.
🔎 Investigations
- 💉 Aspiration of pus may show no organisms on Gram stain.
- 🧫 Culture: colonies evolve from smooth → rough, often wrinkled after days; strong putrid odour typical.
📊 Mortality: ~50% in northeast Thailand (35% in children), ~19% in Australia.
💊 Management
- IV antibiotics:
- 💉 Ceftazidime 2 g tds for 2–3 weeks (first-line).
- Alternative: Imipenem or Meropenem.
- 🔪 Surgical drainage of abscesses when present.
- ➡️ Step-down therapy: 12 weeks of oral combination:
- Doxycycline
- Cotrimoxazole ± Trimethoprim
- ± Chloramphenicol (historical regimens; less common today).
- Severe disease: consider 💉 G-CSF (Granulocyte-Colony Stimulating Factor).
📚 References
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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