Melioidosis Presentation

1. Melioidosis

2. WHAT IS MELIOIDOSIS?
• Melioidosis, also known as Whitmore disease, is caused by the
bacterium Burkholderia pseudomallei (a motile, aerobic, non–spore-
forming bacillus).
• It is clinically and pathologically similar to glanders, although the
epidemiology differs.
• The bacteria thrive in tropical climates. The disease is endemic in
Southeast Asia and Australia, and is also found in the Middle East,
India, and China

3. AN ENVIRONMENTAL BACTERIA
• Burkholderia pseudomallei is found in the soil, rice paddies, and
muddy waters of these areas.
• Polluted and contaminate atmosphere contributes for spread

5. HOW DO PEOPLE GET MELIOIDOSIS?
INGESTION
• Contaminated water
INHALATION
• Dust from contaminated soil
WOUND INFECTION
• Contact with contaminated soil
RARELY
• Person - person
• Animal - person

6. WHO ARE AT RISK
Farming has been shown to strongly associated with incident cases
• Wet season  heavy rainfall,high humidity and temp
the major risk factors are :
• Diabetes
• Liver disease
• Renal disease
• Excessive alcohol consumption
• Cancer or another immune-suppressing condition not related to HIV
• Chronic lung disease (such as cystic fibrosis, chronic obstructive
pulmonary disease, and bronchiectasis)

7. Possible complications of these diseases include the following:
• Septicemia
• Osteomyelitis
• Meningitis
• Brain, lung, liver, or splenic abscess

8. Besides humans, many animal species are susceptible to
melioidosis, including:
• Sheep
• Goats
• Swine
• Horses
• Cats
• Dogs
• Cattle

9. PATHOGENESIS
• Melioidosis is an infectious disease caused by B pseudomallei
• The organism is distributed widely in the soil and water of the tropics.
It is spread to humans through direct contact with a contaminated
source, especially during the rainy season.
• The disease usually occurs in especially among those who have
chronic comorbidities such as diabetes, alcoholism,
immunosuppression, and renal failure
• The incubation period in naturally acquired infections can vary from
days to months to years.

10. PATHOGENESIS
The disease can manifest as Acute, Sub acute, and Chronic disease

11. Localized form
• Bacteria enter the skin through a laceration or abrasion, and a local
infection with ulceration develops.
• The incubation period is 1-5 days.
• Swollen lymph glands may develop.
• Bacteria that enter the host through mucous membranes can cause
increased mucus production in the affected areas.

12. Pulmonary form
• When bacteria are aerosolized and enter the respiratory tract via
inhalation or hematogenous spread, pulmonary infections may
develop.
• Pneumonia, pulmonary abscesses, and pleural effusions can occur.
The incubation period is 10-14 days.
• With inhalational melioidosis, cutaneous abscesses may develop and
take months to appear.

13. Bacteremia/Septicemia
• bacteremia is observed with chronically ill patients (eg, patients with
HIV/diabetes).
• Patients often presents with a history of fever with no evidence of focus of
infection
• The onset may be abrupt and usually rapidly progresses to disseminated
bacteremia ,multi organ involvement and septicaemic shock
• They develop respiratory distress, headaches, fever, diarrhea, pus-filled
lesions on the skin, and abscesses throughout the body.
• Septicemia may be overwhelming, with a 90% fatality rate and death
occurring within 24-48 hours.

14. Chronic form
• The chronic form involves multiple abscesses, which may affect the
liver, spleen, skin, or muscles.
• in addition to this chronic form, can become reactive many years after
the primary infection
• long-standing suppurative focal abscesses with or without fever and is
associated with a good prognosis

15. Progression of infection
• The infection starts with non specific lesion at the inoculum, where
there can be break in the skin.
• Lead to septicemia
• Most common form is pulmonary infection
• Can lead to suppurative infection and bacteremia

16. Clinical Manifestation
Localized Infection:
• Localized pain or swelling
• Fever
• Ulceration
• Abscess
Pulmonary Infection:
• Cough
• Chest pain
• High fever
• Headache
• Anorexia

17. Clinical Manifestation
Bloodstream Infection:
• Fever
• Headache
• Respiratory distress
• Abdominal discomfort
• Joint pain
• Disorientation
Disseminated Infection:
• Fever
• Weight loss
• Stomach or chest pain
• Muscle or joint pain
• Headache
• Seizures

18. Differential Diagnoses
• Anthrax
• Bacterial Pneumonia
• CBRNE - Plague
• CBRNE - Smallpox
• Malaria
• Mycoplasmal Pneumonia
• Typhoid Fever
• Viral Pneumonia

19. DIAGNOSIS
Microbiology
• Gram stain may reveal small, gram-negative bacilli, which stain
irregularly with methylene blue or Wright stain
• may demonstrate a safety pin bipolar appearance.
• The organisms can be cultured from abscesses, secretions, sputum,
blood and urine with standard media.
• Another useful culture medium for isolation of B pseudomallei from
non-sterile sites (sputum, pharynx swabs) is Ashdown's selective
medium.
• MacConkey agar ,Blood agar and chocolate media: sterile specimens

20. LABORATORY INVESTIGATIONS
• Routine tests : FBC, UFEME, renal and liver functions, blood sugar
• Blood cultures 2X ( at 2 different sites at the same time before
antibiotic given)
• Urine culture
• Cultures from abscess, joint aspirate, CSF, sputum or throat swab
where indicated
• PCR for blood, body secretion and urine may also be indicated

21. • Blood culture results for B pseudomallei often positive and positive
urine cultures can indicate prostatitis or renal abscesses.
• In septicemic melioidosis, blood culture results may be negative until
just before death.
• Polymerase chain reaction (PCR) assays are rapid and specific but may
be less sensitive than cultures.

22. RADIOLOGICAL INVESTIGATIONS
• Chest X-ray
• USG abdomen
• CT Scan where indicated such as for cerebral abscess. For the purpose
of the registry and research, it is required that an abdominal CT scan
be done to diagnose prostatic abscess.

23. Serology
Serological test may be helpful in diagnosis of melioidosis. There are
few serological tests available like
• Indirect Haemagglutination Test (IHAT)
• Immunofluorescent Antibody Test (IFAT)
• IgG and IgM ELISA
• Rapid Immunochromatographic (IC) test for IgG and IgM
In endemic area, the most rapid, sensitive and specific for current
infection is IFAT.
Interpretation of IFAT result: Positive : > 1:80 (in endemic area if patient
is asymptomatic, a titre of as high as 1:160 may not be significant but
patient need to be followed up

24. TREATMENT
• As the disease carries high mortality, a prompt and effective
treatment is highly essential
• Surgical Care
• Large abscesses and empyemas should be drained.
• Prostatic and parotid abscesses in melioidosis may require surgical
intervention. Small absesses in the spleen or liver usually respond to
prolonged antibiotic therapy.

25. • The duration of treatment should lost at least 8 weeks.
• The treatment lasting 6 months to 1 year are considered in
immunosuppressive conditions.
• No Vaccines are available

29. Prevention strategies
• Persons with open skin wounds and those with diabetes or chronic
renal diseases are at risk for melioidosis and should avoid contact
with soil and standing water
• Those who perform agriculture work should wear boots
• Health care workers can use standard contact precautions ( mask,
gloves,face shield, gowns) to help prevent infections
• Chlorination of water and heat are effective against the bacterium

30. Thank You