Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei, commonly found in soil and water in Southeast Asia and northern Australia. It most often infects the lungs and symptoms are non-specific, including fever. It is diagnosed through culturing the bacteria from blood, urine, sputum or skin lesions. Treatment involves long-term antibiotics such as ceftazidime and co-trimoxazole, with an overall mortality rate of 50-70% even with treatment.

1. Melioidosis
Introduction
By Dr Nurul Athirah Naserrudin
Medical 0fficer
Klinik Kesihatan Tandek

2. ● Menteri Besar, Datuk Seri Adnan Yaakob, dirawat di Pusat
Perubatan Prince Court, Kuala Lumpur selama seminggu lebih,
disyaki dijangkiti Leptospirosis (kencing tikus) atau Melioidosis
(bakteria disebabkan air dan tanah)

3. Melioidosis in Pahang
January 2000 to June 2003
157 cultured positive in Pahang
The calculated annual incidence of adult melioidosis in
Pahang state was 6.07 per 100, 000 population per year.
78.5% were male.
Malays:83%, Chinese:9.6%, Indians:3%,
Orang Asli :3%

4. Lubuk Yu Outbreak 2010
A boy was suspected to have drowned
A 150-member team of police and army officers, divers,
firemen and volunteers from a nearby village searched
for his body
Following this rescue operation, 22 people presented
with an acute febrile illness
10 were blood culture confirmed melioidosis (4 were
positive for leptospirosis based on PCR)
Among those cultured confirmed: 7 died(all DM, with
severe pneumonia, 1 patient died at home, no culture)

5. What , Why , Where, How?
- History
- Distribution of disease
- Which organism?
- Risk factors
- Method of transmission
-Classification
- Clinical Manifestations
-Symptoms

7. History
1912 : First described by Capt. Alfred Whitmore and C.S.
Krishnaswami ( Indian Medical Service)
- 38 fatal cases of pneumonia amongst the destitute and
morphine addicts in Rangoon, Burma
- COD ? Unknown etiology ? Glander – like disease ( no
equine exposure)
1913 Fletcher (pathologyst) and Stanton(bacteriologyst)
recognised the disease in laboratory animals at the Institute
for Medical Research in Kuala Lumpur, Malaysia
1917 Stanton first described the infection in a human
patient

8. History – during WW II
1948 – 1954 , indo – china
- affects > 100 French soldiers stationed in
indo – china
1973 , Vietnam
- affects > 300 American soldiers
- direct contact wound with mud and water
- “ vietnamese time bomb” - reoccured after
latent up to 20 years

9. First International Symposium on
Melioidosis
By the Malaysian Society of Infectious Diseases and
Chemotherapy, under the Chairmanship of Prof. S D
Puthucheary, was held in Kuala Lumpur from April
7-8, 1994.
About 100 participants from around the world
attended and the papers presented were
subsequently edited and published
as a book

10. How melioidosis got its name ?
The term melioidosis was coined in 1921 by
Stanton and Fletcher and is derived from the
Greek words
“melis ” meaning “a distemper of asses(donkey)”
“eidos” , resemblance.
This was because the disease clinically and
pathophysiologically resembled glanders, a
chronic and debilitating disease of equines
caused by Pseudomonas malle
(pseudoglanders)

11. Epidemiology
In endemic areas, antibodies found in 5-20% agriculture workers,
no hx of clinical disease. Outbreak : Wet season

12. Etiology
● Burkholderia pseudomallei ,
aerobic, gram- negative, motile
bacillus, soil saprophyte
● Oppurtunistic pathogen
● Can survive in phagocytic cells
→ latent infection
● Phylogenetically alike
Pseudomonas mallei
pcture : B. pseudomallei on
Ashdown’s agar. The colony
appears irregular-edge, rough
and pale purple.

13. Risk factors
+oppurtunistic pathogens
+immunosuppriseve subjects
1. DM (50-70%)
2. RF / CKD
4. Retroviral dss
5. Malignancy
6. On steroid therapy
History of
1. recreational activity ; soil/ mud

14. Mode of Transmission
1. Inhalation
2. Ingestion
3. Inoculation
4. breast milk
5. perinatal
6.human to human
●State the intended goal

15. Classification
“ The Great Mimicker”
no pathognomonic
Acute, fulminant , benign → septicemia/
chronic disease
No definite classification
1. Septicimia / Non septicimia
Incubation period : Not defined
Up until months – years
Mortality : bacterimia ~ 100% / Localised 5%
Optimal care & Mx ~35 -50%

16. Symptoms
Non specific – fever (high grade), headache,
vomit, nausea, abdo pain
Skin manifestation : cellulitis
Lung(50%; most common affected organ)
manifestation : cough → pneumonia/ lung
abscess
Systemic ( blood to organs) : chronic form of
melioidosis affecting the heart, brain, liver,
kidneys, joints, and eyes.

18. (2)Diagnosis and Treament

19. Diagnosis
+history of presenting illness ( HOPI)
+hx of travelling to endemic area / soil / oil
area
+risk factors : DM/ malignancy/ taking
steroid / immunoc , etc
+ symptoms ( non specific) ; fever +
respiratory complaints
+ clinical examination : lung, skin

20. Primary skin melioidosis
Secondary (Disseminated) skin melioidosis

21. How to diagnose?
Laboratory diagnosis
1. blood – culture
2. urine
3. pus
4. sputum
Serological test
1. Agglutination test
2.
Immunoflourescence
Imaging : CXR
Gold standard
● Isolation of
B.pseudomallei
from bodily fluids of
patients

24. ● +46 % pneumonia
● +56% unilateral
pulmonary
shadowing
(predominant Rt
lung)
● +44% bilateral
lesions
● +14%cavitation-
● +Rt lobe and Lower
commonest

25. Treatment
1. Antibiotic – ?parenteral or ?oral therapy
(localised skin lesion / kids)
- monotherapy (simple
bacteremia) or combined (septicemia)
- eradication / maintenence
2. Adjuctive / supportive therapy ( to reduce
in hospital mortality ) : HDU , ICU,
splenectomy, IVI insulin, debridement and
curretage , etc
3. No vaccine currently available

27. Treatment
1. Ceftazidime ( 3rd gen Ceph) 2weeks
2. Bactrim (TMP – SPZ ) 6months
* maintenance therapy ( eradication ) - to
prevent relapse/recurrence
*monitor IgG levels and titre: as guideline to
determine duration of eradication therapy

28. Relapse and Recurrent
+immunocompromise
+non complaint to abx
+ Relapse : Reappearance of signs and
symptoms after initial clinical response while
still on antimicrobial therapy.
+ Recurrent : A new episode of melioidosis
caused by the same organism after
convalescence and full clinical recovery

29. Conclusion
-Melioidosis is an infectious disease
caused by a bacterium, Burkholderia
pseudomallei.
-Melioidosis infection commonly involves
the lungs.
-Melioidosis is diagnosed with the help of
blood, urine, sputum, or skin-lesion testing.
-Melioidosis is treated with antibiotics.
- The overall mortality rate is 50-70%.