Melioidosis

1. Melioidosis

2. contents
01 Difinition
1. Risk Factors
2. Transmission
02 Epidemiology
03 Clinical manifestations
04 Diagnosis
05 Differential diagnosis
1. Surgical Treatment
2. Medical Treatment
06 Treatment

3. Difinition
01

4. Gram stain showing scant gram-negative bacilli of Burkhoderia pseudomallei

5. Melioidosis is an infectious disease caused by the
saprophytic Gram negative bacterium,
Burkholderia pseudomallei, which naturally
occurs in soil and water. It causes a wide
spectrum of disease including acute, chronic and
latent presentations. Cambodia is increasingly
identifying this important infection with the
establishment of microbiology laboratories in
the country.

6. Epidemiology
02
The estimated annual global burden of melioidosis is
approximately 165,000 cases, including 89,000 deaths. It occurs
in people of all ages, but the peak incidence is in adults aged 40-
60 years.

7. CDC

8. Primary clinical sites of involvement among patients with melioidosis in Northern Territory of australia

9. Risk factors
Travel to endemic area
Occupational/recreational
environmental exposure Diabetes
Hazardous alcohol use
Chronic renal or liver disease

10. Transmission
Skin Inoculation Inhalation Ingestion

11. 03
Clinical manifestations
 Presence of risk factors
 Fever/sweats
 Cough
 Septic shock
 Regional lyphadenitis/parotitis

12. Skin ulcer in melioidosis

13. Melioidosis osteomyelitis

14. 04 Diagnosis
 Blood culture
 Sputum culture
 Urine culture
 Culture of pus/Swab from skin lesion, abscess,
lymphadenitis, Drained internal abscess( E.g liver abcesses)
 Chest x-ray
 CT abdomen, pelvis and chest
 Abdominal/Pelvis ultrasound

15. Chest radiograph of pulmonary melioidosis

16. Chest X-ray in Fulminant septicemia CT of prostatic abscess due to melioidosis

17. CT of pericardial melioidosis Brain MRI in melioidosis encephalitis

18. CT of melioidosis liver abscesss

19. 05 Differential diagnosis
 Tuberculosis
 Pneumonia
 Sepsis
 Leptospirosis
 Dengue Fever

20. 06 Treatment
Mortality rates are high when presenting with severe
pneumonia and septic shock so early diagnosis and treatment
is essential to have a favorable outcome.

21. Treatment
Surgical Treatment Medical Treatment
All possible attempts should be
made to drain collections of pus
despite the location
Intensive Phase Eradication phase

22. Medical Treatment
Intensive Phase Eradication Phase
IV ceftazidime 2g IV every 6-8 hours (q6-8h)
for at least 14 days (children 50mg/kg per
dose) (maximum 8 g per day for both children
and adults)
Co-trimoxazole (TMP-SMX) 6/30 mg/kg TMP-
SMX PO twice daily (q12h) Treatment is
required for 3 months (12 weeks) except for
patients with osteomyelitis and CNS infection
where longer treatment is required (6 months)
+ Folic acid (0.1 mg/kg up to 5mg PO daily)

24. Compication
 Melioidosis septic shock
 Melioidosis empysema and lung abcesses
 Neurological melioidosis

25. References
 National guidelines fro the clinical management of melioidosis
 UPTODATE
 BMJ

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