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Meliodosis
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Meliodosis

Definition

Disease caused by infection with Burkholderia (Pseudomonas) pseudomallei

Epidemiology & microbiology

  • Gram -ve aerobic bacillus
  • isolated from soil, stagnant streams, ponds, rice paddies in endemic areas (mainly in tropics)
  • human infection usually caused by direct contract with contaminated soil or water through cutaneous innoculation. Less commonly by inhalation or ingestion of contaminated soil or water
  • can occur after latent period of years and may recur months or years after apparent cure

Clinical features

Acute form

  • infection at a localized site (minority present with pneumonia)
  • symptoms of localized abscess
  • septic shock (endemic areas only)
  • rapid progression with high mortality
  • incubation period 2 days

Subacute

  • recrudescence
  • often affects lungs
  • chronic febrile wasting condition resembling reactivation of TB
  • shock is infrequent
  • CXR shows cavities in upper lobes which resemble TB

There are also chronic and subclinical forms of the disease

Investigations

  • culture of relevant specimens
  • presumptive diagnosis can be made on the basis of positive serology (>1:40, although in acute form titres may be < 1:40)

Treatment

  • drain large abscesses
  • acute form: ceftazidime plus cotrimoxazole or doxycycline or chloramphenicol

© Charles Gomersall November 1999

 

©Charles Gomersall, September, 2008 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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