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Melioidosis and glanders 

Melioidosis and glanders

Chapter:
Melioidosis and glanders
Author(s):

S.J. Peacock

DOI:
10.1093/med/9780199204854.003.070615_update_003

Update:

Chapter reviewed in January 2014—minor update to Essentials.

Updated on 29 May 2014. The previous version of this content can be found here.
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date: 25 March 2017

Melioidosis is a serious infection caused by the soil-dwelling Gram-negative bacillus Burkholderia pseudomallei. It is most commonly reported in north-east Thailand and northern Australia, but is increasingly recognized around the world. Infection is predominantly acquired through bacterial inoculation, often related to occupation, and mostly affects adults between the fourth and sixth decade who have risk factors such as diabetes mellitus and renal impairment.

Clinical features—these are very varied, ranging from a septicaemic illness (the commonest presentation), often associated with concomitant pneumonia (50%) and other features including hepatic and splenic abscesses, to a chronic illness characterized by fever, weight loss, and wasting. Case fatality is 40% in north-east Thailand (20–30% in children) and 14% in Australia.

Diagnosis and treatment—diagnosis requires culture of B. pseudomallei (a hazard group 3 biological agent) from any specimen. Serological tests should be used with caution in those with suspected melioidosis who are culture-negative. Aside from supportive care and drainage of collections of pus, prolonged antimicrobial therapy is required, with a parenteral phase of 10 to 14 days (ceftazidime or a carbapenem) followed by oral therapy for 12 to 20 weeks (trimethoprim-sulfamethoxazole). B. pseudomallei is difficult to eradicate and recurrence occurs in 6% of cases within the first year.

Glanders—this resembles melioidosis and is caused by Burkholderia mallei, which appears to have evolved from a single clone of B. pseudomallei.

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