What are the other Names for this Condition? (Also known as/Synonyms)

• Morphia Injectors Septicemia
• Night Cliff Gardener’s Disease
• Whitmore’s Disease

What is Melioidosis? (Definition/Background Information)

• Melioidosis is an infectious disease of humans and animals, prevalent in tropical climates, especially in Southeast Asia and Northern Australia
• It is caused by Burkholderia pseudomallei, a rod-shaped, gram-negative bacterium that is found in abundance in the soil and water
• This disease is characterised by pain in the chest, bones, joints, cough, skin infection, formation of lung nodules, and pneumonia. There are a wide range of symptoms and these differ with the type of Melioidosis present. The complications may include pneumonia, meningitis, and septicemia
• There are various types of Melioidosis and these include:
  • Acute localized infection
  • Pulmonary infection
  • Acute bloodstream infection
  • Chronic suppurative infection          
• Melioidosis commonly occurs in diabetic patients and those who work in paddy fields, in regions where the pathogen is prevalent. Individuals who frequently visit the endemic regions are also at risk
• Antibiotic therapy is the mainstay of treatment. With correct diagnosis and appropriate treatment the prognosis of Melioidosis can get better. However, if this infectious disease is left unattended, it may become fatal, especially the septicemic form
• There are no definitive preventive measures, but individuals with open wounds, diabetes, and renal disease should avoid contact with soil and contaminated water where Burkholderia pseudomallei bacteria thrive

Who gets Melioidosis? (Age and Sex Distribution)

• Melioidosis can occur at any age and there is no gender predilection
• Individuals irrespective race and ethnicity are likely to be infected
• The condition is prevalent in certain parts of Southeast Asia and Northern Australia, where the bacteria thrive

What are the Risk Factors for Melioidosis? (Predisposing Factors)

The following are the risk factors associated with Melioidosis:

• Diabetes mellitus
• Thalassaemia (an inherited blood disorder)
• Kidney disease
• Cystic fibrosis: It is a condition where a thick, sticky mucus builds up in the lungs, digestive tract, and other areas of the body
• Rice paddy farmers: Those who work in agricultural fields are easy targets of Melioidosis
• Increased rainfall (increased precipitation) is a risk factor; especially those who work in muddy fields without properly protecting their hands and feet
• Heavy alcohol consumption
• Chronic lung diseases
• Those undergoing cancer treatment, AIDS patients, or taking immunosuppressive therapy after organ transplant
• Children with chronic diseases or weakened immune system, particularly during the wet seasons, are likely to be susceptible to Melioidosis
• Military personnel, adventurous travellers, or construction and resource extraction workers who come in contact with contaminated soil and water

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Melioidosis? (Etiology)

Melioidosis is an infectious disease that affects both humans and animals, caused by gram-negative bacterium Burkholderia pseudomallei, found in soil and water. The infection is prevalent in regions with tropical climates. The bacteria enter the body and spreads through:

• Cuts and sores in the skin
• Inhalation of dust or droplets
• Ingestion of contaminated water

What are the Signs and Symptoms of Melioidosis?

The signs and symptoms associated with Melioidosis differ with various types of the infection and are as follows:

• Localized Infection:
  • Pain
  • Swelling
  • Fever
  • Ulcers
  • Abscess formation      
• Pulmonary infection:
  • High fever
  • Chest pain
  • Cough
  • Headache
  • Anorexia - decreased appetite
• Bloodstream infection:
  • Headache
  • Fever
  • Respiratory problems
  • Joint pains
  • Abdominal discomfort         
  • Muscle tenderness
  • Disorientation
• Disseminated infection:
  • Weight loss
  • Fever
  • Muscle and joint pain
  • Stomach pain
  • Chest pain           
  • Headaches
  • Seizures

How is Melioidosis Diagnosed?

The diagnosis of Melioidosis may involve the following tests and exams:

• Complete evaluation of medical history (including recent travel history) along with a thorough physical exam
• Isolating B. pseudomallei from blood, urine, sputum, skin lesions, or abscesses by culture test: Samples, such as blood, urine, or sputum, are taken and sent to the laboratory to observe growth of the organism in a specialized environment
• Tests to detect an antibody response to the bacteria
• Chest x-ray to see lung involvement

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Melioidosis?

The possible complications that could arise from Melioidosis include:

• Skin ulcers
• Body organ abscesses: Abscess formation in the liver, spleen, and kidneys
• Pneumonia (bacterial infection of lung)
• Septicemia (spread of infection in blood)
• Meningitis: An infection of the protective coverings of the brain

In some untreated cases, the infection can result in death.

How is Melioidosis Treated?

Once Melioidosis is diagnosed and confirmed, appropriate medications can be prescribed for treatment. The treatment measures may include:

• Intravenous microbial therapy for 10-14 days followed by oral antimicrobial therapy for 3-6 months
• The intravenous antibiotics that are generally used include ceftazidime and meropenem
• The commonly used oral antimicrobial are trimethoprim-sulfamethoxazole and doxycycline

How can Melioidosis be Prevented?

Currently, there are no preventive vaccines available for Melioidosis. However, individuals who are at high risk for the infection can follow the following safety procedures to minimize risks:

• Avoiding or minimising contact with soil and contaminated water where B. pseudomallei bacteria thrives; especially individuals with open skin wounds, diabetics, and those with kidney diseases
• Agricultural workers and farmers should use suitable boots/shoes while working in the fields, to avoid infection to the legs
• Healthcare workers should use masks, gloves, and gowns to protect themselves from infection while treating infected patients

What is the Prognosis of Melioidosis? (Outcomes/Resolutions)

• With proper and early treatment of Melioidosis, the prognosis is improved. A correct diagnosis and immediate medical attention can reduce the mortality rate
• However if Melioidosis is left unattended, it may become fatal, especially if septicemia sets in
• Melioidosis infection can recur in 10-20% of treated patients

Additional and Relevant Useful Information for Melioidosis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/infection-center/