Melioidosis


Melioidosis

Description, Causes and Risk Factors:

An infectious disease of rodents in India and Southeast Asia that is caused by Pseudomonas pseudomallei and is communicable to humans. The characteristic lesion is a small caseous nodule, found generally throughout the body, which breaks down into an abscess; symptoms vary according to the tracts or organs involved.

It is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia where it is widespread. The bacteria causing melioidosis are found in contaminated water and soil. It is spread to humans and animals through direct contact with the contaminated source.

The pathogenesis of melioidosis is not completely understood. The outcome of infection with B. Pseudomallei depends on the balance between the host's immune system, the virulence of the infecting strain and the size and route of the initial inoculum.

People can get melioidosis through direct contact with contaminated soil and surface waters. Humans and animals are believed to acquire the infection by inhalation of contaminated dust or water droplets, ingestion of contaminated water, and contact with contaminated soil, especially through skin abrasions.

It is very rare for people to get the disease from another person. While a few cases have been documented, contaminated soil and surface water remain the primary way in which people become infected.

Besides humans, many animal species are susceptible to melioidosis, including: cats, dogs, cattle, sheep, goats, swine, and horses.

The major risk factors are:

    Contaminated soil or water can put people at risk for melioidosis.

  • Persons with open skin wounds and those with diabetes or chronic renal disease are at increased risk for melioidosis and should avoid contact with soil and standing water.

  • Those who perform agricultural work should wear boots, which can prevent infection through the feet and lower legs.

  • Health care workers can use standard contact precautions (mask, gloves, and gown) to help prevent infection.

Untreated, melioidosis is fatal. When treated with antibiotics, severe forms of the illness have a 50% chance of recovery, but overall the mortality rate is 40%.

Symptoms:

Signs and symptoms may include:

    Localized pain or swelling.

  • Fever.

  • Ulceration.

  • Abscess.

  • Respiratory distress.

  • Abdominal discomfort.

  • Joint pain.

  • Muscle tenderness.

  • Disorientation.

  • Cough.

  • Chest pain.

  • Weight loss.

  • Stomach or chest pain.

  • Muscle or joint pain.

Diagnosis:

The diagnosis of melioidosis is made with a microscopic evaluation of a blood, urine, sputum, or skin-lesion sample in the laboratory. A blood test is useful to detect early acute cases of melioidosis, but it can not exclude the illness if it is negative.

A number of serological tests for the detection of specificB.pseudomallei antibodies have been developed. One of themain drawbacks of antibody assays that limits their value inclinical situations in the presence of background antibody insome healthy individuals in the endemic area. Enzyme linkedimmunosorbent assays (ELISAs) which detect IgG exhibit asensitivity of 96% and a specificity of 97%, whereas theimmunoglobulin M ELISA has a sensitivity of 74% and aspecificity of 99%.However, an internationally standardizedserodiagnostic test for melioidosis is much needed.

Treatment:

When a melioidosis infection is diagnosed, the disease can be treated with the use of appropriate medication. The type of infection and the course of treatment will impact long-term outcome. Treatment generally starts with intravenous (within a vein) antimicrobial therapy for 10-14 days, followed by 3-6 months of oral antimicrobial therapy.

Antimicrobial agents that have been effective against melioidosis include:

    Intravenous therapy consists of: Ceftazidime administered every 6-8 hours (or) Meropenem administered every 8 hours.

  • Oral antimicrobial therapy consists of: Trimethoprim-sulfamethoxazole taken every 12 hours (or) Doxycycline taken every 12 hours.

Patients with penicillin allergies should notify their doctor, who can prescribe an alternative treatment course.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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