Melioidosis, which is sometimes called Pseudomonas pseudomallei infection, is endemic (occurring naturally and consistently) in Southeast Asia, Australia, and parts of Africa. It was rare in the United States prior to recent immigration from Southeast Asia. Melioidosis is presently a public health concern because it is most common in AIDS patients and intravenous drug users.
Causes and symptoms
Melioidosis is caused by Pseudomonas pseudomallei, a bacillus that can cause disease in sheep, goats, pigs, horses, and other animals, as well as in humans. The organism enters the body through skin abrasions, burns, or wounds infected by contaminated soil; inhalation of dust; or by eating food contaminated with P. pseudomallei. Person-to-person transmission is unusual. Drug addicts acquire the disease from shared needles. The incubation period is two to three days.
Chronic melioidosis is characterized by osteomyelitis (inflammation of the bone) and pus-filled abscesses in the skin, lungs, or other organs. Acute melioidosis takes one of three forms: a localized skin infection that may spread to nearby lymph nodes; an infection of the lungs associated with high fever (102°F/38.9°C), headache, chest pain, and coughing; and septicemia (blood poisoning) characterized by disorientation, difficulty breathing, severe headache, and an eruption of pimples on the head or trunk. The third form is most common among drug addicts and may be rapidly fatal.
Melioidosis is usually suspected based on the patient's history, especially travel, occupational exposure
Patients with mild or moderate infections are given a course of trimethoprim-sulfamethoxazole (TMP/SMX) and ceftazidime by mouth. Patients with acute melioidosis are given a lengthy course of ceftazidime followed by TMP/SMX. In patients with acute septicemia, a combination of antibiotics is administered intravenously, usually tetracycline, chloramphenicol, and TMP/SMX.
The mortality rate in acute cases of pulmonary melioidosis is about 10%; the mortality rate for the septicemic form is significantly higher (slightly above 50%). The prognosis for recovery from mild infections is excellent.
There is no form of immunization for melioidosis. Prevention requires prompt cleansing of scrapes, burns, or other open wounds in areas where the disease is common and avoidance of needle sharing among drug addicts.
"Bacterial Diseases: Melioidosis." In The Merck Manual of Diagnosis and Therapy. 16th ed. Ed. Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.
"Ceftazidime." In Nurses Drug Guide 1995, ed. Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.
Pollock, Matthew. "Infections Due to Pseudomonas Species and Related Organisms." In Harrison's Principles of Internal Medicine, ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
"Trimethoprim-sulfamethoxazole." In Nurses Drug Guide 1995, ed. Billie Ann Wilson, et al. Norwalk, CT: Appleton & Lange, 1995.
Rebecca J. Frey
Septicemia—Bacterial infection of the bloodstream. One form of melioidosis is an acute septicemic infection.