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Melioidosis: review and update
A Leelarasamee1, S Bovornkitti
1Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract:
Melioidosis prevails in Southeast Asia and northern Australia. Sporadic cases have been increasingly reported from countries located between 20 degrees north latitude and 20 degrees south latitude as well as in travelers and in soldiers who have resided in these areas. The organisms are commonly found in water and soil and are usually transmitted to humans by cutaneous or respiratory routes. Clinical manifestations range from subclinical infection to overwhelming septicemia that resembles disseminated or localized suppurative infection due to various pathogens. A rapid and accurate diagnosis can be made by demonstration of small, few, and frequently bipolar-stained gram-negative bacilli in exudate or pus. The indirect hemagglutination test is of diagnostic value in cases with involvement of the internal organs or pyrexia of unknown origin. Chloramphenicol, doxycycline, trimethoprim-sulfamethoxazole, and kanamycin constitute conventional and effective chemotherapy. Newer antimicrobial agents such as piperacillin, amoxillin-clavulanic acid, ceftazidime, imipenem, and carumonam are active in susceptibility tests against the causative microorganism, Pseudomonas pseudomallei. Clinical trials for demonstration of the effectiveness of the latter agents in overwhelming septicemic melioidosis are ongoing in endemic areas.
Insights
Melioidosis, a bacterial infection caused by Pseudomonas pseudomallei, is prevalent in tropical regions. Early diagnosis and appropriate antibiotic treatment are crucial for managing this potentially severe disease.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Tropical Medicine
Background:
- Melioidosis is a significant infectious disease prevalent in Southeast Asia and Northern Australia.
- Cases are increasingly reported globally, particularly in tropical and subtropical regions.
- The causative agent, *Pseudomonas pseudomallei*, is found in soil and water.
Observation:
- Transmission occurs via cutaneous or respiratory routes.
- Clinical presentations vary widely, from subclinical infections to severe septicemia.
- Diagnosis can be rapidly achieved by identifying characteristic gram-negative bacilli in clinical samples.
Findings:
- The indirect hemagglutination test aids in diagnosing internal organ involvement or fever of unknown origin.
- Conventional chemotherapy includes chloramphenicol, doxycycline, trimethoprim-sulfamethoxazole, and kanamycin.
- Emerging antimicrobial agents like ceftazidime and imipenem show in vitro activity against *Pseudomonas pseudomallei*.
Implications:
- Accurate and timely diagnosis is essential for effective patient management.
- Established and novel antimicrobial agents provide therapeutic options for melioidosis.
- Ongoing clinical trials are evaluating new treatments for severe septicemic melioidosis in endemic areas.