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Melioidosis in Critical Care: A Review
Sowmya Sridharan1, Isabella B Princess2, Nagarajan Ramakrishnan3
1Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu, India.
Key Points:
(1) Diabetes, hazardous alcohol use, and/or significant heart disease are more likely to develop a critical illness with melioidosis. (2) Pneumonia is the most common presentation. Those with pneumonia or bacteremia are most likely to require intensive care unit admissions. (3) Culture is the mainstay for the diagnosis. However, it is noted that Burkholderia pseudomallei is often wrongly identified as Pseudomonas or other Burkholderia species by commonly available commercial techniques. (4) Therapy consists of an intensive phase with intravenous antibiotics to prevent mortality followed by an eradication phase with oral antibiotics to prevent relapse. (5) Meropenem is the drug of choice for those with septic shock or neurological involvement. For patients with nonpulmonary organ focal sites of infection (neurologic, prostatic, bone, joint, cutaneous, and soft tissue melioidosis), the addition of trimethoprim-sulfamethoxazole (TMP-SMX) to ceftazidime/carbapenem during intensive therapy is recommended. TMP-SMX is the drug of choice for oral antibiotic therapy during the eradication phase. (6) Adequate source control is essential for successful treatment and to prevent relapse. (7) The use of granulocyte-colony stimulating factor (G-CSF) those with septic shock is controversial.
How To Cite This Article:
Sridharan S, B Princess I, Ramakrishnan N. Melioidosis in Critical Care: A Review. Indian J Crit Care Med 2021; 25(Suppl 2):S161-S165.
Insights
Melioidosis, a critical illness often presenting as pneumonia, is more common in patients with diabetes, alcohol abuse, or heart disease. Early diagnosis and appropriate antibiotic therapy, including meropenem and trimethoprim-sulfamethoxazole, are crucial for survival and preventing relapse.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Melioidosis is a severe infectious disease caused by *Burkholderia pseudomallei*.
- Patients with diabetes, hazardous alcohol use, or significant heart disease are at higher risk for critical illness.
- Pneumonia and bacteremia are common presentations, often leading to intensive care unit admissions.
Purpose of the Study:
- To review the critical care aspects of melioidosis.
- To highlight diagnostic challenges and therapeutic strategies.
- To identify risk factors and common clinical presentations.
Main Methods:
- Literature review of melioidosis in critical care settings.
- Analysis of diagnostic methods, focusing on culture limitations.
- Review of current treatment guidelines for intensive and eradication phases.
Main Results:
- *Burkholderia pseudomallei* is frequently misidentified by commercial diagnostic kits.
- Meropenem is recommended for septic shock or neurological involvement.
- Trimethoprim-sulfamethoxazole (TMP-SMX) is key for eradication therapy and recommended in combination for certain focal infections.
Conclusions:
- Prompt diagnosis and source control are vital for successful melioidosis treatment.
- Appropriate antibiotic selection, including TMP-SMX, is essential to prevent mortality and relapse.
- The role of granulocyte-colony stimulating factor (G-CSF) in septic shock remains controversial.
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