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Pulmonary melioidosis
M Ip1, L G Osterberg, P Y Chau
1Division of Pulmonary and Critical Care Medicine, Stanford (Calif) University Medical Center, USA.
Abstract:
Melioidosis is the name given to all diseases caused by the bacterium Pseudomonas pseudomallei. Melioidosis is a tropical disease and prevails in parts of Southeast Asia, northern Australia, and Central and South America. However, in recent years, cases of melioidosis have been reported in the United States and other areas. The organism can infect any organ system, although the lung is the most common organ affected. Pulmonary melioidosis presents either as an acute fulminant pneumonia or as an indolent cavitary disease. In northeastern Thailand, the incidence of P pseudomallei infection is extremely high with significant mortality. One of the key problems with treating melioidosis is its recalcitrance to therapy and high relapse rate. In addition, this Gram-negative rod is resistant to aminoglycosides. In nonendemic regions, patients with melioidosis more typically present with reactivation disease occurring months to years after initial exposure to the organism. The pulmonary disease is mainly in the apices and resembles tuberculosis. With the increasing mobility of people throughout the world and the influx of immigrants from endemic to nonendemic areas, it is important that clinicians be aware of this disease. This article will review the epidemiology, clinical presentations, diagnosis, and treatment of pulmonary melioidosis.
Insights
Melioidosis, a tropical disease caused by Pseudomonas pseudomallei, affects the lungs and is difficult to treat. Increased global travel necessitates clinician awareness of this infection, which can mimic tuberculosis.
Area of Science:
- Infectious Diseases
- Pulmonology
- Microbiology
Background:
- Melioidosis is caused by the bacterium Pseudomonas pseudomallei.
- It is prevalent in tropical regions like Southeast Asia and Australia but is increasingly reported globally.
- The lungs are the most commonly affected organ, presenting as pneumonia or cavitary disease.
Purpose of the Study:
- To review the epidemiology, clinical presentations, diagnosis, and treatment of pulmonary melioidosis.
- To raise awareness among clinicians regarding melioidosis, especially in non-endemic areas.
- To highlight the challenges in treating melioidosis due to its resistance and high relapse rates.
Main Methods:
- Review of existing literature on pulmonary melioidosis.
- Analysis of clinical presentations, including acute pneumonia and indolent cavitary disease.
- Discussion of diagnostic approaches and treatment strategies, considering antibiotic resistance.
Main Results:
- Pulmonary melioidosis can manifest acutely or indolently, often resembling tuberculosis in non-endemic regions.
- Pseudomonas pseudomallei is resistant to aminoglycosides, complicating treatment.
- High mortality and relapse rates are associated with melioidosis, particularly in endemic areas.
Conclusions:
- Clinicians must be aware of melioidosis, especially with increasing global mobility.
- Early diagnosis and appropriate treatment are crucial due to the challenges in managing this infection.
- Further research into effective treatment strategies is needed to combat recalcitrance and high relapse rates.