[Melioidosis: a tropical time bomb that is spreading]

Melioidosis, an infectious disease that affects many mammals, was first identified in Burma by Whitmore in 1912. It is caused by Burkholderia pseudomallei, a gram negative bacillus of the Pseudomonas family, which is found in soil and water. Long present in Southeast Asia and numerous tropical areas, melioidosis has recently appeared in temperate zones including mainland France. The incidence in endemic areas is between 6% and 20% of the population and short period of exposure is sufficient to be contaminated. In man the contamination occurs mainly through skin wounds and the disease can be clinically inapparent. Diabetes, renal disease, and various forms of immunodepression are triggering factors for the onset of a variety of symptoms ranging from acute septicemia to abscesses involving almost any organ in the body. Ceftazidime alone or a combination of clavulanate and amoxicilline is the treatment of choice but the mortality rate in patients with acute forms is still 40% and relapse can occur if treatment is stopped too soon. Bacteriologic and serologic tests can fail and awareness of a history of geographic exposure is an important diagnostic criteria for this disease which has been expanded with the growth of international travel.