II. Epidemiology
- Primarily occurs in southeast asia, Australia
- Worldwide deaths per year: 89,000
III. Pathophysiology
- Burkholderia pseudomallei is an Aerobic Gram Negative Rod
- B. pseudomallei is an opportunistic, facultative intracellular, motile saprophyte
- Potent pathogen with many virulence factors and broad Antibiotic Resistance
- B. pseudomallei contaminates soil and water in tropical regions (esp. Southeast Asia, Australia)
IV. Risk Factors: Systemic Disease
- No known risk factors in 80% of children and 20% of adults
- Zoonotic transmission to humans (e.g. from livestock) is extremely rare
- Contaminated soil or water exposure (esp. during rainy season)
- Diabetes Mellitus (RR 12)
- Male gender
- Age >45 years
- Alcohol Use Disorder
- Liver Disease
- Chronic lung disease
- Chronic Kidney Disease
- Thalassemia
- Immunosuppression
- Corticosteroid Use
V. Signs: Localized
- Incubation Period: 9 days (range 1 to 21 days)
- Skin
- Single, chronic non-healing ulcer
- Lymphadenopathy may be present
VI. Signs: Systemic (Melioidosis)
- On hospital admission, bacteremia in 40-60% and Sepsis in 20%
- Occult infection in 10% of cases
- Pneumonia (40-60%)
- Broad end-organ dissemination
- Splenic Abscess
- Prostate abscess
- Liver Abscess
- Kidney abscess
VII. Differential Diagnosis
VIII. Labs: Diagnosis
- Blood Culture
- Serology is less accurate
IX. Management: Systemic Disease
- See Sepsis
- Early aggressive management of systemic disease is critical
- Intravenous Antibiotics
- Oral Antibiotics (Bacteriostatic, but high susceptibility)
- Trimethoprim–sulfamethoxazole
- Doxycycline
- Amoxicillin Clavulanate (Augmentin)
- Other Antibiotics that are less effective clinically (despite in vitro sensitivity)
X. Management: Post-exposure Prophylaxis
- Indications
- High-risk exposure to B. pseudomallei-contaminated materials via penetrating injuries, or to mouth, eyes
-
Antibiotics for 21 day duration
- Trimethoprim–sulfamethoxazole (preferred)
- Doxycycline
- Amoxicillin Clavulanate (Augmentin)
XI. Prognosis
- Systemic disease mortality 10% with modern ICU care (40% in many endemic regions)
XII. Prevention
- See Prevention of Waterborne Illness
- See Water Disinfection
- Avoid direct soil and water contact at the start of each rainy season (esp. high risk groups)
- Protective clothing (gloves, boots) for higher risk exposures (e.g. rice farmers in Thailand)