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      Melioidosis: the great mimicker

      case-report

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          ABSTRACT

          Melioidosis is an infectious disease endemic in Northern Australia and South East Asia. It is associated with high degrees of morbidity and mortality. On average, around five cases are diagnosed annually in the USA. Diagnosis remains a challenge, as it mimics many other conditions, especially tuberculosis, hence its other name, the ‘great mimicker.’ The present case involves a recent traveler to the Philippines, who presented with episodic fevers and weight loss to his primary care physician. Blood cultures ordered grew Burkholderia pseudomallei. Primary care physicians should suspect melioidosis in symptomatic patients with travel history to endemic areas.

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          Intensity of Rainfall and Severity of Melioidosis, Australia

          Bart Currie, Susan P Jacups (2003)
          In a 12-year prospective study of 318 culture-confirmed cases of melioidosis from the Top End of the Northern Territory of Australia, rainfall data for individual patient locations were correlated with patient risk factors, clinical parameters, and outcomes. Median rainfall in the 14 days before admission was highest for those dying with melioidosis (211 mm), in comparison to 110 mm for those surviving (p = 0.0002). Median 14-day rainfall was also significantly higher for those admitted with pneumonia. On univariate analysis, a prior 14-day rainfall of ≥125 mm was significantly correlated with pneumonia (odds ratio [OR] 1.70 [confidence interval [CI] 1.09 to 2.65]), bacteremia (OR 1.93 [CI 1.24 to 3.02]), septic shock (OR 1.94 [CI 1.14 to 3.29]), and death (OR 2.50 [CI 1.36 to 4.57]). On multivariate analysis, rainfall in the 14 days before admission was an independent risk factor for pneumonia (p = 0.023), bacteremic pneumonia (p = 0.001), septic shock (p = 0.005), and death (p < 0.0001). Heavy monsoonal rains and winds may cause a shift towards inhalation of Burkholderia pseudomallei.
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            Melioidosis: the tip of the iceberg?

            Michael Dance (1990)
            For nearly 80 years clinical melioidosis has been considered a rare disease. This bacterial infection is caused by Pseudomonas pseudomallei, a saprophyte found in soil and surface water of endemic areas. Consequently, those who have most contact with soil, the rural poor, are likely to be at greatest risk of infection. Since the diversity of clinical manifestations necessitates the isolation and identification of the causative organism for a definitive diagnosis of melioidosis and the population at greatest risk within endemic areas rarely have access to an appropriate level of health care, the disease has probably been underrecognized. Melioidosis is now known to be an important cause of human morbidity and mortality in Thailand, and this may be true throughout Southeast Asia, which is usually regarded as the main endemic area for the disease. In Australia, melioidosis causes a smaller number of human infections, while disease among livestock has important economic and possible public health implications. Sporadic reports of the infection indicate its presence in several other tropical regions: in the Indian subcontinent, Africa, and Central and South America. Clinical melioidosis may be highly prevalent in these areas, but underdiagnosed as a result of a lack of awareness of the clinical and microbiological features of the disease, or simply because of a lack of health care facilities. Furthermore, during the last two decades the importation and transmission of melioidosis within nontropical zones have been documented. The causative organism is not difficult to grow, and modern antibiotics have improved disease prognosis. Further studies are needed to determine the true worldwide distribution and prevalence of melioidosis so that improved therapeutic and preventive measures can be developed and applied.
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              Melioidosis Diagnostic Workshop, 20131

              Alex Hoffmaster, David AuCoin, Prasith Baccam … (2015)
              Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Community Hosp Intern Med Perspect
                Journal ID (iso-abbrev): J Community Hosp Intern Med Perspect
                Journal ID (archive): ZJCH
                Journal ID (publisher-id): zjch20
                Title: Journal of Community Hospital Internal Medicine Perspectives
                Publisher: Taylor & Francis
                ISSN (Electronic): 2000-9666
                Publication date Collection: October 2017
                Publication date (Electronic): 19 September 2017
                Volume: 7
                Issue: 4
                Pages: 245-247
                Affiliations
                [ a ] Department of Internal Medicine, San Joaquin General Hospital , French Camp, USA
                Author notes
                CONTACT Mandeep Singh msingh@ 123456sjgh.org Department of Internal Medicine, San Joaquin General Hospital , 500 W. Hospital Rd, French Camp, CA 95231, USA
                Article
                Publisher ID: 1348875
                DOI: 10.1080/20009666.2017.1348875
                PMC ID: 5637701
                PubMed ID: 29046753
                SO-VID: 54184cf2-6ae4-4dd7-9177-ad25c7baf8c5
                Copyright © © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 15 March 2017
                Date accepted : 26 June 2017
                Page count
                Figures: 2, References: 12, Pages: 3
                Categories
                Subject: Case Report
                Subject: Case Report

                Keywords: burkholderia pseudomallei,melioidosis,travel,travel medicine,philippines
                Data availability:
                Keywords: burkholderia pseudomallei, melioidosis, travel, travel medicine, philippines

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