Merck Manual

Please confirm that you are a health care professional

Loading

Melioidosis

(Whitmore Disease)

By

Larry M. Bush

, MD, FACP, Charles E. Schmidt College of Medicine, Florida Atlantic University;


Maria T. Vazquez-Pertejo

, MD, Wellington Regional Medical Center

Last full review/revision Feb 2020| Content last modified Feb 2020
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Melioidosis is an infection caused by the gram-negative bacterium Burkholderia (formerly Pseudomonas) pseudomallei. Manifestations include pneumonia, septicemia, and localized infection in various organs. Diagnosis is by staining and culture. Treatment with antibiotics, such as ceftazidime, is prolonged.

Burkholderia pseudomallei can be isolated from soil and water and is endemic in Southeast Asia; Australia; Central, West, and East Africa; India; the Middle East; and China.

Humans may contract melioidosis by contamination of skin abrasions or burns, ingestion, or inhalation but not directly from infected animals or other humans.

In endemic areas, melioidosis is likely to occur in patients with

Melioidosis is also a potential agent of bioterrorism.

Symptoms and Signs

Melioidosis may manifest acutely or remain latent for years after an inapparent primary infection. Mortality is < 10%, except in acute septicemic melioidosis, which is frequently fatal.

Acute pulmonary infection is the most common form. It varies from mild to overwhelming necrotizing pneumonia. Onset may be abrupt or gradual, with headache, anorexia, pleuritic or dull aching chest pain, and generalized myalgia. Fever is usually > 39° C. Cough, tachypnea, and rales are characteristic. Sputum may be blood-tinged. Chest x-rays usually show upper lobe consolidation, frequently cavitating and resembling tuberculosis. Nodular lesions, thin-walled cysts, and pleural effusion may also occur. The white blood cell count ranges from normal to 20,000/mcL (20 × 109/L).

Acute septicemic infection begins abruptly, with septic shock and multiple organ involvement manifested by disorientation, extreme dyspnea, severe headache, pharyngitis, upper abdominal colic, diarrhea, and pustular skin lesions. High fever, hypotension, tachypnea, a bright erythematous flush, and cyanosis are present. Muscle tenderness may be striking. Signs of arthritis or meningitis sometimes occur. Pulmonary signs may be absent or may include rales, rhonchi, and pleural rubs.

Localized suppurative infection can occur in almost any organ but is most common at the site of inoculation in the skin (or lungs) and associated lymph nodes. Typical metastatic sites of infection include the liver, spleen, kidneys, prostate, bone, and skeletal muscle. Acute suppurative parotiditis is common among children in Thailand. Patients may be afebrile.

Diagnosis

  • Staining and culture

B. pseudomallei can be identified in exudates by methylene blue or Gram stain and by culture. Blood cultures often remain negative except when there is marked bacteremia (eg, in septicemia). Serologic assays are often unreliable in endemic areas because positive results may be due to previous infection.

Chest x-rays usually show irregular, nodular (4 to 10 mm) densities but may also show lobar infiltrates, bilateral bronchopneumonia, or cavitary lesions.

Ultrasonography or CT of the abdomen and pelvis should probably be done to detect abscesses, which may be present regardless of the clinical presentation. The liver and spleen may be palpable. Liver tests, aspartate aminotransferase (AST), and bilirubin are often abnormal. Renal insufficiency and coagulopathy may be present in severe cases. The white blood cell count is normal or slightly increased.

Treatment

  • For symptomatic patients, several weeks of IV antibiotics followed by a prolonged course of an oral drug

Asymptomatic melioidosis needs no treatment.

Symptomatic patients are given ceftazidime 30 mg/kg IV every 6 hours for 2 to 4 weeks (imipenem, meropenem, and piperacillin are acceptable substitutes), then oral antibiotics (one double-strength tablet of trimethoprim/sulfamethoxazole [TMP/SMX] 2 times a day or doxycycline 100 mg 2 times a day) for 3 to 6 months. In children < 8 years and pregnant women, amoxicillin/clavulanate 25/5 mg/kg 3 times a day is used instead of doxycycline.

Key Points

  • Melioidosis is acquired by skin contact, ingestion, or inhalation; it is not acquired directly from infected animals or people.

  • The most common manifestation is an acute pulmonary infection (occasionally severe), but suppurative lesions may occur in the skin and/or many other organs; septicemia, which has high mortality, may result.

  • Diagnose using staining and culture; blood cultures are done but often are negative except in severe septicemia.

  • Treat symptomatic patients with IV ceftazidime followed by a prolonged course of oral TMP/SMX or doxycycline; in children < 8 years and pregnant women, use amoxicillin/clavulanate instead of doxycycline.

Drugs Mentioned In This Article

Drug Name Select Trade
PROVAYBLUE
No US brand name
AMOXIL
FORTAZ, TAZICEF
PERIOSTAT, VIBRAMYCIN
MERREM
Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read

Also of Interest

Videos

View All
Overview of Zika Virus Infection
Video
Overview of Zika Virus Infection
3D Models
View All
SARS-CoV-2
3D Model
SARS-CoV-2

SOCIAL MEDIA

TOP