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Melioidosis: Causes, Symptoms, Diagnosis, Treatment, and Prevention

Burkholderia pseudomallei, a bacterium prevalent in soil and water in tropical and subtropical locations, particularly in Southeast Asia and northern Australia, is the source of the deadly illness melioidosis. The body's systems and organs, including the blood, joints, brain, skin, and lungs, can all be impacted by melioidosis. If not appropriately and quickly treated, it can result in a broad variety of symptoms, from minor to severe, and can be deadly. Whitmore's sickness is another name for melioidosis.

Causes

Melioidosis is caused by exposure to B. pseudomallei, which can enter the body through different routes, such as:

• Inhalation of contaminated dust or water droplets

• Ingestion of contaminated food or water

• Skin contact with contaminated soil or water, especially through cuts or wounds

• Injection of contaminated drugs or fluids

The risk of getting melioidosis is higher for people who have certain medical conditions or factors that weaken their immune system, such as:

• Diabetes

• Chronic kidney disease

• Chronic lung disease

• Liver disease

• Alcohol abuse

• Cancer

• HIV/AIDS

• Steroid use

• Transplant recipients

The risk of getting melioidosis is also higher for people who live or work in areas where B. pseudomallei is endemic, and who have frequent contact with soil or water, such as farmers, gardeners, construction workers, or travelers.

Symptoms

The symptoms of melioidosis depend on the type and severity of the infection, and the organs or systems involved. The symptoms may appear within days, weeks, months, or even years after exposure to B. pseudomallei. The symptoms may include:

• Fever and chills

• Cough and chest pain

• Shortness of breath and difficulty breathing

• Headache and confusion

• Abdominal pain and diarrhea

• Skin ulcers, abscesses, or nodules

• Joint pain and swelling

• Muscle pain and weakness

• Weight loss and loss of appetite

• Seizures and coma

Melioidosis can be classified into four main types, based on the clinical presentation and the outcome of the infection:

• Acute localized infection, which affects a single site, such as the skin, muscle, or bone, and causes a localized abscess or ulcer. This type of infection usually resolves with antibiotic treatment, and has a good prognosis.

• Acute pulmonary infection, which affects the lungs, and causes pneumonia, bronchitis, or lung abscess. This type of infection can be mild or severe, and can spread to other organs, such as the brain or the liver. This type of infection requires intensive antibiotic treatment, and has a variable prognosis.

• Acute bloodstream infection, which affects the blood, and causes septicemia or septic shock. This type of infection is the most serious and life-threatening, and can affect multiple organs, such as the heart, kidneys, or spleen. This type of infection requires immediate and aggressive antibiotic treatment, and has a poor prognosis.

• Chronic infection, which affects one or more sites, and causes persistent or recurrent symptoms, such as fever, weight loss, or fatigue. This type of infection can mimic other chronic diseases, such as tuberculosis, cancer, or fungal infection. This type of infection requires long-term antibiotic treatment, and has a variable prognosis.

Diagnosis

The diagnosis of melioidosis is based on the clinical history, physical examination, and laboratory tests. The laboratory tests may include:

• Blood tests, to check for the presence of B. pseudomallei, or its antibodies or antigens, in the blood. Blood tests can also check for signs of infection, inflammation, or organ damage.

• Sputum tests, to check for the presence of B. pseudomallei in the sputum, which is the mucus that comes out of the lungs when coughing.

• Urine tests, to check for the presence of B. pseudomallei in the urine.

• Stool tests, to check for the presence of B. pseudomallei in the stool.

• Wound or abscess tests, to check for the presence of B. pseudomallei in the pus or fluid that comes out of the wound or abscess.

• Cerebrospinal fluid (CSF) tests, to check for the presence of B. pseudomallei in the CSF, which is the fluid that surrounds and protects the brain and the spinal cord.

• Imaging tests, such as X-rays, ultrasound, CT scan, or MRI, to check for the presence and extent of the infection in the lungs, bones, joints, or other organs.

Treatment

The treatment of melioidosis consists of two phases: the intensive phase and the eradication phase. The intensive phase aims to control the infection and prevent its spread, while the eradication phase aims to eliminate the remaining bacteria and prevent relapse.

• Intravenous antibiotics, such as imipenem, meropenem, or ceftazidime, are administered during the intensive phase for a minimum of 10 to 14 days, or until the patient's condition stabilizes and their symptoms significantly improve. Hospitalization and intensive care may be necessary during the intense phase, particularly for individuals with complex or severe infections.

• During the eradication phase, patients must take oral antibiotics for at least three to six months, or until the infection is entirely eradicated, such as trimethoprim-sulfamethoxazole, doxycycline, or amoxicillin-clavulanate. The elimination phase can be completed at home under the doctor's close supervision and continuous follow-up.

The course of treatment for melioidosis can change according on the organs or systems affected, the kind and severity of the infection, how well the antibiotics work, and whether any consequences or underlying diseases are present. In addition, supportive care such as oxygen therapy, fluid and electrolyte replacement, pain management, and surgery to remove or drain the infected tissue or organ may be used in the treatment of melioidosis.

Prevention

The prevention of melioidosis involves avoiding or reducing the exposure to B. pseudomallei, and improving the immune system. Some of the preventive measures are:

• Wearing protective clothing, gloves, boots, and masks, when working or playing in areas where B. pseudomallei is endemic, and where there is contact with soil or water.

• Washing and disinfecting any wounds or cuts that may have been exposed to soil or water, and covering them with a bandage or dressing.

• Boiling or filtering any water that may be contaminated with B. pseudomallei, before drinking or using it for cooking or washing.

• Avoiding raw or undercooked food that may be contaminated with B. pseudomallei, such as vegetables, fruits, or meat.

• Seeking medical attention promptly if any symptoms of melioidosis occur, and following the prescribed treatment regimen.

• Controlling or treating any underlying conditions that may weaken the immune system, such as diabetes, kidney disease, liver disease, or HIV/AIDS.