Melioidosis.

Burkholderia pseudomallei
Dr.T.V.Rao MD
 Burkholderia pseudomallei
Melioidosis.
► Burkholderia pseudomallei causes an
infectious disease called melioidosis. 
This bacteria is most commonly found
in Southeast Asia, especially in
Thailand and in Northern Australia.  It
was first discovered in Australia in far
northern Queensland in 1962, but has
now spread progressively to the west
and south.
 What is Melioidosis?
► Melioidosis,also called Whitmore's
disease, is an infectious disease
caused by the bacterium Burkholderia
pseudomallei. Melioidosis is clinically
and pathologically similar to glanders
disease, but the ecology and
epidemiology of melioidosis are
different from glanders.
 An environmental
Bacteria
► Burkholderia
pseudomallei is
found in the soil,
rice paddies, and
muddy waters of
these areas.
► Polluted and
contaminate
atmosphere
contributes for
spread  
 Spread of B.pseudomallei
Infections
► B.pseudomallei is a facultative
intracellular pathogen.  It is
pathogenic because of its ability to
invade, resist factors in serum, and
survive intracellularly.   It is easily
contracted by inhaling dust containing
the bacteria or by having contact
between contaminated soil and cuts or
scrapes of the skin
 How Melidiosis is spread
► Humans and animals, like sheep, goats
and horses are believed to acquire the
infection by inhalation of dust,
ingestion of contaminated water and
contact with contaminated soil
especially through skin abrasions.
Melioidosis can also spread from
person to person by contact with the
body fluids of an infected person.
 Human Infections
initiated
► Human infections
are initiated with
contamination of
skin abrasions.
► By Ingestion
► By inhalation.
 Morphology
► B.pseudomallei is a
small, motile, aerobic
Gram –ve
► Grows on standard
bacteriological medium
► The colines vary from
muciod and smooth to
rough wrinkled.
► The color of the
colonies vary from
cream to orange.
► Grows at even 420c
Can be Epizootic Infection
► Sheep, horses, Goats, swine, can
harbor the infection
► However animals are unlikely to be
primary reservoirs of infection
It is a gram negative bacteria
with a safety pin like
appearance.
Growth on Standard Medium
► Grows on Standard
Bacteriological
media, colonies
become rough and
wrinkled on
prolonged
incubation
 Colonies of B.pseudomallei
on Ashdown media
► Ashdown's medium is a
selective culture medium for
the isolation and
characterisation of
Burkholderia pseudomallei.
the medium contains
crystal violet and
Gentamycin as selective
agents to suppress the
growth of other bacteria.
Colonies of B. pseudomallei
also take up neutral red
which is present in the
medium, Ashdown's agar
needs to be incubated for a
minimum of 96 hours
instead of 48 hours.
 Pathogenesis
► The disease can manifest as Acute,
Sub acute, and Chronic disease
► Incubation may be as short as 2 – 3
days
► Latent infections can occurs after
months to years
 Progress of Infection
► The infection starts with non specific
lesion at the inoculum, where there
can be break in the skin.
► Lead to septicemia
► Most common form is pulmonary
infection
► Can lead to suppurative infection and
bacterimia
 Respiratory Infection
► The most dangerous
infection can be
associated with
respiratory infection
► Can lead to suppurative
lesions.
► Consolidations of upper
lobe of the lung
► Can mimic
tuberculosis.
► Progressive illness can
produce cavities
 Spreading lesions
► Systemic infections
spread from the
primary lesions on
the skin.
► Can spread to
lungs, Myocardium,
Liver and Bone.
► Can present with
unexplained
systemic disease.
Latent Infection in Melidiosis
► The latent infection can reactivate as
result of immuno supression
► A high level of suscipicion in endemic
areas is gratifying.
► Any unexplained clinical symptoms
and signs should be explored for
infections.
 Who are at risk
► Individuals with diabetes are at a higher risk
for contracting melioidosis.  About 40% of
meliodiosis patients are diabetic.  Other
factors that may increase the risk of
contracting meliodiosis are excessive
alcohol consumption, chronic renal disease,
and chronic lung disease.  However, even
though these factors do increase the risk of
contracting melioidosis, cases of infection
can still occur in healthy adults and children
occasionally. 
 Clues to Respiratory
infection
► Pulmonary infection: This form of the
disease can produce a clinical picture
of mild bronchitis to severe
pneumonia. The onset of pulmonary
melioidosis is typically accompanied
by a high fever, headache, anorexia,
and general muscle soreness. Chest
pain is common, but a non-productive
or productive cough with normal
sputum is the hallmark of this form of
melioidosis.
 Immuno supression can be
leading cause
► Acute bloodstream infection: Patients with
underlying illness such as HIV, renal failure,
and diabetes are affected by this type of the
disease, which usually results in septic
shock. The symptoms of the bloodstream
infection vary depending on the site of
original infection, but they generally include
respiratory distress, severe headache, fever,
diarrhea, development of pus-filled lesions
on the skin, muscle tenderness, and
disorientation. This is typically an infection
of short duration, and abscesses will be
found throughout the body.
 Diagnosis
► Melioidosisis
diagnosed by
isolating
Burkholderia
pseudomallei from
the blood, urine,
sputum, or skin
lesions. Detecting
and measuring
antibodies to the
bacteria in the
blood is another
 Bacteriological Diagnosis
► Gram stain of the
material from skin
lesions, sputum.
► Small gram-ve
bacilli with specific
Bipolar staining can
be leading clue.
► In all suspected
cases staining with
Wright's stain and
methylene blue
Serology
► Strains of
B.pseudomallei are
identified serologically
by agglutination tests,
rapid slide or tube
agglutination
► Recently ELISA based
on monoclonal
antitoxin is avialble for
rapid diagnosis in
endemic areas of
melioidosis.
 Treatment
► As the disease carries high mortality, a
prompt and effective treatment is
highly essential
► A surgical drainage of organized
surgical lesions.
► Tetracyclnes, Sulfonamides,
Trimethoprim-Sulphmethoxazole are
effective.
► Ceftazidime is highly effective
 Duration of Antibiotic
Treatment
► The duration of treatment should lost
at least 8 weeks.
► The treatment lasting 6moths to 1
year are considered in
immunosuppressive conditions.
► No Vaccines are available
 Bio Hazard and
B.pseudomallei
► Human laboratory
acquired infection with,
B.pseudomallei and
P.mallei is a hazard
► Both organisms are
included in category A
pathogen.
► Included in category 3
and to be handled with
greatest care and strict
and designated
isolation conditions.
Created for Medical
and paramedical
students in
Developing world
Dr.T.V.Rao MD
Email
doctortvrao@gmail.com