Melioidosis

Melioidosis 

Melioidosis is a disease you get from the bacterium Burkholderia pseudomallei (B. pseudomallei). You get it from direct contact with contaminated soil or water. Its symptoms vary depending on how you got infected and whether you have underlying conditions.

Both humans and animals can get melioidosis, but people can’t get it from animals. Melioidosis is also sometimes called Whitmore’s disease.

Causes

A person can get melioidosis when they come into contact with water or soil that carries the bacterium Burkholderia pseudomallei.

This can happen if a person:

• comes into contact with contaminated soil, especially via skin cuts or abrasions
• drinks contaminated water
• inhales dust or water droplets
• Human-to-human transmission is. However, it is possible for a person to transmit the bacterium to another person.

Symptoms of melioidosis

The symptoms of melioidosis vary depending on the type of infection. Types of melioidosis include pulmonary (lung), bloodstream, local, and disseminated infections. In general, it takes two to four weeks for symptoms to appear after exposure to the bacterium. However, symptoms may take hours or years to appear, and some people have the disease without having symptoms.

Pulmonary infection

The most common way melioidosis shows up in people is through a lung infection. A lung problem can arise independently, or it can result from a blood infection. Lung symptoms can be mild, like bronchitis, or severe, including pneumonia and leading to septic shock. Septic shock is a serious blood infection that can rapidly lead to death.

Symptoms of pulmonary infection may include:

cough with normal sputum (the mixture of saliva and mucus that can rise into the throat from coughing) or no sputum, called a nonproductive cough

• chest pain during breathing
• high fever
• headache and general muscle soreness
• weight loss

Pulmonary melioidosis infection can mimic tuberculosis because they both can lead to pneumonia, high fever, night sweats, weight loss, bloody sputum, and pus or blood in the lung tissues. 

Bloodstream infection

Without fast, appropriate treatment, a pulmonary infection can progress to septicemia, which is an infection of the bloodstream. Septicemia is also known as septic shock and is the most serious form of melioidosis. It’s common and life-threatening.

Septic shock usually occurs quickly, though it may develop more gradually in some. Its symptoms include:

• fever, especially with shivers and sweating (rigors)
• headache
• sore throat
• breathing problems, including shortness of breath
• upper abdominal pain
• diarrhea
• joint pain and muscle tenderness
• disorientation
• sores with pus on the skin or internally in the liver, spleen, muscle, or prostate

People with these specific conditions have a higher risk of developing a melioidosis bloodstream infection:

• diabetes
• kidney disease
• alcohol abuse
• liver disease
• thalassemia
• chronic lung infections, including cystic fibrosis, chronic obstructive pulmonary disease (COPD), and bronchiectasis
• cancer or another condition that affects immune system function but isn’t related to HIV

People older than age 40 may also have a higher risk of contracting a melioidosis blood infection and developing more serious symptoms than younger people.

Local infection

This type of melioidosis affects the skin and organs just under the skin. Local infections can spread to the bloodstream, and bloodstream infections can cause local infections. Symptoms may include:

• pain or swelling in a contained (localized) area, such as the parotid glands, which are most commonly associated with mumps and are located below and in front of the ear
• fever
• ulcerations or abscesses on, or just below, the skin, these may start as firm, gray or white nodules that become soft and inflamed, and then look like wounds caused by flesh-eating bacteria

Disseminated infection

In this type of melioidosis, sores form in more than one organ and may or may not be related to septic shock. Symptoms may include:

• fever
• weight loss
• stomach or chest pain
• muscle or joint pain
• headache
• seizures

Infected sores are most commonly located in the liver, lung, spleen, and prostate. Less commonly, infections occur in the joints, bones, lymph nodes, or brain.

Diagnosis

Your doctor can diagnose a melioidosis infection by separating Burkholderia pseudomallei bacteria from:

• Blood test
• Urine sample
• Throat swab
• Skin lesion test
• Abscesses

Doctors may also diagnose it by looking for an antibody response to the bacteria. They may identify the diagnosis as:

• Localized infection, it’s limited to one part of the body. 
• Lung infection
• Bloodstream infection
• Disseminated infection, the bacteria may have spread to different organs in the body.

Note 1: Confirm by culture or other specific diagnostic laboratory tests the initial diagnosis and any relapse or chronic activity of infection.

Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, lung lesions, or meningitis