Melioidosis (Whitmore’s disease)

-Caused by the Gram (-) organism Burkholderia pseudomallei

Epidemiology

–Predominantly in Southeast Asia, Northern Australia, and China (most commonly from Thailand, Malaysia, Singapore)

Transmission

–Percutaneous inoculation (soil/contaminated water)
-Inhalation (more common during severe weather events, eg:Tsunami/Hurricane)
-Aspiration
-Rarely Ingestion

Risk factors

–Occupational exposure (Eg: Rice farming)
–Immunocompromised
–DMII
–Alcohol use
–CKD
–Chronic lung disease
–Thalassemia

However, can occur in healthy individuals as well! 

Clinical Manifestations

1)Localized Infection-skin ulcers/abscesses
2)Pulmonary Infection->50 % of patients, with >25 % having cavitary pulmonary nodules 
3)Bloodstream infection-More than half of patients have bacteremia on presentation and septic shock develops in >20 % of patients 
4)Disseminated infection-Septic Arthritis, osteomyelitis, but can form parenchymal abscesses in ANY organ (eg: Spleen, Kidney, Prostate, Brain amongst others)

Can MIMIC Tb and Malignancy-Consider Melioidosis in any patient with cavitary nodules and skin findings! 

Treatment 

Remember that Burkholderia is inherently RESISTANT to penicillin, ampicillin, 1st/2nd gen cephalosporins amongst others-Treatment is very prolonged!

Intensive phase (10-14d): IV Ceftazidime, Meropenem, or Imipenem
Oral Eradication Therapy (3-6 months): TMP-SMX (preferred over doxycycline)

Source Control! Search and Treat internal-organ abscesses