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Meliodosis

Melioidosis is a bacterial infection caused by Burkholderia pseudomallei , which was formerly known as Pseudomonas pseudomallei. Melioidosis occurs in tropical and subtropical areas including Australia and Southeast Asia. It is most prevalent in northeast Thailand, northern Australia, Singapore, and parts of Malaysia. In the United States, cases usually involve persons immigrating or visiting from endemic areas. However, three cases have been reported in U.S. residents with no travel history outside of the United States.Humans, domestic animals and humans can become infected with B. Pseudomallei. Infection usually occurs by ingestion, percutaneous inoculation, or inhalation of the bacterium. Human-to-human transmission is rare, but can occur through sexual transmission, breastfeeding and birth. Incubation period for melioidosis ranges from 1 to 21 days, with a median of 9 days.

Disease can be localized, pulmonary, or disseminated. Pneumonia is the most common clinical presentation. Clinical presentation can be acute or chronic. Signs and symptoms of melioidosis often mimic other diseases such as community-acquired pneumonia or tuberculosis. Other clinical presentations include skin ulceration, gastrointestinal ulceration, sepsis, or abscesses. Medical conditions that predispose persons for melioidosis include diabetes mellitus, alcoholism, chronic lung disease, chronic renal disease, liver disease, hematologic malignancy, thalassemia, cancer, long-term steroid use, and other non-HIV-related immune suppressed condition.

Confirmation of melioidosis is achieved with isolation of B. pseudomallei from blood, urine, sputum, throat swabs, abscesses or wounds. Early diagnosis and treatment is critical in reducing the mortality rate from this disease, which can approach 90% in septic patients with delayed diagnosis and treatment

Treatment of melioidosis consists of two phases: an intensive phase, followed by an eradication phase. The intensive phase involves intravenous antimicrobial therapy for a minimum of 10 days with ceftazidime, meropenem, or imipenem. The eradication phase consists of oral therapy with trimethoprim-sulfamethoxazole (TMP/SMX) for 3–6 months. 

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