Some of us may never hear about melioidosis before, partly because it’s a relatively rare infectious disease that is endemic in Malaysia, Thailand, Singapore and Australia only. Within Malaysia, the majority of cases were reported in Pahang and Sabah—perhaps due to the diligence of the state health authorities in initiating state-level registries for melioidosis.
Melioidosis was first documented in what was then known as Malaya in an outbreak in 1913 involving laboratory guinea pigs and rabbits at the Institute for Medical Research, Kuala Lumpur.
With that being said, we all should have a basic understanding about melioidosis. The first reason is that melioidosis is highly fatal, especially when it gets into the person’s blood (called bacteremia). The death rate of a bacteraemic melioidosis is close to 100% if left untreated. With aggressive medical care, the death rate may be brought down to 37 to 54%. The second reason is that melioidosis disproportionately affects people with diabetes. More than half of the melioidosis cases occurred in people with diabetes.
What’s melioidosis?
Melioidosis is a deadly infection caused by the bacteria known as Burkholderia pseudomallei.
Times 5 magnification of colonies of Burkholderia pseudomallei on Ashdown's agar after 4 days' incubation. Image credit: Gavin Koh, CC BY-SA 4.0 , via Wikimedia Commons
Many people may have melioidosis without showing any symptoms. For those who show symptoms, it may take 1 to 21 days, but sometimes even years. The presentations can be highly variable:
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Pneumonia, which is the inflammation of lungs. The person may experience cough and breathing difficulty.
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Fever
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Joint swelling and pain (known as septic arthritis)
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Eye infections
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Swellings in the brain and spinal cord
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Abscesses (collection of pus) in the abdominal areas
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Septicemia, which starts off as local inflammation and slowly spreads to various parts of the body, causing organ failures
Image credit: https://www.nature.com/articles/nrdp2017107/figures/4
How is melioidosis transmitted?
You can catch melioidosis from the following:
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Inhalation of contaminated dust particles
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Direct contact with contaminated soil and water through penetrating wounds, existing skin abrasions, burns
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Drinking contaminated water
To prevent melioidosis, practise personal hygiene, wear protective clothing when working in possibly contaminated places, and do not drink any uncooked water.
Who is at risk for melioidosis?
Melioidosis is an opportunistic infection, i.e. it mostly affects people with lower immunity due to medical conditions and certain medical treatments they are taking.
As we mentioned above,people with diabetes have a higher likelihood of catching melioidosis.
Besides, people with long-term lung diseases, kidney impairment and liver diseases are also at higher risks of being infected with melioidosis. People with impaired immunity, such as those who are taking chemotherapy treatment for cancers, immunosuppressive treatments for autoimmune diseases (corticosteroid therapy), HIV infection or systemic lupus erythematosus (SLE) may also be at risk for melioidosis.
Unrelated to the immune status, but people who work in the agricultural sector also have higher risk of contracting melioidosis because of their work environment.
Treatment of melioidosis
Since melioidosis is a bacterial infection, antibiotic therapy is in order. Melioidosis requires at least 2 weeks of intensive antibiotics given intravenously, followed by 12 to 20 weeks of oral antibiotics to eradicate the infection. The types of antibiotics that may be given to treat melioidosis include meropenem, imipenem, ceftazidime and trimethoprim/sulfamethoxazole (Bactrim). Doctors may also prescribe the patient with folic acid tablets (vitamin B9) to replenish the loss of folate caused by Bactrim.
Antibiotic killing bacteria be like:
If you develop any signs of infections, such as unresolved fever, pus in infected wounds, nausea, vomiting, persistent cough and difficulty in breathing, visit the hospital immediately. Your doctor would do a proper diagnosis and offer appropriate treatment. Do not take any possible signs of infections likely, especially if you are part of the high-risk groups mentioned above.
A word from DOC2US
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Cover image credit: Gavin Koh, CC BY-SA 4.0 , via Wikimedia Commons
