Clinical guideline for diagnosis and management of melioidosis

Abstract

Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis.

Development of Real-Time PCR Assays and Evaluation of Their Potential Use for Rapid Detection of Burkholderia pseudomallei in Clinical Blood Specimens

“…If enrichment media are used instead, the presence of B. pseudomallei in nonsterile specimens such as sputum and throat swabs may be overlooked due to the speedier growth of other commensal organisms. As a result of these factors, many patients who are clinically suspected of having septicemic melioidosis remain without a culture-confirmed diagnosis, and this increases their likelihood of receiving inappropriate antimicrobial therapy (11,26). Serological tests to detect B. pseudomallei-specific antibodies such as the indirect hemagglutination assay and enzyme-linked immunosorbent assay have been used clinically, but they are not reliable and useful for the diagnosis of active infections in melioidosis-endemic regions such as Thailand where seroconversion is common (2,4,23).…”

Melioidosis Mimicking Tuberculosis in an Endemic Zone: A Case Report

“…[13] Further investigation was done to make it more confirmed like inoculation into SS agar media produced colony growth; incubation at 42 0 C was produced the colony growth 13 . An indirect ELISA for IgM antibody was done and had found a high titre in the blood which was 1:1600 dilution 14 . All agglutination reactions were conducted in a class II biological safety cabinet by gowned and gloved staff.…”

The public health implications of melioidosis

“…The infection is a collection of disease states caused by the Gram-negative bacterial species, Burkholderia pseudomallei (formerly known as Pseudomonas pseudomallei). These conditions include a rapidly fatal Gram-negative septicemia, with or without pneumonia, central nervous system infection, localized abscess formation or soft tissue infection and asymptomatic exposure with seroconversion [5]. These conditions overlap somewhat, since localized infection may spill over to cause systemic infection, and septicemia may result in dissemination to distant tissues in which localized infection occurs.…”