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PubMed1995

Visceral abscess in melioidosis.

A retrospective analysis was done in 81 patients with visceral abscess due to melioidosis treated at Khon Kaen Hospital, northeastern Thailand from 1985 to 1993. The clinical presentations were fever 100 per cent, abdominal pain 39 per cent, cough 34.8 per cent, abdominal tenderness 27.5 per cent and palpable mass 24.6 per cent. The laboratory findings were not diagnostic of the etiology. The abscesses were detected by ultrasonography in 97.25 per cent and computed tomography 2.25 per cent. The lesions were found in the spleen 72.8 per cent, liver 45.7 per cent, kidney 12.3 per cent and prostate gland 2.5 per cent. Seventy-six per cent of the patients had diseases in multiple organs (viscera, lungs and others). The preliminary diagnoses were fever of unknown origin, septicemia and urinary tract diseases in one-half of the cases. Patients presenting with fever of unknown origin from an endemic area, like northeastern Thailand, should arouse suspicion of melioidosis and search for the organism is advised. Diagnostic imaging methods, ultrasonography and computed tomography are valuable tools for detection of a solid internal organ abscess.

Abscess↗

PubMedDate not supplied

[The early laboratory diagnosis of the pulmonary form of glanders and melioidosis by using rapid methods of immunochemical analysis].

The problems of the sanitary guarding of frontiers comprise such aspects as the early recognition of infectious diseases, even those which are considered exotic in the Russian Federation. These diseases include glanders and melioidosis, infections which are endemic for some frontier regions. The study performed on experimental models of the pulmonary form of glanders and melioidosis with the acute course of the diseases demonstrates that the use of such laboratory diagnostic methods as immunosorbent variants of the enzyme-linked, chemiluminescent and immunofluorescent immunoassays permits making reliable diagnosis as early as 3-12 hours after aspiration infection.

Acute Disease↗

PubMed1993

Neonatal melioidosis.

We report a neonate with melioidosis. The presentation, progress and treatment are described, followed by a discussion on melioidosis.

Fatal Outcome↗

PubMed1995

Melioidosis in a goat.

Melioidosis was diagnosed in an adult Boer goat ewe. The owner initially noticed swelling of one half of the udder. Several firm nodules developed in the affected part of the udder 2 weeks later. At necropsy, abscesses containing a creamy to yellowish-green exudate were found in the mammary gland and one of the kidneys. Pure cultures of Pseudomonas pseudomallei were isolated from the abscesses in the udder and inoculation of male guinea-pigs with the causative bacterium, produced a Shwartzman reaction in the testis and serositis as well as necrotic lesions, in parenchymatous organs. The isolate showed sensitivity to amoxycillin-clavulanate, but resistance to a number of other antimicrobials. This appears to be the first case of melioidosis in a domestic animal in South Africa.

Abscess↗

PubMed1995

Serodiagnosis of melioidosis in Malaysia.

Current diagnosis of melioidosis is based on bacterial culture and/or serology which is becoming increasingly useful. An IgM-ELISA using heat-killed whole cells of Pseudomonas pseudomallei was developed and compared with an indirect haemagglutination technique (IHAT) and an indirect immunofluorescent technique(IFAT). The IgM-ELISA using a P:N ratio of > or = 2 had a sensitivity of 91% and a specificity of 96%. All 3 assays were further used in a seroepidemiological survey amongst different groups of patients and healthy individuals. It was found that the IFAT performed better than the IHAT, detecting antibodies to P. pseudomallei in 6% of diabetics, 5% of pyrexics, 8% of pregnant women and 3% of farmers. For the same groups the IgM-ELISA detected antibodies in 1% of pyrexics, 8% of pregnant women and a further 14% of farmers. The IgM-ELISA was found to be sensitive and useful for the serological diagnosis of acute melioidosis.

Adult↗

PubMed1996

Melioidosis: two indigenous cases in Taiwan.

We report the first two indigenously acquired cases of melioidosis in Taiwan, diagnosed by positive culture and biochemically identified using the ID 32 GN system (BioMerieux Vitek Inc, Hazelwood, MO, USA). The first patient was a 75-year-old Chinese woman who had not travelled abroad since her arrival from mainland China (San-Tung province) 47 years ago. She presented with spontaneous bacterial peritonitis and hepatitis C-related liver cirrhosis with septic shock. Burkholderia pseudomallei (formerly Pseudomonas pseudomallei) was isolated from cultures of both blood and ascites fluid. The second patient, a 70-year-old Chinese man, presented with right lower lobar pneumonia complicated with empyema and septic shock. Blood cultures grew B. pseudomallei. Both patients had underlying diabetes mellitus; one also had liver cirrhosis and chronic renal failure, while the other had a renal stone. The first patient died of refractory septic shock prior to diagnosis. The second patient survived with the use of intravenous ceftazidime for 30 days, followed by oral amoxicillin-clavulanic acid for a further 3 months. These cases serve as a reminder to clinical physicians that melioidosis is now no longer exclusive to patients with a history of travel to endemic areas. A high index of clinical suspicion is required for early diagnosis and treatment in order to reduce the mortality and improve clinical outcome.

Aged↗

PubMed1977

Sensitivity of radionuclide isotope brain scan in cerebral melioidosis: case report.

Melioidosis, an unusual infectious disease formerly confined to the Orient, is being seen with increasing frequency in the United States. We present a report of a patient who had recently traveled in the Far East and subsequently developed pulmonary melioidosis complicated by a fatal encephalitis. Although the radionuclide brain scan was markedly abnormal, computed tomographic studies were minimally abnormal on one occasion and within normal limits on another. The radionuclide brain scan appears to have greater sensitivity in diagnosis of early encephalitis and, therefore, may be the more valuable of the two studies in the diagnosis of this disorder.

Asia, Southeastern↗

PubMed1996

Melioidosis; a treatment challenge.

Ceftazidime has reduced the mortality of severe disease by half, but melioidosis remains a difficult and expensive infection to treat. Empirical treatment of septicemia with aminoglycosides combined with penicillin, ampicillin, or second-generation cephalosporins is ineffective. The response to appropriate antibiotic treatment is slow, and most patients require a minimum of 2 weeks of high-dose parenteral treatment. Large abscesses should be drained if possible. Ceftazidime remains the drug of choice, but co-amoxyclav is an effective alternative (although treatment failure rates are slightly higher), and preliminary experience with imipenem is encouraging. The relapse rate following 8 weeks of treatment is approximately 28%, and this is reduced to 9% with 20 weeks of treatment. The relapse rate is determined by the extent of the infection and not the underlying predisposing condition. Resistance to all treatment antimicrobials has been documented, but this has not proved a major problem to date. Patients who survive the acute phase of melioidosis require life-long follow-up.

Ceftazidime↗

PubMed1997

[Melioidosis: a tropical time bomb that is spreading].

Melioidosis, an infectious disease that affects many mammals, was first identified in Burma by Whitmore in 1912. It is caused by Burkholderia pseudomallei, a gram negative bacillus of the Pseudomonas family, which is found in soil and water. Long present in Southeast Asia and numerous tropical areas, melioidosis has recently appeared in temperate zones including mainland France. The incidence in endemic areas is between 6% and 20% of the population and short period of exposure is sufficient to be contaminated. In man the contamination occurs mainly through skin wounds and the disease can be clinically inapparent. Diabetes, renal disease, and various forms of immunodepression are triggering factors for the onset of a variety of symptoms ranging from acute septicemia to abscesses involving almost any organ in the body. Ceftazidime alone or a combination of clavulanate and amoxicilline is the treatment of choice but the mortality rate in patients with acute forms is still 40% and relapse can occur if treatment is stopped too soon. Bacteriologic and serologic tests can fail and awareness of a history of geographic exposure is an important diagnostic criteria for this disease which has been expanded with the growth of international travel.

Anti-Bacterial Agents↗

PubMed1986

Septic melioidosis after a visit to Southeast Asia.

A case is reported of a fifty-seven year old man with fever, who was admitted to hospital after a recent visit to Southeast Asia. Among the clinical findings prostatitis and broncho-pneumonia were noted. Within twenty-four hours irreversible fulminant sepsis developed although he was treated with cefotaxime, tobramycin and erythromycin. Post mortem Pseudomonas pseudomallei was cultured from blood and aspirate collected by bronchoscopy. It is important to consider melioidosis as a cause of septic illness in patients who have been visiting Southeast Asia.

Humans↗

PubMed2005

Infected pseudoaneurysm of the femoral artery secondary to melioidosis infection of a previous femoropopliteal bypass graft.

Infected arterial aneurysm or pseudoaneurysm caused by Burkholderia pseudomallei is very rare; a review of the literature reveals only five previously reported cases. We report the first case of melioidosis infection of a previous femoropopliteal bypass graft complicated by para-anastomotic pseudoaneurysm of the femoral artery successfully treated by surgical removal of the old graft and creation of a new, extraanatomic, external iliac-to-popliteal bypass graft.

Aged↗

PubMed1978

Melioidosis presenting as prostatitis--a case report from Sabah.

Previous reports of melioidosis in Sabah are reviewed and a detailed account of a case, presenting as prostatitis, in a 40-year-old British male is given. The history suggested that the organism, Pseudomonas pseudomallei, was transmitted by a fly which entered the eye. Diagnosis was delayed and treatment presented some difficulty, the organism being relatively insensitive to amplicillin and gentamicin. Co-trimoxazole was the most effective, followed by minocycline. Cure was eventually achieved and after four years the patient was fit and normal, except for sterility.

Adult↗

PubMed1984

First report of septicaemic melioidosis in Hong Kong.

Septicaemia due to Pseudomonas pseudomallei was found in five patients; it complicated pneumonia in three. Four patients were old and had diabetes mellitus; the fifth patient, though young, was immunocompromised by steroid therapy. The clinical features were indistinguishable from those of other Gram-negative septicaemia. Four of the patients died. This was the first report of septicaemic melioidosis in Hong Kong where the disease might be endemic. Soil sampling and serological survey gave further supporting evidence. Early treatment using a bactericidal anti-Pseudomonal cephalosporin, such as ceftazidime, was suggested for this life-threatening infection.

Adult↗

PubMedDate not supplied

A prospective comparison of co-amoxiclav and the combination of chloramphenicol, doxycycline, and co-trimoxazole for the oral maintenance treatment of melioidosis.

An open randomized comparison of the oral 'conventional' regimen (combination of chloramphenicol, cotrimoxazole and doxycycline) and co-amoxiclav for the maintenance treatment of melioidosis was conducted in Ubon Ratchatani, north-eastern Thailand, between 1989 and 1992. The total antibiotic treatment duration was 20 weeks. Of 101 patients followed, 10 (10%; 95% confidence interval [CI] 4.9-17.5%) subsequently relapsed: 2 of 52 patients (4%) in the oral 'conventional' group, and 8 of 49 patients (16%) receiving oral co-amoxiclav. This compares with a relapse rate of 23% in our previous study of 8 weeks' total therapy. Only 50% of patients complied with the 20 weeks' treatment regimen and poor compliance proved the most significant risk factor for subsequent relapse (relative risk [RR] 4.9, 95% CI 1.2-20.3). Neither the presence of known underlying disease nor choice of initial parenteral treatment was significantly associated with a higher risk of relapse. Co-amoxiclav is safer and better tolerated, but may be less effective (RR of relapse 0.4, 95% CI 0.2-1.2) than the oral 'conventional' regimen. The minimum duration of total treatment with either regimen should be 12-20 weeks, depending on clinical progress.

Adolescent↗

PubMedDate not supplied

Melioidosis with multiple cerebral abscesses.

Melioidosis from Pseudomonas pseudomallei is common in endemic areas (particularly southeast Asia) and is being recognized with increasing frequency in developed countries. Central nervous system involvement is a rare complication with a high mortality. A patient with multiple cerebral abscesses caused by this organism is presented to demonstrate that successful treatment is possible when a high index of clinical suspicion leads to early diagnosis.

Brain Abscess↗

PubMed2005

Time-kill curves as a tool for targeting ceftazidime serum concentration during continuous infusion for treatment of septicaemic melioidosis.

Melioidosis is a fatal community-acquired infection endemic in tropical areas. Ten isolates of the causative microorganism were subjected to time-kill study using a range of ceftazidime concentrations. This study demonstrated that a ceftazidime concentration of eight times the minimum inhibitory concentration yielded an optimal bactericidal effect and should be the target concentration administered by continuous infusion.

Anti-Bacterial Agents↗

PubMed2005

Rapid molecular typing of Burkholderia pseudomallei, isolated in an outbreak of melioidosis in Singapore in 2004, based on variable-number tandem repeats.

An increase in the number of reported melioidosis cases was observed in the first 4 months of 2004. These cases were associated with a significant increase in case-fatality rate compared with the past 5 years. In order to exclude the possibility of a single source, including the possibility of intentional release of Burkholderia pseudomallei, we applied a multiplex PCR-based multilocus variable-number tandem repeat (VNTR) assay to determine the clonality of the clinical isolates. Our investigation indicated that a total of 30 different VNTR types could be distinguished in the 32 clinical isolates of B. pseudomallei obtained during this period, thus indicating that infection was unlikely to have occurred from a single source. Our experience underscores the usefulness of a rapid strain typing method in augmenting an epidemiological investigation into an infectious disease outbreak, particularly at a time where the intentional use of biological agents is a potential threat to public health.

Bacterial Typing Techniques↗

PubMed2006

Clinical variation in melioidosis in pigs with clonal infection following possible environmental contamination from bore water.

An outbreak of melioidosis occurred in pigs on a rural property in the tropical north of the Northern Territory of Australia. The pigs were mostly asymptomatic but lesions in the parotid glands suggested an oral route of infection. Skin lesions were also common and one piglet had disseminated infection. Pulsed-field gel electrophoresis showed an identical pattern amongst Burkholderia pseudomallei isolates from the pigs, with similarity to an isolate from the unchlorinated bore water supplying the property.

Animals↗