Melioidosis.Melioidosis. Burkholderia pseudomalleiBurkholderia pseudomallei

Dr.T.V.Rao MDDr.T.V.Rao MD

Burkholderia Burkholderia pseudomalleipseudomallei Melioidosis.Melioidosis.

Burkholderia Burkholderia pseudomalleipseudomallei causes an causes an infectious disease called melioidosis.  infectious disease called melioidosis.  This bacteria is most commonly This bacteria is most commonly found in Southeast Asia, especially in found in Southeast Asia, especially in Thailand and in Northern Australia.  It Thailand and in Northern Australia.  It was first discovered in Australia in far was first discovered in Australia in far northern Queensland in 1962, but northern Queensland in 1962, but has now spread progressively to the has now spread progressively to the west and south.west and south.

What is Melioidosis?What is Melioidosis?

Melioidosis, also called Whitmore's Melioidosis, also called Whitmore's disease, is an infectious disease disease, is an infectious disease caused by the bacterium caused by the bacterium Burkholderia pseudomallei.Burkholderia pseudomallei. Melioidosis is clinically and Melioidosis is clinically and pathologically similar to glanders pathologically similar to glanders disease, but the ecology and disease, but the ecology and epidemiology of melioidosis are epidemiology of melioidosis are different from glanders. different from glanders.

An environmental An environmental BacteriaBacteria

Burkholderia Burkholderia pseudomalleipseudomallei is is found in the soil, found in the soil, rice paddies, and rice paddies, and muddy waters of muddy waters of these areas.these areas.

Polluted and Polluted and contaminate contaminate atmosphere atmosphere contributes for contributes for spread  spread  

Spread of Spread of B.B.pseudomalleipseudomallei InfectionsInfections

B.B.pseudomalleipseudomallei is a facultative is a facultative intracellular pathogen.  It is intracellular pathogen.  It is pathogenic because of its ability to pathogenic because of its ability to invade, resist factors in serum, and invade, resist factors in serum, and survive intracellularly.   It is easily survive intracellularly.   It is easily contracted by inhaling dust contracted by inhaling dust containing the bacteria or by having containing the bacteria or by having contact between contaminated soil contact between contaminated soil and cuts or scrapes of the skinand cuts or scrapes of the skin

How Melidiosis is spreadHow Melidiosis is spread

Humans and animals, like sheep, Humans and animals, like sheep, goats and horses are believed to goats and horses are believed to acquire the infection by inhalation of acquire the infection by inhalation of dust, ingestion of contaminated water dust, ingestion of contaminated water and contact with contaminated soil and contact with contaminated soil especially through skin abrasions. especially through skin abrasions. Melioidosis can also spread from Melioidosis can also spread from person to person by contact with the person to person by contact with the body fluids of an infected person. body fluids of an infected person.

Human InfectionsHuman Infections initiatedinitiated

Human infections Human infections are initiated with are initiated with contamination of contamination of skin abrasions.skin abrasions.

By IngestionBy Ingestion By By inhalation.inhalation.

MorphologyMorphology B.pseudomallei is a B.pseudomallei is a

small, motile, aerobic small, motile, aerobic Gram –veGram –ve

Grows on standard Grows on standard bacteriological bacteriological mediummedium

The colines vary from The colines vary from muciod and smooth to muciod and smooth to rough wrinkled.rough wrinkled.

The color of the The color of the colonies vary from colonies vary from cream to orange.cream to orange.

Grows at even 42Grows at even 4200cc

Can be Epizootic Can be Epizootic InfectionInfection

Sheep, horses, Goats, swine, can Sheep, horses, Goats, swine, can harbor the infectionharbor the infection

However animals are unlikely to be However animals are unlikely to be primary reservoirs of infectionprimary reservoirs of infection

It is a gram negative bacteria It is a gram negative bacteria with a safety pin like with a safety pin like

appearanceappearance. .

Growth on Standard Growth on Standard MediumMedium

Grows on Standard Grows on Standard Bacteriological Bacteriological media, colonies media, colonies become rough and become rough and wrinkled on wrinkled on prolonged prolonged incubationincubation

Colonies of B.pseudomallei Colonies of B.pseudomallei on Ashdown mediaon Ashdown media

Ashdown's mediumAshdown's medium is a is a selective culture medium for selective culture medium for the isolation and the isolation and characterisation of characterisation of Burkholderia pseudomalleiBurkholderia pseudomallei. . the medium contains the medium contains crystal violetcrystal violet and and Gentamycin as selective Gentamycin as selective agents to suppress the agents to suppress the growth of other bacteria. growth of other bacteria. Colonies of Colonies of B. pseudomalleiB. pseudomallei also take up also take up neutral redneutral red which is present in the which is present in the medium, Ashdown's agar medium, Ashdown's agar needs to be incubated for a needs to be incubated for a minimum of 96 hours minimum of 96 hours instead of 48 hours. instead of 48 hours.

PathogenesisPathogenesis

The disease can manifest as Acute, The disease can manifest as Acute, Sub acute, and Chronic diseaseSub acute, and Chronic disease

Incubation may be as short as 2 – 3 Incubation may be as short as 2 – 3 daysdays

Latent infections can occurs after Latent infections can occurs after months to yearsmonths to years

Progress of InfectionProgress of Infection

The infection starts with non specific The infection starts with non specific lesion at the inoculum, where there lesion at the inoculum, where there can be break in the skin.can be break in the skin.

Lead to septicemia Lead to septicemia Most common form is pulmonary Most common form is pulmonary

infectioninfection Can lead to suppurative infection and Can lead to suppurative infection and

bacterimia bacterimia

Respiratory InfectionRespiratory Infection The most dangerous The most dangerous

infection can be infection can be associated with associated with respiratory infectionrespiratory infection

Can lead to Can lead to suppurative lesions.suppurative lesions.

Consolidations of upper Consolidations of upper lobe of the lunglobe of the lung

Can mimic Can mimic tuberculosis.tuberculosis.

Progressive illness can Progressive illness can produce cavitiesproduce cavities

Spreading lesionsSpreading lesions

Systemic infections Systemic infections spread from the spread from the primary lesions on primary lesions on the skin.the skin.

Can spread to Can spread to lungs, Myocardium, lungs, Myocardium, Liver and Bone.Liver and Bone.

Can present with Can present with unexplained unexplained systemic disease.systemic disease.

Latent Infection in Latent Infection in MelidiosisMelidiosis

The latent infection can reactivate as The latent infection can reactivate as result of immuno supressionresult of immuno supression

A high level of suscipicion in endemic A high level of suscipicion in endemic areas is gratifying.areas is gratifying.

Any unexplained clinical symptoms Any unexplained clinical symptoms and signs should be explored for and signs should be explored for infections.infections.

Who are at riskWho are at risk

Individuals with diabetes are at a higher risk Individuals with diabetes are at a higher risk for contracting melioidosis.  for contracting melioidosis.  About 40% of About 40% of meliodiosis patients are diabetic.meliodiosis patients are diabetic.  Other   Other factors that may increase the risk of factors that may increase the risk of contracting meliodiosis are excessive alcohol contracting meliodiosis are excessive alcohol consumption, chronic renal disease, and consumption, chronic renal disease, and chronic lung disease.  However, even though chronic lung disease.  However, even though these factors do increase the risk of these factors do increase the risk of contracting melioidosis, cases of infection can contracting melioidosis, cases of infection can still occur in healthy adults and children still occur in healthy adults and children occasionally. occasionally. 

Clues to Respiratory Clues to Respiratory infectioninfection

Pulmonary infection:Pulmonary infection: This form of the This form of the disease can produce a clinical picture of disease can produce a clinical picture of mild bronchitis to severe pneumonia. mild bronchitis to severe pneumonia. The onset of pulmonary melioidosis is The onset of pulmonary melioidosis is typically accompanied by a high fever, typically accompanied by a high fever, headache, anorexia, and general headache, anorexia, and general muscle soreness. Chest pain is muscle soreness. Chest pain is common, but a non-productive or common, but a non-productive or productive cough with normal sputum productive cough with normal sputum is the hallmark of this form of is the hallmark of this form of melioidosis. melioidosis.

Immuno supression can be Immuno supression can be leading causeleading cause

Acute bloodstream infection: Acute bloodstream infection: Patients with Patients with underlying illness such as HIV, renal failure, underlying illness such as HIV, renal failure, and diabetes are affected by this type of and diabetes are affected by this type of the disease, which usually results in septic the disease, which usually results in septic shock. The symptoms of the bloodstream shock. The symptoms of the bloodstream infection vary depending on the site of infection vary depending on the site of original infection, but they generally include original infection, but they generally include respiratory distress, severe headache, respiratory distress, severe headache, fever, diarrhea, development of pus-filled fever, diarrhea, development of pus-filled lesions on the skin, muscle tenderness, and lesions on the skin, muscle tenderness, and disorientation. This is typically an infection disorientation. This is typically an infection of short duration, and abscesses will be of short duration, and abscesses will be found throughout the body. found throughout the body.

DiagnosisDiagnosis

Melioidosis is Melioidosis is diagnosed by diagnosed by isolating isolating Burkholderia Burkholderia pseudomalleipseudomallei from from the blood, urine, the blood, urine, sputum, or skin sputum, or skin lesions. Detecting lesions. Detecting and measuring and measuring antibodies to the antibodies to the bacteria in the blood bacteria in the blood is another means of is another means of diagnosis diagnosis

Bacteriological DiagnosisBacteriological Diagnosis

Gram stain of the Gram stain of the material from skin material from skin lesions, sputum.lesions, sputum.

Small gram-ve Small gram-ve bacilli with specific bacilli with specific Bipolar staining can Bipolar staining can be leading clue.be leading clue.

In all suspected In all suspected cases staining with cases staining with Wright's stain and Wright's stain and methylene blue methylene blue

SerologySerology

Strains of Strains of B.pseudomallei are B.pseudomallei are identified serologically identified serologically by agglutination tests, by agglutination tests, rapid slide or tube rapid slide or tube agglutination agglutination

Recently ELISA based Recently ELISA based on monoclonal on monoclonal antitoxin is avialble for antitoxin is avialble for rapid diagnosis in rapid diagnosis in endemic areas of endemic areas of melioidosis.melioidosis.

TreatmentTreatment

As the disease carries high mortality, As the disease carries high mortality, a prompt and effective treatment is a prompt and effective treatment is highly essentialhighly essential

A surgical drainage of organized A surgical drainage of organized surgical lesions.surgical lesions.

Tetracyclnes, Sulfonamides, Tetracyclnes, Sulfonamides, Trimethoprim-Sulphmethoxazole are Trimethoprim-Sulphmethoxazole are effective.effective.

Ceftazidime is highly effectiveCeftazidime is highly effective

Duration of Antibiotic Duration of Antibiotic TreatmentTreatment

The duration of treatment should lost The duration of treatment should lost at least 8 weeks.at least 8 weeks.

The treatment lasting 6moths to 1 The treatment lasting 6moths to 1 year are considered in year are considered in immunosuppressive conditions.immunosuppressive conditions.

No Vaccines are availableNo Vaccines are available

Bio Hazard and Bio Hazard and B.pseudomalleiB.pseudomallei

Human laboratory Human laboratory acquired infection acquired infection with, B.pseudomallei with, B.pseudomallei and P.mallei is a and P.mallei is a hazardhazard

Both organisms are Both organisms are included in category A included in category A pathogen.pathogen.

Included in category 3 Included in category 3 and to be handled and to be handled with greatest care and with greatest care and strict and designated strict and designated isolation conditions.isolation conditions.

Created for Medical Created for Medical and paramedical and paramedical

students in students in Developing worldDeveloping world

Dr.T.V.Rao MDDr.T.V.Rao MD

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