Overview of melioidosis

Melioidosis is caused by the soil and water saprophyte Burkholderia pseudomallei. It is endemic in northern Australia and parts of the Asia–Pacific region, and more recently has been found in Africa and the Americas. It may present in returned travellers, sometimes months or years after exposure.

The clinical presentation varies. People with diabetes, chronic kidney disease, chronic respiratory disease (especially cystic fibrosis), a history of hazardous alcohol consumption and those on immunosuppressive therapy are at risk of developing more severe illness. Pneumonia is the most common presentation, but bacteraemic spread can cause abscesses in any organ (especially the spleen and prostate). Localised cutaneous ulcers or abscesses are also common. Asymptomatic infection, latent infection and relapse can occur.

The use of selective culture media, serology, nucleic acid amplification testing (eg polymerase chain reaction [PCR]) and antigen detection (eg lateral flow immunoassay) can assist diagnosis, but culture of B. pseudomallei remains the only way to make a definitive diagnosis. Perform imaging in all cases to look for deep-seated infection. Computed tomography (CT) of the abdomen and pelvis is recommended for adult males; abdominal ultrasound (to reduce exposure to radiation) is recommended for adult females and children. Seek advice from an infectious diseases physician or a clinical microbiologist.