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Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions.
Eur Respir J. 2003 Sep; 22(3):542-50.ER

Abstract

Melioidosis is endemic in South East Asia, Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. While 20-36% of melioidosis cases have no evident predisposing risk factor, the vast majority of fatal cases have an identified risk factor, the most important of which are diabetes, alcoholism and chronic renal disease. Half of all cases present with pneumonia, but there is great clinical diversity, from localised skin ulcers or abscesses without systemic illness to fulminant septic shock with multiple abscesses in the lungs, liver, spleen and kidneys. At least 10% of cases present with a chronic respiratory illness (sick > 2 months) mimicking tuberculosis and often with upper lobe infiltrates and/or cavities on chest radiography. As with tuberculosis, latency with reactivation decades after infection can also occur, although this is rare. Confirmation of diagnosis is by culture of B. pseudomallei from blood, sputum, throat swab or other samples. Microbiology laboratories need to be informed of the possibility of melioidosis, as those not familiar with it can misidentify the organism. Antibiotic therapy is initial intensive therapy with i.v. ceftazidime or meropenem or imipenem +/- cotrimoxazole for > or = 10 days, followed by eradication therapy with cotrimoxazole +/- doxycycline +/- chloramphenicol (first 4 weeks only) for > or = 3 months. Melioidosis has been increasingly recognised in returning travellers in Europe and recently melioidosis and colonisation with B. pseudomallei have been documented in cystic fibrosis patients visiting or resident in endemic areas.

Authors+Show Affiliations

Menzies School of Health Research, Flinders University, Darwin, Australia. bart@menzies.edu.au

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

14516149

Citation

Currie, B J.. "Melioidosis: an Important Cause of Pneumonia in Residents of and Travellers Returned From Endemic Regions." The European Respiratory Journal, vol. 22, no. 3, 2003, pp. 542-50.
Currie BJ. Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions. Eur Respir J. 2003;22(3):542-50.
Currie, B. J. (2003). Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions. The European Respiratory Journal, 22(3), 542-50.
Currie BJ. Melioidosis: an Important Cause of Pneumonia in Residents of and Travellers Returned From Endemic Regions. Eur Respir J. 2003;22(3):542-50. PubMed PMID: 14516149.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions. A1 - Currie,B J, PY - 2003/10/1/pubmed PY - 2004/1/15/medline PY - 2003/10/1/entrez SP - 542 EP - 50 JF - The European respiratory journal JO - Eur. Respir. J. VL - 22 IS - 3 N2 - Melioidosis is endemic in South East Asia, Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. While 20-36% of melioidosis cases have no evident predisposing risk factor, the vast majority of fatal cases have an identified risk factor, the most important of which are diabetes, alcoholism and chronic renal disease. Half of all cases present with pneumonia, but there is great clinical diversity, from localised skin ulcers or abscesses without systemic illness to fulminant septic shock with multiple abscesses in the lungs, liver, spleen and kidneys. At least 10% of cases present with a chronic respiratory illness (sick > 2 months) mimicking tuberculosis and often with upper lobe infiltrates and/or cavities on chest radiography. As with tuberculosis, latency with reactivation decades after infection can also occur, although this is rare. Confirmation of diagnosis is by culture of B. pseudomallei from blood, sputum, throat swab or other samples. Microbiology laboratories need to be informed of the possibility of melioidosis, as those not familiar with it can misidentify the organism. Antibiotic therapy is initial intensive therapy with i.v. ceftazidime or meropenem or imipenem +/- cotrimoxazole for > or = 10 days, followed by eradication therapy with cotrimoxazole +/- doxycycline +/- chloramphenicol (first 4 weeks only) for > or = 3 months. Melioidosis has been increasingly recognised in returning travellers in Europe and recently melioidosis and colonisation with B. pseudomallei have been documented in cystic fibrosis patients visiting or resident in endemic areas. SN - 0903-1936 UR - https://www.unboundmedicine.com/medline/citation/14516149/Melioidosis:_an_important_cause_of_pneumonia_in_residents_of_and_travellers_returned_from_endemic_regions_ L2 - http://erj.ersjournals.com/cgi/pmidlookup?view=long&pmid=14516149 DB - PRIME DP - Unbound Medicine ER -