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==transmission==
*''Burkholderia pseudomallei'' lives in soil and water
*close and repetitive contact to soil and freshwater, especially occupationally
**rice farmers in Thailand, Aboriginals in Australia
*most of cases unclear contact history
*immersion in freshwater or aspiration of freshwater like in tsunami may cause infection
*outbreak case mediated by contaminated water supply, disinfectant or detergents
==incubation period==
*1-21 days after apparent exposure
**mean 9 days
*rarely long latency
**a case of 62 years after exposed in Viet Nam
***"Vietnamese time-bomb"
**keep latent in macrophage for long time
***rational of long-term maintenance oral treatment
**where ''Burkholderia''-containing macrophages are kept in human body is still unknown
==risk factors==
*60-90% of cases have underlying conditions
*especially diabetes mellitus and chronic renal failure
**steroid, alcohol abuse, liver dysfunction, chronic lung disease, etc.
*HIV never predisposes to melioidosis
==clinical course==
*peak in 40-60 y/o
*male > female, presumably difference of exposure activity
*most asymptomatic or mild non-specific
**60-70% of endemic area population show seroconversion until 4 y/o
*apparent case shows sepsis with fever and rigor
**80% of apparent cases have pneumonia
***widespread consolidations or cavitations
****mimics TB
*altered mental status
*jaundice
*diarrhea
*widespread metastatic abscesses
**liver, spleen, parotid gland, prostate in male, cutaneous, subcutaneous, keratitis
*parotitis/parotid abscess common in children in Thailand
**in endemic areas, melioidosis is the commonest cause of children's suppurative parotits
*hepatosplenic abscess common in Thailand
*prostatic abscess common in Australia
==diagnosis==
*Culture only
**oxidase positive gram negative rods resistant to aminoglycosides but susceptible to co-amoxiclav should be assumed as ''B. pseudomallei'' until proven otherwise
*serological or molecular test have low sensitivity and low specificity
*unevenly stained gram negative bipolar bacilli
==treatment==
#2 weeks intensive parenteral antimicrobial
*ceftazidime or meropenem IV
#12-20 weeks eradicative oral antimicrobial
*co-trimoxazole or co-amoxicluv PO
==prognosis==
*mortality of severe mellioidosis 40% in Thailand, 14% in Australia
**deaths within 48hrs after hospitalization common
**less mortal without underlying condition
*treatment response slow
**mean 9 days fever
*reinfection in 1-3.4% of survivors in long-term followup
