Melioidosis

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2022年10月16日 (日) 16:42時点におけるVaccipedia.admin (トーク | 投稿記録)による版 (→‎clinical course)
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pathogen

  • Burkholderia pseudomallei
  • potential biological weapon

epidemiology

  • endemic South Asia, Southeastern Asia and Australia
    • especially in Northeastern Thailand and Northern Australia
    • Third ID death in Northeaster Thailand following after HIV and TB
  • reason of localized distributions are unknown
  • highly seasonal, most in rainy season
    • stormy weather events like typhoon

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

  1. 2 weeks intensive parenteral antimicrobial
  • ceftazidime or meropenem IV
  1. 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