Melioidosis

Infection by Burkholderia pseudomallei, a soil saprophyte found in paddy fields.
Commonest cause of fatal community-acquired sepsis in Northern Territory Australia. Accounts for 20% of community acquired sepsis in north-east Thailand.

Clinical features

Sepsis. Metastatic abcesses to any site. Nodular shadowing on CXR ('blood-borne pneumonia').

Diagnosis

Containment level 3 organism: warn laboratory before sending specimen! Blood culture or indirect haemagglutination.

Treatment

Ceftazidime 120mg/kg/day for 2–4 weeks, then docycycline + co-trimoxazole for 20 weeks to prevent relapse. Consider imipenem if not responsive.

Prognosis

Very poor: 95% of patients presenting with septic shock die within 48h. Even with optimal treatment, mortality is 25–40%. 23% will eventually relapse (but <10% with antibiotic prophylaxis).