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.
Sepsis. Metastatic abcesses to any site. Nodular shadowing on CXR
Containment level 3 organism: warn laboratory before sending
specimen! Blood culture or indirect haemagglutination.
Ceftazidime 120mg/kg/day for 2–4 weeks,
then docycycline + co-trimoxazole for 20 weeks to prevent relapse.
Consider imipenem if not responsive.
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).