Melioidosis is one of Burkholderia (formerly Pseudomonas) pseudomallei induced infection. It comes here to pneumonia, septicemia and localized infections in different organs. The diagnosis is made by staining or by the cultural detection of pathogens. Treatment is with antibiotics such. As ceftazidime, which is given over a longer period.
The pathogen can be isolated from the soil and water and is endemic in Southeast Asia, Australia, Central, West and East Africa, India, the Middle East and China.
Melioidosis is one of Burkholderia (formerly Pseudomonas) pseudomallei induced infection. It comes here to pneumonia, septicemia and localized infections in different organs. The diagnosis is made by staining or by the cultural detection of pathogens. Treatment is with antibiotics such. As ceftazidime, which is given over a longer period. The pathogen can be isolated from the soil and water and is endemic in Southeast Asia, Australia, Central, West and East Africa, India, the Middle East and China. People can purchase a melioidosis by contamination of abrasions or burns, ingestion or inhalation, but not directly from infected animals or other people. In endemic areas, melioidosis occurs more often in patients with diabetes alcoholism Chronic kidney disease immunodeficiency including AIDS melioidosis is a potential substance for bioterrorism. Symptoms and complaints The infection can manifest as acute or remain latent for years after a non-obvious primary infection. The mortality rate is <10%, except in acute septicemic melioidosis, which is often fatal. Most commonly an acute pulmonary infection occurs. This varies from a mild to fulminant necrotizing pneumonia. The onset may be abrupt or gradual, with headache, anorexia, pleuritic or blunt chest pain and generalized myalgia. The fever is> 39 ° C as a rule. Characteristically, there is coughing, tachypnea and rales. The sputum may be blood tinged. The chest X-ray usually shows frequently compaction of the upper lobe of the lung, cavitation and is reminiscent of tuberculosis. Nodular lesions, thin-walled cysts and pleural effusions may also occur. The leukocyte counts are between normal and 20,000 / ul. An acute septicemic infection begins abruptly with septic shock and involvement of multiple organs, there is disorientation, extreme shortness of breath, severe headache, pharyngitis, colicky abdominal pain, diarrhea, and pustular skin lesions. Furthermore, there is high fever, tachypnea, a bright erythema and cyanosis. There may be a pronounced muscle stiffness. Occasionally, to arthritic or meningitis symptoms. Pulmonary symptoms may be absent, but may also be present in the form of whistling, humming and giemenden rales and pleural rub. A localized suppurative infection can occur in almost any organ, but is most common at the vaccination site in the skin (or lung) and the associated lymph nodes. Typical Metastaselokalisationen of infection include the liver, spleen, kidney, prostate, bone, and skeletal muscle. Acute suppurative parotiditis is common among children in Thailand. Patients may be afebrile. Diagnostic staining and culture B. pseudomallei can be stained and in exudates by methylene blue or Gram stain culturally demonstrated. Blood cultures often remain negative unless significant bacteremia (z. B. septicemia). Serological assays are often unreliable in endemic areas because positive results may be due to previous infections. The chest X-ray usually shows compaction irregular nodular (4-10 mm), but can also show lobar infiltrates, bilateral bronchopneumonia or caverns lesions. An ultrasound or CT of the abdomen and pelvis should probably be performed to detect abscesses that may be present regardless of the clinical presentation. Liver and spleen may be palpable. Liver function tests, AST and bilirubin are often abnormal in. Renal failure and coagulopathy may be present in severe cases. The white blood cell count is inconspicuous or slightly increased. Sometimes therapy ceftazidime followed by trimethoprim / sulfamethoxazole (TMP / SMX) Asymptomatic infection does not require treatment. Symptomatic patients is two to four weeks every 6 hours iv ceftazidime 30 mg / kg given (imipenem, meropenem and piperacillin are also effective alternatives), then oral antibiotics (a doubly strong tablet TMP / SMX 2 times / day or doxycycline 100 mg 2 times / day for 3 to 6 months. In children <8 years pregnant women, amoxicillin / clavulanate 5.25 mg / kg used three times a day instead of doxycycline Important points melioidosis is acquired through skin contact, ingestion or inhalation;.. it is not acquired directly from infected animals or humans, the most common manifestation is an acute pulmonary infection (sometimes difficult), but suppurative lesions of the skin and / or many other organs may occur; septicemia, which has a high mortality, the result may be stain and culture are used to diagnose;. blood cultures are performed, but are often negative, except those with severe septicemia. Symptomatic patients are injected i.v. with ceftazidime, followed by a longer treatment with oral TMP / SMX and either doxycycline or in children treated <8 years and pregnant women amoxicillin / clavulanate.