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Melioidosis - Skin
See also in: International Travel,Pulmonary
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Melioidosis - Skin

See also in: International Travel,Pulmonary
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Contributors: Art Papier MD, William Van Stoecker MD
Other Resources UpToDate PubMed

Synopsis

Melioidosis, or Whitmore's disease, is an infection caused by the gram-negative bacillus, Burkholderia pseudomallei. It is also known as Stanton's disease, pseudo-glanders, and glanders-like disease of Rangoon.

The disease is most commonly seen in tropical climates. It is endemic to Southeast Asia and northern Australia with most cases occurring during the rainy season. It may also be found in the South Pacific, Africa, India, the Middle East, and Central and South America.

Melioidosis is acquired through skin abrasions, inhalation, and other types of contact with contaminated water and soil.

There are four clinically distinct types of melioidosis: localized, pulmonary, septicemic and chronic. Melioidosis is usually nonfatal, except in the septicemic form.

Localized
Acute localized melioidosis usually presents with a skin nodule or pustule. The skin lesions typically occur 1 to 5 days following an initial bacterial inoculation through a break in the skin from contaminated water or soil. Lymphadenitis and regional lymphadenopathy are common. Associated systemic symptoms may include fever, chills and myalgias. It may progress to septicemia, especially in immunocompromised patients or the chronically ill.

Pulmonary
Pulmonary melioidosis has a clinical presentation that can vary from a mild bronchitis to a severe pneumonia. Symptoms occur 10 to 14 days after inhalation of aerosolized bacteria and include sudden onset of high fever, chills, productive or non-productive cough, chest pain, headache, anorexia and myalgia. This is the only form of melioidosis that presents with a cough. Skin abscesses may be seen, even months after infection.

Septicemic
Septicemic melioidosis usually results in septic shock and is most likely to occur in immunocompromised and those with diabetes and renal insufficiency. Symptoms include headache, fever, chills, diarrhea, disseminated abscesses, myalgia, skin pustules, disorientation, and respiratory distress. Mortality rates are at least 90% and death may occur within 48 hours, even with therapy. Patients with diabetes, cirrhosis, lung disease, renal disease, cystic fibrosis, the immunocompromised, and those who consume kava root are predisposed to septicemic infection.

Chronic
Chronic suppurative melioidosis usually has a delayed onset and presents with abscesses in organs such as the skin, brain, liver, lungs, and spleen. It may also produce abscesses in the lymphatics, bones, and joints.

The incubation period of melioidosis can vary anywhere between 2 days and years. Person-to-person transmission is possible, including sexual transmission. Currently there is no vaccine for melioidosis.

In endemic areas, military personnel, agricultural workers, farmers, gardeners, and tourists are at higher risk for contracting melioidosis. Patients with a medical history of diabetes are at much higher risk of infection.

Note: Wear protective clothing and footwear in endemic areas.

Codes

ICD10CM:
A24.9 – Melioidosis, unspecified

SNOMEDCT:
428111003 – Melioidosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Localized
Pulmonary
Septicemic
Any other causes of sepsis-like picture including:
Chronic

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 06/21/2017
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Melioidosis - Skin
See also in: International Travel,Pulmonary
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Melioidosis : Chest pain, Cough, Fever, Headache, Contaminated drinking water exposure, Dyspnea, Myalgia, Contaminated soil
Copyright © 2018 VisualDx®. All rights reserved.