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Melioidosis A Rare But Serious
Tropical Disease Considered As
An Emerging Problem
Nyoman Sri BudayantiDept. of Microbiology, UNUD
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MELIOIDOSIS
Emerging infectious diseases
Potentially fatal infection diseases
severe ds, high mortality, persist in the bodyfor several years
before emerging
Considered as potential agents for biologicalwelfare &
biological terrorism
Caused by Burkholderia pseudomalleisoil organism
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Endemic in regions of Southeast Asia and
Northern Australia (200 of equator)
Highly endemic in North-eastern part of
Thailand
Reported from : Malaysia, Hong Kong,
Taiwan, Papua New Guinea, Guam, Vietnam,
Philippine, Myanmar
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Seroprevalence :
Thailand (21-47%), Queensland (7,8-29%),Malaysia (1,9-15,8%),
Vietnam (6,4-31,8%),
Hong Kong (14%)
Bali 18,7% from CAP patient
(Budayanti, 2005)
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Incidence of Melioidosis in Indonesia ???
True absence of the disease in the region
Lack of recognition by clinicalLack of facilities capable of
isolating and
identifying B. pseudomallei.
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Burkholderia pseudomallei
A motile Gram negative bacillus
Family Pseudomonadaceae Pseudomonas
pseudomallei
Widely distributed in the soil and water
rice farming
Primarily a disease of animal : horse, mules,donkey
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Clinical features
The Great Imitator :
Broad spectrum of clinical sign, latent foryears, mimics
tuberculosis
Four form of the diseases (CDC,2000):1. Acute Localized
Infection
2. Acute Pulmonary Infection
3. Acute Bloodstream Infection / Septicemic /Disseminated
Melioidosis
4.Chronic Suppurative Infection
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Clinical features
The incubation period :
1-21 days (mean 9 days)
2 days
26 years
the virulence of the strain, the immune
status host, the size of inoculum
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Clinical features
Mode of transmission :
Inhalation
Inoculation
Ingestion
Unusual modes of transmission
perinatal transmission
laboratory-acquired cased
sexual transmission
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Factor Disposisi
The occupational exposure to contaminated
soil and water
Diabetes mellitus
Alcohol excess
Renal diseases
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Pathogenesis
Facultative intracellular pathogen
Exopolysaccharides
Lipase Phospholipase C
Hemolysin
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Diagnosis
CultureGold standard
Gram negative rods
Oxidase positiveResistance to gentamicin and colistin
Ashdowns media : metallic sheen and
characteristic coloni
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CULTURE
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Diagnosis
Antigen detection :
ELISA, Immunofluoresence
Antibody detection :IHA, a rapid immunochromogenic test
Molecular methods
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Treatment
Initial intensive therapy :
Ceftazidime or meropenem with
cotrimoxazole for more than 10 days
Eradication therapy :
Cotrimoxazole with doxycycline orchlorampenicol for more than 3
month
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A POTENTIAL BIOWEAPON
Low technological requirements and cost of
production
High infectivity
Long environmental survival
Easy dissemination by aerosol
A substantial capacity to cause illness anddeath
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