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Melioidosis is an important public health problem in some regions, and a potential bioweapon. Recent reports confirm that it is endemic in China, Taiwan and Laos, but the true incidence in most countries is unknown, and the ecology poorly understood. Potable water was the source of two recent outbreaks. The epidemiology and clinical manifestations of the disease in Australia are similar to those in Thailand, although prostatic abscesses and neurological manifestations are more common and parotid abscesses less so. Mycotic aneurysms are not uncommon. Patients with cystic fibrosis are at risk of pulmonary melioidosis. Comparison with the avirulent Burkholderia thailandensis has identified capsular polysaccharide as an important virulence determinant in Burkholderia pseudomallei. Diagnosis still relies on culture, and a throat swab is a worthwhile sample. Several beta-lactams, such as meropenem, reduce the mortality, and long courses of cotrimoxazole-containing regimes are needed to prevent relapse. The value of adjunctive treatments, such as granulocyte colony-stimulating factor, warrants further evaluation.

Original publication

DOI

10.1097/00001432-200204000-00005

Type

Chapter

Publication Date

04/2002

Volume

15

Pages

127 - 132

Addresses

Public Health Laboratory, Derriford Hospital, Plymouth, Devon, UK. david.dance@phnt.swest.nhs.uk

Keywords

Humans, Burkholderia pseudomallei, Melioidosis, Lactams, Trimethoprim-Sulfamethoxazole Combination, Anti-Bacterial Agents