Melioidosis is an infectious disease caused by an aerobic, non-spore forming gram negative bacillus, Burkholderia pseudomallei. It is known to be of high incidence in parts of rural South East Asia, and in Northern Australia. Pneumonia is the commonest manifestation. We report here three cases of neurological melioidosis from the registry of 169 cases of melioidosis in Bintulu Hospital, Sarawak, East Malaysia, with a review of neurological melioidosis in the literature. The annual incidence of melioidosis is estimated to be 8 per 100,000 populations in the Bintulu district. Neurological melioidosis accounts for 1.8% of our melioidosis cases. A review of 76 cases of neurological melioidosis reported in the literature inclusive of our 3 cases shows that localized brain or spinal inflammation or abscess is the most common manifestation occurring in 80% of patients. Close to half (53%) have intra axial abscess (brain or spinal cord), a quarter (27%) have extra axial lesions only (epidural or subdural collection, osteomyelitis or scalp abscess), and another quarter (27%) have both intra and extra axial lesions. Thus, B. pseudomallei appears to be unique among the bacterial central nervous system infection to be able to affect the brain and its contiguous tissues, crossing the tissue plane particularly resulting in osteomyelitis, scalp abscess and vice versa. Two thirds of the neurologicalmelioidosis patients have only neurological disease with no evidence of disease elsewhere. Key words: Burkholderia pseudomallei; neurological melioidosis; Bintulu; Sarawak; Malaysia
Melioidosis

Melioidosis

Background: Melioidosis is a potentially fatal disease caused by Burkholderia pseudomallei. Over a century after its discovery, there seems to be a paucity of reported cases in the Philippines relative to other countries where it is found to be endemic. This suggests that the true burden of melioidosis in the country is not well-defined. The rarity of the disease, its protean clinical manifestations, and the lack of pathognomonic features pose a great diagnostic challenge. Furthermore, the proper recognition of the organism is an extreme necessity as it is intrinsically resistant to numerous antibiotics and requires specific long-term treatment. Case: This is a case of a 49-year-old Filipino diagnosed with a metastatic spinal disease from a primary thyroid carcinoma and underwent posterior spinal decompression and stabilization. Revision of instrumentation was done following identification of an implant loosening. During the interim, wound dehiscence and infection developed. The patient was readmitted and underwent debridement of the lumbosacral spine. Wound cultures all yielded growth of Burkholderia pseudomallei. The patient received meropenem and then trimethoprim-sulfamethoxazole with ciprofloxacin during the intensive and eradication phase, respectively. Erythrocyte sedimentation rate and C-reactive protein were monitored and a significant reduction in both values reflected a good therapeutic response. Conclusion This is a rare case of a deep surgical site infection caused by Burkholderia pseudomallei. It is known that melioidosis is a potentially fatal infection but is under-reported in the Philippines. At present, further epidemiological studies along with an increased level of awareness of melioidosis are greatly needed to help define the true burden of illness and optimize patient management following prompt recognition.
Melioidosis ; Philippines ; Burkholderia pseudomallei

Burkholderia ; isolation & purification ; China ; Humans ; Melioidosis

Melioidosis, which is infection with the Gram-negative bacterium Burkholderia pseudomallei, is an important cause of sepsis in Southeast Asia and northern Australia and mainly affects diabetics who come into direct contact with wet soil. It presents as a febrile illness, ranging from an acute fulminant septicemia to a chronic debilitating localized infection. Only two cases of chronic infection have been reported in Korea. Both patients had lived in Southeast Asia for more than 1 year. We report a case of melioidosis presenting as acute fulminant septicemia and pneumonia in a 47-year-old diabetic male who had visited Cambodia for 4 days, 1 month before admission. He died of refractory septic shock and multi-organ failure within 10 hours of admission. Melioidosis should be suspected in any severely ill febrile patient with an underlying predisposing condition who lives in, or has travelled from, an endemic area.
Asia, Southeastern ; Australia ; Burkholderia pseudomallei ; Cambodia ; Humans ; Korea ; Male ; Melioidosis ; Middle Aged ; Pneumonia ; Sepsis ; Shock, Septic ; Soil

With globalization, foreign patients are frequently encountered at the clinical practice in Korea. As the number of migrant workers from Southeast Asia has been notably rising since the late 1990's, unfamiliar tropical infectious diseases that they bring out, may give great challenges to the routine clinical practice in Korea. Melioidosis is a community-acquired infection caused by a gram-negative bacillus, Burkholderia pseudomallei. It has been endemic in Southeast Asia and Northern Australia, where B. pseudomallei is a soil saprophyte and invades the host through inoculation or inhalation. It frequently presents as an acute septicemia with a high mortality rate of 40%, mainly in patients with chronic underlying diseases, such as diabetes mellitus. Recently, we encountered a case of fatal disseminated melioidosis in a migrant worker from Thailand. We suggest an importance of melioidosis as a cause of community-acquired sepsis in migrant workers from Southeast Asia.
Adult ; *Burkholderia pseudomallei ; Drug Resistance, Multiple ; Humans ; Male ; Melioidosis/*diagnosis/pathology/radiography ; Thailand ; Tomography, X-Ray Computed

Melioidosis, which is an infectious disease caused by Burkholderia pseudomallei, is prevalent mostly in Southeast Asia and northern Australia; it can progress to abscess formation, pneumonia and sepsis, and ultimately cause death. A 66-yr-old male patient with diabetes mellitus was hospitalized for sepsis 3 months after coming back from Cambodia, and B. pseudomallei was identified from the blood culture. The B. pseudomallei strain was found to be susceptible to carbapenem, and non-susceptible to trimethoprim/sulfamethoxazole and ceftazidime. Although the patient was treated with carbapenem, to which the strain was susceptible, the bacteremia persisted, and progressed to septic shock and pneumonia, and eventually to acute respiratory distress syndrome (ARDS). The patient died on the 12th day of hospitalization. This study, which reports the first case of ceftazidime-nonsusceptible B. pseudomallei in Korea, indicates the importance of B. pseudomallei infection, which is highly likely to be imported to Korea, and discuss its clinical progress, which can lead to fatality.
Abscess ; Asia, Southeastern ; Australia ; Bacteremia ; Burkholderia pseudomallei* ; Burkholderia* ; Cambodia ; Ceftazidime ; Communicable Diseases ; Diabetes Mellitus ; Hospitalization ; Humans ; Korea ; Male ; Melioidosis ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Sepsis ; Shock, Septic

Melioidosis is an infectious disease caused by the Gram-negative bacillus, Burkholderia pseudomallei. It is endemic in Southeast Asia and northern Australia, where B. pseudomallei is a soil saprophyte and invades the host through inoculation, inhalation or ingestion. It infects mostly adults with predisposing conditions, mainly diabetes mellitus. The lung is the most commonly affected organ, presenting with either cough or fever resulting from a primary spread. Also, seeding and abscess formation can arise in any organ. However, prostatic abscess due to melioidosis is uncommon. We report a case of pneumonia, and prostate and scrotal abscesses due to Burkholderia pseudomallei, in a 48-year-old man with diabetes mellitus who had a history of working in Malaysia. This is the first report of genitourinary infection of melioidosis in Korea.
Abscess ; Adult ; Asia, Southeastern ; Australia ; Bacillus ; Burkholderia ; Burkholderia pseudomallei ; Communicable Diseases ; Cough ; Diabetes Mellitus ; Eating ; Fever ; Humans ; Inhalation ; Korea ; Lung ; Malaysia ; Melioidosis ; Middle Aged ; Pneumonia ; Prostate ; Seeds ; Soil

Out of 60 national communicable diseases in Korea, 23 are zoonoses, diseases transmissible from animals to humans. Among the bacterial zoonoses, plague, brucellosis, anthrax, Q fever, tularemia, glanders, and melioidosis are categorized as a high-level threat of bioterrorism and biowarfare in the world. In this paper, the trends of notifiable bacterial zoonoses recently occurring or recurring in Korea and other potential pathogens for bioterrorism or biowarfare are reviewed. Notifiable bacterial zoonoses recently occurring in Korea are enterohemorrhagic Escherichia coli (EHEC) infection, tetanus, tuberculosis, scrub typhus, leptospirosis, brucellosis, and anthrax. Other bacterial diseases recently emerging are tularemia, ehrlichiosis, and Q fever. However, no human case of plague, glanders, and melioidosis has been reported yet.
Animals ; Anthrax ; Bioterrorism ; Brucellosis ; Communicable Diseases ; Communicable Diseases, Emerging ; Ehrlichiosis ; Enterohemorrhagic Escherichia coli ; Glanders ; Humans ; Korea ; Leptospirosis ; Melioidosis ; Plague ; Q Fever ; Scrub Typhus ; Tetanus ; Tuberculosis ; Tularemia ; Zoonoses*

BACKGROUND: Musculoskeletal involvement in melioidosis is often seen in conjunction with a disseminated illness. Recent reports suggest that operative management of musculoskeletal melioidosis has favourable results. The purpose of this study was to review the patient profile and clinical outcomes of Burkholderia pseudomallei infection in the musculoskeletal system. METHODS: Hospital records of 163 patients who were diagnosed to have B. pseudomallei infection between January 2009 and December 2014 were reviewed. Patients underwent surgical and nonsurgical management depending upon the tissue of involvement. Epidata software was used to record the data. The SPSS ver. 17.0 was used for analysis. RESULTS: Eighteen out of 24 patients who had musculoskeletal melioidosis were available for follow-up. Septic arthritis, osteomyelitis, and intramuscular abscess were the common diagnosis, with 6 patients in each group. Twelve patients required surgical intervention. All patients received a full course of parenteral ceftazidime followed by oral doxycycline and co-trimoxazole. Two out of 6 patients (33.3%) died among those who had nonsurgical management as compared to none in the group who had surgical management. This was significant at 10% level of significance (p = 0.098). The rest were followed up for a minimum of 1 year with no evidence of disease recurrence. CONCLUSIONS: This series describing musculoskeletal involvement in melioidosis is the largest such study from a recently recognized ‘endemic’ region. Of importance are the patterns of musculoskeletal involvement, pitfalls in diagnosis and adequate clinical response with timely diagnosis and appropriate surgical management.
Abscess ; Arthritis, Infectious ; Burkholderia pseudomallei* ; Burkholderia* ; Ceftazidime ; Debridement ; Diagnosis ; Doxycycline ; Follow-Up Studies ; Hospital Records ; Humans ; Melioidosis ; Musculoskeletal System ; Osteomyelitis ; Recurrence ; Synovitis ; Trimethoprim, Sulfamethoxazole Drug Combination