Melioidosis is also called Whitmore’s disease. Both animals and humans are affected by this deadly condition. It is caused by the bacterium Burkholderia pseudomallei, which spreads through contact with dirty water and soil. According to a study which was done in 2016, about 165,000 cases occur each year. The disease was 1st found in Burma in 1912.
The disease is rare in the U.S. According to the CDC, four cases were registered in the U.S. in 4 different states between March and July, resulting in 2 deaths and national attention. The only places in the U.S. where the bacteria is found naturally are Puerto Rico and U.S. Virgin Islands. Most people in the U.S. need not worry unless they travel to areas where the disease is common. It is more common in northern Australia, Southeast Asia, and other tropical climates. It has the potential to spread in areas where it is typically not found.
Depending on the type of infection, the symptoms vary. Typers of the disease include pulmonary, local, bloodstream, and disseminated infections. CDC says after exposure to the bacterium, it takes 2 to 4 weeks for symptoms to appear. Sometimes symptoms might take hours or years to appear, and some people do not have symptoms but have the disease.
People and animals directly contact soil or water contaminated with the bacterium B. pseudomallei can develop the disease. The most common ways of direct contact, according to the CDC, include:
- Breathing in contaminated dust or water droplets.
- Drinking dirty water that hasn’t been chlorinated.
- Touching contaminated soil with the hands or feet.
Transmission can also occur between people due to contact with blood or bodily fluids, but this is rare. In contaminated soil and water, the bacteria can live for years.
Experts believe that cases of the diseases can be seen chiefly in tropical and subtropical areas. The areas where most cases are recorded are Thailand, Malaysia, Singapore, northern Australia, Vietnam, Papua New Guinea, Hong Kong, Taiwan, India, Pakistan, Bangladesh. The outbreak of the disease is typical after heavy rainfall, typhoon, monsoon, or flooding.
People who will have higher chances of contact with B. pseudomallei in water or soil include adventure travelers, forestry, fishing, farming, workers in construction, military personnel. A 1999 review of the disease case studies found that diabetes is one of the significant risk factors for developing the severeness of the disease. People with lung, kidney, or liver disease are also at higher risk of developing melioidosis.
Animals can also get the disease. They can pick up the condition from contaminated water and soil, infected animals’ milk, urine, feces, nasal secretions, and wounds. The most commonly affected animals are swine, goats, sheep, horses, cats, dogs, cattle.
Types of Melioidosis –
Pulmonary infection –
- The most common way the disease shows up in people is through lung infection. Independently a lung problem can arise, or a blood infection can cause it. The infection can be mild or severe.
- Symptoms include cough with normal sputum or no sputum, chest pain during breathing, high fever, headache, general muscle soreness, and weight loss.
- It can mimic tuberculosis.
Bloodstream infection –
- Without appropriate and fast treatment, a pulmonary infection can progress to septicemia. This is an infection of the bloodstream.
- It is the most severe form of the disease.
- It’s common and life-threatening.
- It occurs quickly, but for some, it may develop gradually.
- Symptoms include fever, especially with shivers and sweating, headache, sore throat, breathing problems, upper abdominal pain, diarrhea, joint pain and muscle tenderness, disorientation, sores with pus on the skin or internally in the liver, spleen, muscle, or prostate.
- People who have diabetics, kidney disease, alcohol abuse, liver disease, thalassemia, chronic lung infections, cancer have higher chances of the disease.
- People older than 40 years also have the risk of developing the disease.
Local infection –
- It affects the skin and organs just under the skin.
- It can spread to the bloodstream, and bloodstream infections can cause local infections.
- Symptoms include pain or swelling in a contained area, fever, ulcerations, or abscesses on or just below the skin.
Disseminated infection –
- In this disease, sores form in more than one organ and may or may not be related to septic shock.
- Symptoms include fever, weight loss, stomach or chest pain, muscle or joint pain, headache, seizures.
- In the prostate, spleen, lung, and liver infected, sores are most commonly located.
Detection of Melioidosis –
The doctor might recommend testing if people have traveled to areas where the bacteria is common and has developed symptoms. Lab tests are performed on blood, urine, sputum, or the fluid from abscesses and skin lesions to look for the presence of the bacteria. It can also be diagnosed by detecting a rise in antibodies to the bacteria in a blood sample.
A vaccine is not available for the disease. The emphasis is on the prevention of the bacteria in a blood sample. The long-term outcome will be affected by the type of infection and the course of treatment. To treat infection, experts recommend that people affected by the disease receive antibiotics intravenously for two weeks. To get the antibiotics to the site of the bacteria, intravenous treatment is the most effective way. After two weeks, again, an assignment is done on the patient to find out if additional treatment is required. CDC recommends after this three to six months of oral antimicrobial therapy.
Intravenous therapy includes –
- Ceftazidime is administered every 6–8 hours,
- Meropenem is administered every 8 hours.
Oral antimicrobial therapy –
- Trimethoprim-sulfamethoxazole took every 12 hours
- Amoxicillin/clavulanic acid is taken every 8 hours.
Patients with penicillin allergies should inform their doctors so that an alternative treatment course can be planned. Many people experience a full recovery after treatment, but relapse is possible and would require additional treatment. People who have had severe cases relapse is more likely to happen.
CDC works on Melioidosis –
- Research is being done to improve lab tests and developing better ways to diagnose the disease.
- Working with scientists and doctors from countries where the disease is common to have a better understanding.
- Providing support to labs across the U.S.
- Stockpiling antibiotics for distribution.
- Writing guidance so that doctors and health workers have accurate information on how to treat the disease.
- Regulating the possession, use, and transfer of the germs that cause the disease.
- Training the healthcare providers and public health workers on emergency response preparation.