Melioidosis and Glanders

Melioidosis is an infection caused by the gram-negative bacterium Burkholderia pseudomallei, a soil organism prevalent across large areas of rural east and south Asia and northern Australia. Diabetes mellitus, chronic renal disease, cirrhosis, alcoholism, and immune compromise all predispose to melioidosis. Systemic infection is characterized by abscess formation, commonly in the lungs, liver, and spleen and often in skeletal muscle or prostate, and a high treated mortality (>30%). In contrast local skin and soft tissue infections may occur in otherwise healthy individuals. These have a good prognosis. Melioidosis causes a unique syndrome in children of suppurative parotitis. B. pseudomallei is readily cultured from blood or infected sites. Systemic infections require high-dose antibiotic treatment initially with parenteral ceftazidime or meropenem for at least 10 days, followed by oral therapy to complete 20 weeks’ treatment with trimethoprim–sulfamethoxazole. Glanders is an infection with B. mallei, a pathogen of horses and other equines; it is now very rare.