What is melioidosis? Symptoms and treatment

A DEADLY tropical virus that attacks the brain is causing fresh concern worldwide.

Melioidosis is considered one of the most dangerous infections out there – but what is it and how common are cases?

Concerns about the bug have been sparked by a flurry of cases in the US.

Four cases have been detected in Georgia, Kansas, Minnesota and Texas, of which two resulted in death.

Around a dozen cases of melioidosis are typically found in the states each year, linked to international travel.

But the US Centers for Disease Control and Prevention (CDC) is baffled that the most recent cases have not been abroad.

The disease is caused by bugs naturally found in some parts of the world with tropical climates like Southeast Asia – Thailand, Malaysia and Singapore – and northern Australia.

But experts say melioidosis is of “high public health significance” and is likely to grow in global cases due to international travel.

A paper last October warned the disease is “significantly under-diagnosed” and largely “neglected”.

There have been 46 cases in the UK between 2010 and 2019, according to the authors led by London School of Hygiene and Tropical Medicine.

They wrote there was a “rising incidence of melioidosis imported into the UK” compared to the past, but that many cases are not being formally reported.

Infected people have commonly returned from Thailand, India and Nigeria.

What is melioidosis?

Melioidosis is an infectious disease caused by the bacteria Burkholderia pseudomallei.

The bug is found in contaminated water and soil. 

It has potential to spread into areas it is not typically found, and is considered a potential "biological weapon", the CDC says.

What are the symptoms of melioidosis?

Symptoms of melioidosis vary because there are several types of the disease.

It usually causes a lung infection, with symptoms of a fever, headache, loss of appetite, cough, shortness of breath and chest pain.

A localised infection of the skin can lead to abscesses, swelling and ulcers.

If melioidosis enters the blood, this can cause fever, headache, respiratory distress, stomach pain, joint pain and disorientation.

This could develop into life-threatening septicemia, which is common among melioidosis patients. 

In the most chronic cases, the infection can spread through the skin and blood and into the heart, brain, liver, kidneys, joints and eyes – called disseminated infection.

Melioidosis can be at first mistaken for other diseases because of its wide range of symptoms.

It typically takes two to four weeks for the symptoms to appear after a person is exposed, which also makes it hard for health chiefs to track where it came from.

How is melioidosis spread?

The main way people catch melioidosis is through contact with the contaminated source.

The bug may enter a person’s skin if they touch contaminated soil while they have cuts on their skin.

Humans can also get it through inhaling contaminated dust or water droplets, the CDC says.

But it is “very rare” for someone to catch it from another person.

How serious is melioidosis?

Melioidosis is known for having a high fatality rate. 

Between 10 and 50 per cent of people who catch it die, compared to less than one per cent of people who get sick with flu.

Anyone can get melioidosis. However, those with underlying poor health are the most at risk.

The CDC has warned kidney disease, diabetes and excessive alcohol use can increase risk of serious illness.

Other vulnerable people include those with liver disease, chronic lung infections such as cystic fibrosis and COPD, and those with a condition that suppresses their immune system, such as cancer. 

Of the 46 cases seen in the UK over a decade, 16 needed intensive care.

Patients in the UK have had cystic fibrosis, kidney failure, and type 2 diabetes.

The Cystic Fibrosis Trust in the UK has produced specific guidance about melioidosis for patients planning to travel to melioidosis-endemic areas.

Can melioidosis be treated?

Although up to half of people infected with melioidosis may die, it can be treated with the use of appropriate medication.

First doctors give antibiotics through an IV which may last for several weeks.

Oral antibiotics would then need to be taken for a few months.

How to prevent melioidosis

People most likely to come into contact with melioidosis are:

  • military personnel
  • workers in construction, farming, fishing, and forestry
  • adventure travelers

These people are advised to take extra precautions, such as wearing protective clothing while working.

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