GLOBAL DISTRIBUTION

The disease occurs predominantly in southeastern Asia and northern Australia. The countries where the disease is most frequent are Thailand, Australia, Malaysia and Singapore. The distribution of melioidosis has been described in the Asian region such as Vietnam, Camboya, Laos, subcontinental India, as well as in other continents such as Papua Nueva Guinea in Oceania, Africa, Central America and South America. In Brazil, the first cases occurred in Ceará in 2003 and since then the State has been detecting the disease and warning about the detection of the disease in other regions of the country. In addition to Ceará, there is a record of the disease in Mato Grosso and Alagoas.

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TRANSMISSION

Transmission can occur through inhalation of contaminated water or octopus particles, ingestion or aspiration of contaminated water, inoculation into skin and mucous membranes, particularly skin that is not intact.

Person-to-person transmission is extremely rare with few cases described (sexual and vertical transmission).

Occupational transmission in the laboratory, although rare, can also occur.

PERIODO DE INCUBACIÓN 
The incubation period is variable. An Australian studio showed an incubation period of 1 to 21 days with an average of 9 days. In acute cases, the incubation period should be short, and it can be only 2 to 3 days. The disease can remain latent for long periods and has been described up to 62 years after exposure.

RISK FACTORS
Anyone is susceptible to contracting the infection, but melioidosis is more common in people with pre-existing illnesses such as diabetes, chronic kidney disease, chronic lung disease, chronic liver disease or people taking therapy with corticosteroids or immunosuppressive drugs or those that are alcoholic.

CLINICAL MANIFESTATIONS

The disease is considered a "spectacular imitation" because it can present multiple clinical forms and be confused with other infections. The main clinical presentations of the disease are:
- asymptomatic infection
- Localized infection with soft tissue and skin infection.
- Pulmonary infection: acute infection leads to severe pneumonia.
- Symptoms include high fever, cough, chest pain, muscle pain and headache.
- Severe acute infection can progress quickly with difficulty breathing and respiratory failure.
- Chronic lung infection is similar to tuberculosis with prolonged fever, cough and weight loss.
- Infection in the blood stream ("septicemia"): symptoms usually include high fever, headache, restlessness, disorientation, difficulty breathing and lowering of blood pressure.
- Chronic infection: any organ or part of the body can be infected and therefore the symptoms can be very varied. Infections can occur in joints, lymph nodes, abscesses in various places, such as the liver, the stomach, the brain and the prostate.

DIAGNOSIS
The diagnosis is carried out in the laboratory and is carried out by means of the microbiological culture of Burkholderia pseudomallei obtained from blood, sputum, secretions from herides or abscesses, CSF, bronchial washings or other available samples. Molecular biology tests are also used.

DIAGNOSIS
The diagnosis is carried out in the laboratory and is carried out by means of the microbiological culture of Burkholderia pseudomallei obtained from blood, sputum, orine secretions from herides or abscesses, CSF, bronchial washings or other available samples. Molecular biology tests are also used.

TREATMENT
The treatment is carried out with the appropriate use of antibiotics. The beginning is carried out intravenously for a period of 2 to 4 weeks, followed by an oral treatment that generally extends from 3 to 6 months to prevent relapse. The treatment must be as early as possible to reduce the high lethality of the disease.

PREVENTION
There is no vaccine to prevent the disease. Preventive measures are recommended to minimize the risk of exposure, especially for people with risk factors for contracting the disease. These include water treatment, proper washing of food contaminated with soil, use of protective equipment such as boots and gloves in case of occupational exposure in agriculture or other activities with exposure to soil and water and compliance with laboratory biosafety standards.

BIBLIOGRAPHIC REFERENCES
BARTH, AL et al. Cystic fibrosis patient with Burkholderia pseudomallei infection acquired in Brazil. J Clin Microbiol, v. 45, no. 12, p.4077-4080, Dec. 2007.
CHENG, AC; CURRIE, BJ Melioidosis: epidemiology, pathophysiology and management. Clin Microbiol Rev, v.18, p. 383-416, 2005.  
CURRIE, BJ; JACUPS, S. Intensity of Rainfall and Severity of Melioidosis, Australia. Emerg Infect Dis, v. 12, no. 9, p. 1538-1542, 2003.  
CURRIE, BJ Endemic melioidosis in tropical Northern Australia: a 10-year prospective study and review of the literature. Clin Infect Dis, v. 31, p. 981-986, 2000.  
DANCE, DAB Melioidosis as an emerging global problem. Acta Tropica, vol. 74, p. 115-119, 2000.  
INGLIS, TJ; ROLIM, DB; RODRIGUEZ, JL Clinical guideline for diagnosis and management of melioidosis. Rev Inst Med Trop Sao Paul, v. 48, no. 1, p. 1-4, Jan-Feb. 2006.  
INGLIS, TJ; ROLIM, DB; SOUSA, AQ Melioidosis in the Americas. Am J Trop Med Hyg, v. 75, no. 5, p. 947-954, Nov. 2006. 
INGLIS, TJ; MEE, B.; CHANG, B. The environmental microbiology of melioidosis. Rev. Med. Microbiol, v. 12, p. 13-20, 2001. 
ROLIM, DB et al. Melioidosis, northeastern Brazil. Emerg Infect Dis, v. 11, p. 1458-1460, 2005.  
ROLIM, DB Epidemiological study of the first outbreak of melioidosis in Brazil. 2004.82 f. Dissertation (Master in Public Health) – Faculty of Medicine, Federal University of Ceará, Fortaleza, 2004.
ROLIM, DB Burkholderia pseudomallei in the State of Ceará: characterization of reservoirs. 2009. 157f. Thesis (Doctorate in Medical Sciences) – Faculty of Medicine, Federal University of Ceará, Fortaleza, 2009.  
ROLIM, DB; ROCHA, MF; BRILLIANT, RS; CORDEIRO, RA; LEITÃO, NP JR.; INGLIS, TJ; SIDRIM, JJ Environmental isolates of Burkholderia pseudomallei in Ceará State, northeastern Brazil. Appl Environ Microbiol. v. 75, no. 4, p. 1215-1218, Dec. 2008.