WORLD DISTRIBUTION 

The disease occurs predominantly in Southeast Asia and Northern Australia. The countries where the disease is most prevalent are Thailand, Australia and Malaysia. The distribution of melioidosis is expanding and has been described in the Asian region such as Vietnam, Cambodia, Laos, subcontinental India, as well as in other continents such as Papua New 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 alerting for the detection of the disease in other regions of the country. In the Americas, Brazil has the highest number of cases. In addition to Ceará, there is a record of the disease in Alagoas, Piauí, Mato Grosso and Mato Grosso do Sul. By the year 2019, Ceará had registered 50 cases in 26 municipalities.

TRANSMISSION 

Transmission can occur through exposure to bacteria through inhalation of soil particles or water, inoculation into skin and mucous membranes, particularly broken skin, ingestion or aspiration of contaminated water. Person-to-person transmission is extremely rare with few cases described (sexual, vertical and breast milk transmission). Occupational laboratory transmission, although rare, can also occur.

INCUBATION PERIOD 
The incubation period is variable. An Australian study showed an incubation period of 1 to 21 days with an average of 9 days. In acute cases, the incubation period is usuallybe short, and may only be 2 to 3 days. The disease can remain latent for long periods and has been described up to 29 years after exposure.

RISK FACTORS
Anyone can get the infection, but melioidosis is more common in people with preexisting conditions such as diabetes, chronic kidney disease, chronic lung disease, chronic liver disease, or people who use corticosteroid therapy or immunosuppressant drugs or are alcoholics.

CLINICAL MANIFESTATIONS 

The disease is considered a “spectacular imitator” 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 skin and soft tissue infection.

• Pulmonary infection– common community pneumonia unresponsive to commonly used antibiotics up to severe pneumonia.  Symptoms can be nonspecific such as fever, cough, chest pain, myalgia and headache. Severe acute infection can rapidly progress to respiratory failure. Chronic lung infection is similar to tuberculosis with prolonged fever, cough, and weight loss.

• Bloodstream infection (sepsis) - symptoms usually include high fever, headache, agitation, disorientation, respiratory distress and hypotension.

• chronic infection- any organ or part of the body can be infected and, therefore, the symptoms tend to be quite varied. Infections may occur in the joints, lymph nodes, abscesses in various

sites such as the liver, spleen, brain and prostate.

 

DIAGNOSIS  

Diagnosis is laboratory-based and performed through the isolation of Burkholderia pseudomallei through microbiological culture obtained from blood, urine, oropharyngeal swab, sputum, secretions from wounds or abscesses, cerebrospinal fluid, bronchial washings or other available specimens.  Molecular biology tests are also used for confirmation.

TREATMENT  
Treatment is with appropriate use of antibiotics. The beginning is done intravenously for a period of 2 to 8 weeks, followed by prolonged oral therapy usually from 3 to 6 months to prevent recurrence. Treatment should be as early as possible to reduce the high lethality of the disease.

PREVENTION

There is no vaccine to prevent the disease. Prevention measures are recommended to minimize the risk of exposure, especially for people with risk factors for acquiring the disease. These include avoiding exposure to soil and water, especially in the first weeks after rain, treating drinking water, properly washing food contaminated with soil, using 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 standards

biosafety in the laboratory.

BIBLIOGRAPHICAL REFERENCES 

Benoit, T.; Blaney, DD; Doker, TJ; Gee, JE; Mindy, G.; Elrod, M.; Rolim, DB; Inglis, TJJ; Hoffmaster, AR; Bower, AW; et al. Review article: A review of melioidosis cases in the Americas. Am. J. Trop. Med. Hyg. 2015, 93, 1134–1139.

 

Currie BJ, Anstey NM. Treatment and prognosis of melioidosis. 2018. Available from: https://www.uptodate.com

 

Currie BJ, Dance D. Melioidosis and Glanders. BMJ Best Practice. 2018.

  
Currie BJ. Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment. Semin Respire Crit Care Med. 2015; 36(1):111–25. https://doi.org/10.1055/s-0034-1398389 PMID: 25643275

  
Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nature microbiology. 2016; 1:15008.
 

ROLIM, DB et al. Melioidosis, northeastern Brazil. Emerg Infect Dis, v. 11, p. 1458-1460, 2005

Rolim DB, Lima RXR, Ribeiro AKC, Colares RM, Lima LDQ, Rodríguez-Morales AJ, Montúfar FE, Dance DAB. Melioidosis in South America. Trop Med Infect Dis. 2018 Jun 5;3(2):60. 

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.   

 

Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, et al. Melioidosis. Nature reviews Disease primers. 2018; 4:17107.