melioidosis (Whitmore's disease)
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Etiology
- infection with Burkholderia pseudomallei (Pseudomonas pseudomallei)
Epidemiology
- more prevalent in parts of Southeast Asia
- sporadic cases have been reported in the USA
- organism is widely distributed in water & soil
- infection occurs after direct inoculation through skin or less commonly inhalation
- 2% of army personnel stationed in Vietnam were seropositive for Pseudomonas pseudomallei - most were free of disease
- person to person transmission unlikely
- Better Homes & Gardens-branded essential oil infused aromatherapy room spray with gemstones (also described as lavender-scented spritz from Walmart) containing Burkholderia pseudomallei resulted in 4 confirmed cases & 2 deaths in U.S. 2021[5]
- cases in Minnesota, Kansas, & Texas
- first case & death in Kansas, March 2021
Clinical manifestations
- disease is generally latent for months to years, but may manifest after 3 days
- acute pneumonia
- pleurisy
- subacute presentation with upper lobe lesions
- cavitation
- may resemble tuberculosis
Laboratory
- culture
- blood culture
- sputum culture
- culture secretions
Radiology
- subacute presentation with upper lobe lesions
- cavitation
Management
- reportable disease
- isolation recommended despite lack of human to human transmission
- antibiotics
- alternative imipenem cilastin with or without Bactrim
- for local disease with mild-moderate toxicity, use 2 of 3 antibiotics for 30 days, then switch to monotherapy for completion of 60-150 day course
- for extrapulmonary suppurative disease, 6-12 months of antibiotic therapy is recommended
- in hospital treatment
- ceftazidime 2 g IV q6h (50 mg/kg up to 1 g in children) for at least 14 days
- meropenem 1 g IV q8h for at least 14 days (25 mg/kg up to 1 g in children) coupled with cotrimoxazole 320/1600 mg PO/IV bid for at least 14 days (8/40 mg/kg up to 320/1600 mg in children)
- follow with 60 days - 12 months of oral antibiotics as above (5 or 6) for eradication
- abscesses may need to be drained
- no proven postexposure prophylaxis
- no vaccine
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook, Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 227
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 799
- ↑ eMedicine. Glanders and Melioidosis http://www.emedicine.com/emerg/topic884.htm
- ↑ Wikipedia: Melioidosis http://en.wikipedia.org/wiki/Melioidosis
- ↑ 5.0 5.1 Kavilanz P Walmart recalls aromatherapy spray that contained deadly bacteria. CNN Business. October 23, 2021 https://www.cnn.com/2021/10/22/business/walmart-room-spray-recall-bacteria/index.html
Phend C CDC Details Deadly Aromatherapy Outbreak. Tropical disease hit middle America and could pop up again, agency scientists say. MedPage Today March 2, 2022 https://www.medpagetoday.com/primarycare/generalprimarycare/97467
Gee JE, Bower WA, Kunkel A et al Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray. N Engl J Med 2022; 386:861-868. March 3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35235727 https://www.nejm.org/doi/full/10.1056/NEJMoa2116130