An exotic pulmonary infection in Thailand: Melioidosis

Melioidosis is an infectious disease from Burkholderia pseudomallei and is confined in specific geographic areas such as Southeast Asia. Its highest prevalence in Thailand is in the north-eastern part. Most infected patients had worked paddy fields or had underlying diseases such as diabetes mellitus. Melioidosis can manifest clinically, with either disseminated or localized features. In the disseminated form patients developed an acute and progressive course with septicaemia. In contrast, patients with the localized form usually presented with prolonged fever, and symptoms of one or more organ involvement, in particular the lung and the liver. Definite diagnosis of melioidosis is made by an isolation of Burkholderia pseudomallei from a variety of clinical specimens. Treatment of choice for the septicaemic patients is an initial combination of ceftrazidime and trimethoprime- sulfamethoxazole, followed by trimethoprime-sulfamethoxazole for up to 6-12 months depending on the result of clinical specimen culture. Treatment for the localized form requires simultaneous antibiotic therapy and surgical drainage. However, optimum duration of antibiotic therapy remains unknown so further research is required. Melioidosis is an important disease in terms of mortality rate and it requires rapid diagnosis and treatment. To prevent recurrence, it is necessary to continue oral doxycycline or trimethoprime- sulfamethoxazole for 6-12 months.