Melioidosis A24.3

Pseudomonas pseudomallei (Burkholderia pseudomallei), a gram-negative rod-shaped bacterium. The ability to intracellular persistence and the ability to form so-called viable but not culturable (VBNC) variants enables the pathogen to remain in the organism for years largely unaffected by the immunological defence of the affected person.

Acute pleuro-pneumonic picture, sepsis, purulent melting metastases in skin, internal organs, muscles. Petechial exanthema. In the second week of illness, possible development of lentil-sized pustules.

Primary localized infection of the skin after inoculation of the pathogen with development of phlegmonous inflammation is also possible.

Early and sufficiently long therapy (at least 8 weeks) with Ceftazidim (e.g. Fortum) 120 mg/kg bw/day i.v. is the method of choice.

Alternatively, combination therapies e.g. with doxycycline (e.g. Doxycyclin Heumann) 2 times/day 100 mg p.o., trimethoprim/sulfamethoxazole(e.g. Cotrimox-Wolff Tbl.) 10/50 mg/kg bw/day p.o. are described.

Alternatively: Imipenem (e.g. Zienam®). Adults: 3-4 times/day 0.5-1.0 g i.v., infants: 60 mg/kg bw/day distributed over 4 ED.

1. Chaowgul W et al (1993) Relapse in melioidosis: incidence and risk factors. J Infect Dis 168: 1181-1185
2. Cheng AC et al (2004) Adjunctive granulocyte colony-stimulating factor for treatment of septic shock due to melioidosis. Clin Infect Dis 38: 32-37
3. Soffler C et al (2014) Pathogenesis of percutaneous infection of goats with Burkholderia pseudomallei: clinical, pathologic, and immunological responses in chronic melioidosis. Int J Exp Catholic 95:101-119
4. Suputtamongokol Y et al (1994) Ceftazidime vs amoxicillin/Clavulanate in the treatment of severe melioidosis. Clin Infect Dis 19: 864-853
5. White NJ (2003) Melioidosis. Lancet 361: 1715-1722
6. Whitmore A, Krishnaswami CS (1912) An account of the discovery of a hitherto undescribed infective disease occurring among the population of Rangoon. Indian Med Gazette 47: 262-267