1. MelioidosisIntroductionBy Dr Nurul Athirah NaserrudinMedical 0fficerKlinik Kesihatan Tandek

2. Menteri Besar, Datuk Seri Adnan Yaakob, dirawat di PusatPerubatan Prince Court, Kuala Lumpur selama seminggu lebih,disyaki dijangkiti Leptospirosis (kencing tikus) atau Melioidosis(bakteria disebabkan air dan tanah) 3. Melioidosis in PahangJanuary 2000 to June 2003157 cultured positive in PahangThe calculated annual incidence of adult melioidosis inPahang state was 6.07 per 100, 000 population per year.78.5% were male.Malays:83%, Chinese:9.6%, Indians:3%,Orang Asli :3% 4. Lubuk Yu Outbreak 2010A boy was suspected to have drownedA 150-member team of police and army officers, divers,firemen and volunteers from a nearby village searchedfor his bodyFollowing this rescue operation, 22 people presentedwith an acute febrile illness10 were blood culture confirmed melioidosis (4 werepositive for leptospirosis based on PCR)Among those cultured confirmed: 7 died(all DM, withsevere pneumonia, 1 patient died at home, no culture) 5. What , Why , Where, How?- History- Distribution of disease- Which organism?- Risk factors- Method of transmission-Classification- Clinical Manifestations-Symptoms 6. History1912 : First described by Capt. Alfred Whitmore and C.S.Krishnaswami ( Indian Medical Service)- 38 fatal cases of pneumonia amongst the destitute andmorphine addicts in Rangoon, Burma- COD ? Unknown etiology ? Glander like disease ( noequine exposure)1913 Fletcher (pathologyst) and Stanton(bacteriologyst)recognised the disease in laboratory animals at the Institutefor Medical Research in Kuala Lumpur, Malaysia1917 Stanton first described the infection in a humanpatient 7. History during WW II1948 1954 , indo china- affects > 100 French soldiers stationed inindo china1973 , Vietnam- affects > 300 American soldiers- direct contact wound with mud and water- vietnamese time bomb - reoccured afterlatent up to 20 years 8. First International Symposium onMelioidosisBy the Malaysian Society of Infectious Diseases andChemotherapy, under the Chairmanship of Prof. S DPuthucheary, was held in Kuala Lumpur from April7-8, 1994.About 100 participants from around the worldattended and the papers presented weresubsequently edited and publishedas a book 9. How melioidosis got its name ?The term melioidosis was coined in 1921 byStanton and Fletcher and is derived from theGreek wordsmelis meaning a distemper of asses(donkey)eidos , resemblance.This was because the disease clinically andpathophysiologically resembled glanders, achronic and debilitating disease of equinescaused by Pseudomonas malle(pseudoglanders) 10. EpidemiologyIn endemic areas, antibodies found in 5-20% agriculture workers,no hx of clinical disease. Outbreak : Wet season 11. Etiology Burkholderia pseudomallei ,aerobic, gram- negative, motilebacillus, soil saprophyte Oppurtunistic pathogen Can survive in phagocytic cells latent infection Phylogenetically alikePseudomonas malleipcture : B. pseudomallei onAshdowns agar. The colonyappears irregular-edge, roughand pale purple. 12. Risk factors+oppurtunistic pathogens+immunosuppriseve subjects1. DM (50-70%)2. RF / CKD4. Retroviral dss5. Malignancy6. On steroid therapyHistory of1. recreational activity ; soil/ mud 13. Mode of Transmission1. Inhalation2. Ingestion3. Inoculation4. breast milk5. perinatal6.human to humanState the intended goal 14. Classification The Great Mimickerno pathognomonicAcute, fulminant , benign septicemia/chronic diseaseNo definite classification1. Septicimia / Non septicimiaIncubation period : Not definedUp until months yearsMortality : bacterimia ~ 100% / Localised 5%Optimal care & Mx ~35 -50% 15. SymptomsNon specific fever (high grade), headache,vomit, nausea, abdo painSkin manifestation : cellulitisLung(50%; most common affected organ)manifestation : cough pneumonia/ lungabscessSystemic ( blood to organs) : chronic form ofmelioidosis affecting the heart, brain, liver,kidneys, joints, and eyes. 16. (2)Diagnosis and Treament 17. Diagnosis+history of presenting illness ( HOPI)+hx of travelling to endemic area / soil / oilarea+risk factors : DM/ malignancy/ takingsteroid / immunoc , etc+ symptoms ( non specific) ; fever +respiratory complaints+ clinical examination : lung, skin 18. Primary skin melioidosisSecondary (Disseminated) skin melioidosis 19. How to diagnose?Laboratory diagnosis1. blood culture2. urine3. pus4. sputumSerological test1. Agglutination test2.ImmunoflourescenceImaging : CXRGold standard Isolation ofB.pseudomalleifrom bodily fluids ofpatients 20. +46 % pneumonia +56% unilateralpulmonaryshadowing(predominant Rtlung) +44% bilaterallesions +14%cavitation- +Rt lobe and Lowercommonest 21. Treatment1. Antibiotic ?parenteral or ?oral therapy(localised skin lesion / kids)- monotherapy (simplebacteremia) or combined (septicemia)- eradication / maintenence2. Adjuctive / supportive therapy ( to reducein hospital mortality ) : HDU , ICU,splenectomy, IVI insulin, debridement andcurretage , etc3. No vaccine currently available 22. Treatment1. Ceftazidime ( 3rd gen Ceph) 2weeks2. Bactrim (TMP SPZ ) 6months* maintenance therapy ( eradication ) - toprevent relapse/recurrence*monitor IgG levels and titre: as guideline todetermine duration of eradication therapy 23. Relapse and Recurrent+immunocompromise+non complaint to abx+ Relapse : Reappearance of signs andsymptoms after initial clinical response whilestill on antimicrobial therapy.+ Recurrent : A new episode of melioidosiscaused by the same organism afterconvalescence and full clinical recovery 24. Conclusion-Melioidosis is an infectious diseasecaused by a bacterium, Burkholderiapseudomallei.-Melioidosis infection commonly involvesthe lungs.-Melioidosis is diagnosed with the help ofblood, urine, sputum, or skin-lesion testing.-Melioidosis is treated with antibiotics.- The overall mortality rate is 50-70%.