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 Bacterial Diseases - MELIOIDOSIS

(Pseudoglanders, Whitmore's disease)

AGENT:

Pseudomonas pseudomallei (Malleomyces pseudomallei, Actinobacillus pseudomallei ) -- MOTILE, Gram negative rod

RESERVOIR AND INCIDENCE

Normal inhabitant of surface soil and water in Southeast Asia, and tropical areas. Recent studies have shown that the water of tanks in which exotic aquarium fishes were imported was contaminated. Occurs in wild rodents, goats, pigs, sheep. Also identified in Chimps, orangutans, and macaques. There is no evidence that animals are important reservoirs, except in the transfer of the agent to new foci. Rare in the U.S. except in drug users.

TRANSMISSION:

By inhalation from moist soil-water reservoir, by contact with contaminated soil or water through overt or inapparent skin wounds, or by ingestion of contaminated feeds. Can be venereal in man.

DISEASE IN ANIMALS:

Signs include loss of weight, swelling of joints, fever, cough, and chest pain. Skin lesions with fistulous tracks can develop. Emaciation and multiple abscesses in lung, bone, viscera. A chronic draining purulent skin lesion in a primate is suspect. Incubation period can be 6 months to three years. Sheep seem especially susceptible - over 25% mortality can occur in outbreaks.

DISEASE IN MAN:

Clinical disease is not common in man but subclinical disease in endemic areas based on serology is common. It may simulate typhoid fever or TB including pulmonary cavitation, empyema, chronic abscesses and osteomyelitis. High case fatality rate (80%) in people who do develop clinical signs.

DIAGNOSIS:

Culture and isolation from lesions, a rising serological titer is confirmatory.

TREATMENT:

Ceftazidime. Alternates: Chloramphenicol or Trimethoprim-sulfamethoxazole.

CONTROL:

Safe disposal of sputum and wound discharges.