Melioidosis A Rare But Serious Tropical Disease Considered As An Emerging Problem

Nyoman Sri Budayanti Dept. of Microbiology, UNUD

MELIOIDOSIS
Emerging infectious diseases Potentially fatal infection diseases severe ds, high mortality, persist in the body for several years before emerging Considered as potential agents for biological welfare & biological terrorism Caused by Burkholderia pseudomallei soil organism

 Endemic in regions of Southeast Asia and Northern Australia (200 of equator) Highly endemic in North-eastern part of Thailand Reported from : Malaysia, Hong Kong, Taiwan, Papua New Guinea, Guam, Vietnam, Philippine, Myanmar

Seroprevalence : Thailand (21-47%), Queensland (7,8-29%), Malaysia (1,9-15,8%), Vietnam (6,4-31,8%), Hong Kong (14%) Bali 18,7% from CAP patient (Budayanti, 2005)

Incidence of Melioidosis in Indonesia ??? True absence of the disease in the region Lack of recognition by clinical Lack of facilities capable of isolating and identifying B. pseudomallei.

Burkholderia pseudomallei
A motile Gram negative bacillus Family Pseudomonadaceae Pseudomonas pseudomallei Widely distributed in the soil and water rice farming Primarily a disease of animal : horse, mules, donkey

Clinical features
The Great Imitator : Broad spectrum of clinical sign, latent for years, mimics tuberculosis Four form of the diseases (CDC,2000): 1. Acute Localized Infection 2. Acute Pulmonary Infection 3. Acute Bloodstream Infection / Septicemic / Disseminated Melioidosis 4.Chronic Suppurative Infection

Clinical features
The incubation period : 1-21 days (mean 9 days) 2 days 26 years the virulence of the strain, the immune status host, the size of inoculum

Clinical features
Mode of transmission : Inhalation Inoculation Ingestion Unusual modes of transmission perinatal transmission laboratory-acquired cased sexual transmission

Factor Disposisi
The occupational exposure to contaminated soil and water Diabetes mellitus Alcohol excess Renal diseases

Pathogenesis
Facultative intracellular pathogen Exopolysaccharides Lipase Phospholipase C Hemolysin

Diagnosis
Culture Gold standard Gram negative rods Oxidase positive Resistance to gentamicin and colistin Ashdowns media : metallic sheen and characteristic coloni

CULTURE

Diagnosis
Antigen detection : ELISA, Immunofluoresence Antibody detection : IHA, a rapid immunochromogenic test Molecular methods

Treatment
Initial intensive therapy : Ceftazidime or meropenem with cotrimoxazole for more than 10 days Eradication therapy : Cotrimoxazole with doxycycline or chlorampenicol for more than 3 month

A POTENTIAL BIOWEAPON
Low technological requirements and cost of production High infectivity Long environmental survival Easy dissemination by aerosol A substantial capacity to cause illness and death

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