Melioidosis

Melioidosis is an <a href="/facts/Infectious_disease/182XrncP">infectious disease</a> caused by a <a href="/facts/Gram-negative/S1PbVtp4">gram-negative</a> <a href="/facts/Bacterium/wC8xSCsU">bacterium</a> called <a href="/facts/Burkholderia_pseudomallei/JeCs8htg">Burkholderia pseudomallei</a>. Most people exposed to B. pseudomallei experience no symptoms, but complications can range from <a href="/facts/Fever/waVxR2Ac">fever</a> and skin changes to <a href="/facts/Pneumonia/Jw0KquTA">pneumonia</a>, <a href="/facts/Abscess/BW3TH8kb">abscesses</a>, and <a href="/facts/Septic_shock/yc9mgmrz">septic shock</a>, which can be fatal. Approximately 10% of people with melioidosis develop symptoms that last longer than two months, termed "chronic melioidosis".
Prior to the Vietnam war less than a handful of patients had diagnosed in the United States in the twentieth century. In 1966, Spotnitz et al discovered that a number of servicemen with delayed onset of pulmonary infections had previously been deployed in Vietnam. Spotnitz coined the term “Vietnam Time Bomb” highlighting the fact that Burkholderia pseudomallei could remain dormant for years.The term gained traction as subsequent studies revealed latent infections in Vietnam veterans with estimates suggesting up to 250,000 U.S. soldiers were exposed. Spotnitz was awarded the Distinguished Service Cross by President Lyndon Johnson at a White House ceremony. 
Humans are infected with B. pseudomallei by contact with contaminated soil or water. The bacteria enter the body through wounds, inhalation, or ingestion. Person-to-person or animal-to-human transmission is extremely rare. The infection is constantly present in Southeast Asia (particularly northeast <a href="/facts/Thailand/GCUnN4JK">Thailand</a>) and northern Australia. In temperate countries such as Europe and the United States, melioidosis cases are usually imported from countries where melioidosis is endemic. The signs and symptoms of melioidosis resemble <a href="/facts/Tuberculosis/ggPyovAl">tuberculosis</a> and misdiagnosis is common. Diagnosis is usually confirmed by the growth of B. pseudomallei from an infected person's blood or other bodily fluid such as pus, sputum, and urine. Those with melioidosis are treated first with an "intensive phase" course of intravenous antibiotics (most commonly <a href="/facts/Ceftazidime/KeXbaPTy">ceftazidime</a>) followed by a several-month treatment course of <a href="/facts/Co-trimoxazole/dcYzn4mR">co-trimoxazole</a>. In countries with an advanced healthcare system, approximately 10% of people with melioidosis die from the disease. In less developed countries, the death rate could reach 40%.
Efforts to prevent melioidosis include: wearing protective gear while handling contaminated water or soil, practising hand hygiene, drinking boiled water, and avoiding direct contact with soil, water, or heavy rain. There is little evidence to support the use of melioidosis prophylaxis in humans. The <a href="/facts/Antibiotic/sF1kIfxg">antibiotic</a> <a href="/facts/Co-trimoxazole/dcYzn4mR">co-trimoxazole</a> is used as a preventative only for individuals at high risk of getting the disease after being exposed to the bacteria in laboratory settings. One study conducted in 2018 determined that the drug could be useful in preventing melioidosis in high-risk renal failure patients undergoing haemodialysis. There is no approved vaccine for melioidosis.
Approximately 165,000 people are infected by melioidosis per year, resulting in about 89,000 deaths, based on a mathematical model published in 2016. <a href="/facts/Diabetes/2xeHXbsI">Diabetes</a> is a major risk factor for melioidosis; over half of melioidosis cases are in people with diabetes. Increased rainfall and severe weather events such as thunderstorms are associated with an increased number of melioidosis cases in <a href="/facts/Endemic_(epidemiology)/YXHcRrQX">endemic</a> areas.

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Melioidosis