Cutaneous melioidosis: a review of the literature

Fertitta, L.; Monsel, Gentiane; Torresi, Joseph; Caumes, Éric

doi:10.1111/ijd.14167

Cited by 12 publications

(3 citation statements)

References 31 publications

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Section: Clinical Presentationmentioning

confidence: 99%

“…A recent literature review revealed just 43 reported cases of primary cutaneous melioidosis (474). The majority of cases (67%) occurred in travelers, with Thailand (48%) being the most common destination (474). Interestingly, in Australian children, primary cutaneous melioidosis is a common presentation (49%), with only 20% presenting with pneumonia and 16% bacteremic (475).…”

Section: Clinical Presentationmentioning

confidence: 99%

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Human Melioidosis

2020

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SUMMARY The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Human Melioidosis

2020

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“…Approximately 20% of individuals present with cutaneous melioidosis (CM), mostly with chronic ulcers and abscesses but CM can also be complicated by necrotising fasciitis, osteomyelitis and sepsis. 2 3 In non-endemic areas, melioidosis poses a diagnostic challenge due to its ability to mimic other diseases including pulmonary tuberculosis.…”

Section: Introductionmentioning

confidence: 99%

Leg ulceration due to cutaneous melioidosis in a returning traveller

et al. 2021

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A 26-year-old man, returned to the UK having travelled extensively in Asia. He was referred with a 3-month history of distal leg ulceration following an insect bite while in Thailand. Despite multiple courses of oral antibiotics, he developed two adjacent ulcers. A wound swab isolated an organism identified as Burkholderia thailandensis. The histology of the skin biopsy was non-specific. A diagnosis of cutaneous melioidosis was made, based on clinical and microbiological grounds. The ulcers re-epithelialised on completion of intravenous ceftazidime followed by 3 months of high dose co-trimoxazole and wound care. Many clinical microbiology laboratories have limited diagnostics for security-related organisms, with the result that B. pseudomallei, the causative bacterium of melioidosis, may be misidentified. This case highlights the importance of maintaining high levels of clinical suspicion and close microbiological liaison in individuals returning from South-East Asia and northern Australia with such symptoms.

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