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Tuesday, April 5, 2011

MELIOIDOSIS

Meliodosis is caused by Pseudomonas pseudomallei, a micro organism closely related to P.mallei, the cause of glanders, which is a rare disease of horses and rarely their grooms.
 P.pseudomallei is a saprophyte found in puddles following recent rain. Infection is through abrasions of the skin. Diabetics and patients with severe burns are particularly susceptible. The disease is commonest in the Far East and S.E.Asia and occurs rarely in India, Africa, Australia and America.
Pathology
A bacteraemia is followed by the formation of abscesses in the lungs, liver and spleen.
Clinical features
There is high fever, prostration and sometimes diarrhoea with signs of pneumonia and enlargement of the liver and spleen. A chest radiograph resembles that of acute caseous tuberculosis. In more chronic forms multiple abscesses recur in subcutaneous tissue and bone.
Diagnosis
Culture of blood, sputum or pus may yield P.pseudomallei. Except in fulminating infections, anti bodies may be detected by indirect haemoagglutination, direct agglutination, and complement-fixation tests.
Management
In acute illness prompt treatment,without waiting for cultural confirmation may be life saving. Tetracycline 3g daily is given with chloramphenicol 3g daily, in divided doses. Treatment is maintained for weeks or months until pulmonary cavities have healed.

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