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melioidosis (Whitmore's disease)
Etiology:
- infection with Burkholderia pseudomallei (Pseudomonas pseudomallei)
Epidemiology:
1) more prevalent in parts of Southeast Asia
2) sporadic cases have been reported in the USA
3) organism is widely distributed in water & soil
4) infection occurs after direct inoculation through skin or less commonly inhalation
5) 2% of army personnel stationed in Vietnam were seropositive for Pseudomonas pseudomallei - most were free of disease
6) person to person transmission unlikely
7) Better Homes & Gardens-branded essential oil infused aromatherapy room spray with gemstones (also described as lavender-scented spritz from Walmart) containing Burkholderia pseudomallei resulted in 4 confirmed cases & 2 deaths in U.S. 2021 [5]
- cases in Minnesota, Kansas, & Texas
- first case & death in Kansas, March 2021
Clinical manifestations:
1) disease is generally latent for months to years, but may manifest after 3 days
2) acute pneumonia
3) pleurisy
4) subacute presentation with upper lobe lesions
5) cavitation
6) may resemble tuberculosis
Laboratory:
- culture
a) blood culture
b) sputum culture
c) culture secretions
Radiology: chest X-ray
a) subacute presentation with upper lobe lesions
b) cavitation
Management:
1) reportable disease
2) isolation recommended despite lack of human to human transmission
3) antibiotics
a) amoxicillin clavulanate
b) doxycycline
c) Bactrim
4) alternative imipenem cilastin with or without Bactrim
5) for local disease with mild-moderate toxicity, use 2 of 3 antibiotics for 30 days, then switch to monotherapy for completion of 60-150 day course
6) for extrapulmonary suppurative disease, 6-12 months of antibiotic therapy is recommended
7) in hospital treatment
a) ceftazidime 2 g IV q6h (50 mg/kg up to 1 g in children) for at least 14 days
b) meropenem 1 g IV q8h for at least 14 days (25 mg/kg up to 1 g in children) coupled with cotrimoxazole 320/1600 mg PO/IV bid for at least 14 days (8/40 mg/kg up to 320/1600 mg in children)
c) follow with 60 days - 12 months of oral antibiotics as above (5 or 6) for eradication
7) abscesses may need to be drained
8) no proven postexposure prophylaxis
9) no vaccine
Related
Burkholderia pseudomallei (Pseudomonas pseudomallei)
glanders
General
bacterial infection
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook, Isselbacher et al (eds), McGraw-Hill
Inc. NY, 1995, pg 227
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 799
- eMedicine. Glanders and Melioidosis
http://www.emedicine.com/emerg/topic884.htm
- Wikipedia: Melioidosis
http://en.wikipedia.org/wiki/Melioidosis
- Kavilanz P
Walmart recalls aromatherapy spray that contained deadly bacteria.
CNN Business. October 23, 2021
https://www.cnn.com/2021/10/22/business/walmart-room-spray-recall-bacteria/index.html
- Phend C
CDC Details Deadly Aromatherapy Outbreak.
Tropical disease hit middle America and could pop up again, agency scientists say.
MedPage Today March 2, 2022
https://www.medpagetoday.com/primarycare/generalprimarycare/97467
- Gee JE, Bower WA, Kunkel A et al
Multistate Outbreak of Melioidosis Associated with Imported Aromatherapy Spray.
N Engl J Med 2022; 386:861-868. March 3
PMID: 35235727
https://www.nejm.org/doi/full/10.1056/NEJMoa2116130