Melioidosis

• An infection caused by bacteria found in soil and water
• More common in tropical Northern Australia during wet season. Has occurred in Central Australia after heavy rains and flooding
• Usually affects adults with risk factors

People with melioidosis can go from a bit sick to very unwell very quickly — all need to go to hospital

Risk factors

• Diabetes — highest risk
• Heavy use of alcohol or kava
• Chronic kidney disease
• Chronic lung disease
• Immune suppression from disease or therapy, especially steroids
• Underlying cancer

Consider melioidosis in person with

• Pneumonia
• Fever, unwell
• Ulcers or boils on skin that take longer than usual to heal
• Lower abdominal pain, prostate melioidosis (trouble passing urine in men)

Ask

• History of symptoms and when they started

Check

• Head-to-toe exam

Do

Collect samples

• U/A for MC&S — ask laboratory to culture for melioidosis 
• Blood for cultures, FBC, melioidosis serology
• If coughing — sputum for MC&S — ask laboratory to culture for melioidosis
• Swabs — throat swabs and rectal swabs for all suspected cases. If unhealed lesion — wound swabs. If cough — extra sputum
• Put in Ashdown's medium, label 'cultures for melioidosis' and keep at room temperature — Ashdown's is special melioidosis culture medium. Keep in fridge before use
• If Ashdown’s medium not available — use ordinary transport medium and ask laboratory to culture for melioidosis

Management and referral

• If you suspect melioidosis — medical consult
• If risk factors and moderate/severe pneumonia — send to hospital
• If other symptoms but not very unwell — do tests, give usual treatment and wait for results
• If melioidosis confirmed by culture — medical consult to send to hospital
• If melioidosis serology positive — infectious diseases unit consult
• If confirmed diagnosis and very unwell — will need treatment before going to hospital
• Take blood for blood cultures before giving antibiotics
• Give (if available) ceftazidime IV — adult 2g, child 50 mg/kg up to 2g
• If ceftazidime is not available — give ceftriaxone IV — adult 2g, child 50mg/kg/dose up to 2g — doses — single dose AND transfer to hospital for directed melioidosis therapy
• If melioidosis suspected but not confirmed ADD to ceftriaxone —  gentamicin IV — doses — single dose for other bacteria
• If allergy — medical consult
• If likely to be transferred to ICU — retrieval team will give meropenem if needed
• Hospital treatment will be IV antibiotics (ceftazidime or meropenem) for a minimum of 2 weeks but often longer is needed

Follow-up

• Melioidosis can come back — further treatment is needed for at least 3 months after IV antibiotics are completed
• Give trimethoprim-sulfamethoxazole oral — adult more than 60 kg — 320+1600 mg, adult 40 to 60 kg — 240+1200 mg, child 1 month or older — 6+30 mg/kg up to 240+1200 mg, twice a day (bd)
• Folic acid oral once a day — adult 5mg, child 0.1 mg/kg up to 5mg 
  
• Weekly follow-up — check any problem taking antibiotics
• Monthly medical follow-up including FBC, LFT, UEC to check for medicine side effects
• Record clearly in file notes that person has had melioidosis