Have you ever heard of a disease called 'Melioidosis'? The name may sound a bit strange. But this is a disease that should be taken into account in countries like ours where there is a lot of heat and humidity, especially for those who are exposed to soil and water. So there is nothing to be afraid of, let's talk about this simply, in a way that you can understand.
What is Melioidosis?
Simply put, melioidosis is a disease caused by a bacterium . It is caused by a type of bacteria called Burkholderia pseudomallei (B. pseudomallei). It is transmitted to us through direct contact with contaminated soil or water that contains this bacteria. The symptoms you develop can vary from person to person. It depends on how you became infected and whether you have other underlying conditions.
This disease can affect both humans and animals. However, it is not transmitted from animals to humans . It is also important to remember that this disease is sometimes called "Whitmore's disease".
Where is Melioidosis most common?
The bacteria `B. pseudomallei` is most common in the soil and water sources of northern Australia and Southeast Asia - especially our neighboring countries like Thailand, Singapore, and Malaysia. However, these patients have also been reported from other parts of the world.
Imagine, this bacteria was discovered in the coastal environment of Mississippi, USA, in 2022. Also, in 2021, this bacteria was found in a substance in an aromatherapy spray, and several people have developed the disease from it. This means that this bacteria can be found in unexpected places.
Who is most affected by Melioidosis?
In areas where this bacteria is common, it most commonly affects adults with underlying medical conditions, usually between the ages of 40 and 60. Surprisingly, children under the age of 15 are very rarely affected by this disease.
Who is at higher risk of developing melioidosis?
You are at higher risk of developing this disease if you live or work in an area where B. pseudomallei bacteria are common, and if you have any of the following health conditions:
- Diabetes Mellitus : This is a problem that many people have.
- Alcohol use disorder
- Chronic kidney disease
- Chronic lung diseases : For example, `(Cystic fibrosis)` or `(COPD)`.
- Cancer or other diseases that weaken the immune system : However, HIV infection does not appear to increase the risk of melioidosis.
- Thalassemia
Also, those who engage in jobs or hobbies that frequently come into contact with soil and surface water, such as gardening, landscaping, and farming, in areas where the `B. pseudomallei` bacteria is prevalent, are at higher risk. Imagine, Uncle Kamal, who has diabetes in our village, works in the fields, and he often steps into muddy water. He has to be careful about this kind of disease.
What are the symptoms of Melioidosis?
The symptoms you experience will vary depending on where in your body the infection is. You may have symptoms in your lungs, skin, blood, or multiple areas at once.
Symptoms of melioidosis of the lungs (Pulmonary melioidosis)
If you have an infection in your lungs, you may experience symptoms like:
- Cough
- Difficulty breathing (dyspnea)
- Chest pain
- Fever
- Appetite
- Headache
Melioidosis in your skin (localized) symptoms
If it's a skin infection, you may see things like:
- Wounds, ulcers, or abscesses
- Swollen lymph nodes
- Fever
Symptoms of Melioidosis in your blood
Sometimes, along with signs of infection in the skin or lungs, there may also be signs of infection in the blood (septicemia). This is also called blood poisoning. The symptoms are:
- High fever
- Extreme fatigue/fatigue
- Headache
- Difficulty breathing/shortness of breath
- Stomach pain
- Joint pain
- Mental changes such as confusion and memory loss
Symptoms of Chronic (disseminated) melioidosis
Sometimes symptoms can last for two months or more . During this time, the B. pseudomallei bacteria can spread to different parts of the body. Symptoms can include:
- Chronic cough
- Fever
- Weight loss
- Night sweats
- Coughing up blood
- Stomach or chest pain
- Muscle or joint pain
- Headache
- Epileptic states (seizures)
How long after exposure to the bacteria do symptoms appear?
For most people, symptoms appear within one to four weeks of being exposed to the bacteria. This is called the incubation period. But surprisingly, some people can develop symptoms months, even years, after being exposed to the bacteria. So it's a little complicated.
What causes melioidosis?
The cause of this, as I mentioned earlier, is a bacterium called `B. pseudomallei`. It lives in surface water (ponds, rivers, lakes) and soil. This bacterium is especially common in tropical or subtropical regions.
How do people get melioidosis?
You get this disease through direct contact with soil or water contaminated with the bacteria `B. pseudomallei`. There are several ways this bacteria can enter your body:
- Through a wound on your skin, like a cut or scratch.
- Inhalation : This means that this bacteria can enter your respiratory system along with dust particles in the soil.
- Aspiration of contaminated water into the lungs : This can happen when working in water or bathing.
- By drinking or ingesting contaminated water.
B. pseudomallei infections are more common during the rainy season, especially after heavy rains, because at that time the bacteria in the soil come to the surface and enter water sources.
Can Melioidosis be transmitted from person to person?
This is a problem that many people have. Melioidosis is very rare to spread from one person to another. The main way to get infected is through contact with contaminated soil or water. So don't be unnecessarily alarmed.
How is Melioidosis diagnosed?
Your doctor will first ask you about your symptoms, examine you, and then take samples of your blood or other bodily fluids for testing. They may also ask about your occupation, hobbies, or recent travel history.
The samples are sent to a lab, where technicians will check your samples for the presence of the B. pseudomallei bacteria and for antibodies against it. The samples used to confirm melioidosis are:
- Blood
- Urine
- Sputum
- Pus from a wound
How is Melioidosis treated?
Doctors treat this disease with two types of antibiotics in two stages. This is a somewhat lengthy treatment.
- In the first (intensive) phase : You will be given intravenous (IV) antibiotics for at least two weeks. This is a treatment that requires hospitalization.
- In the second (eradication phase) : You will need to take oral antibiotics for at least three months.
Depending on the severity of your condition, you may need additional treatment, such as draining abscesses if they are present.
What antibiotics are used for melioidosis?
Among the intravenous (injected) antibiotics, your doctor may prescribe:
- `Ceftazidime` `(Ceftazidime)`
- `Meropenem` `(Meropenem)`
- `Imipenem` `(Imipenem)`
These can be given as oral antibiotics:
- `Trimethoprim/sulfamethoxazole` `(Trimethoprim/sulfamethoxazole - TMP/SMX)`
- `Amoxicillin/clavulanic acid` `(Amoxicillin/clavulanic acid - co-amoxiclav)`
The most important thing is to take the medication exactly for the full course of treatment prescribed by the doctor. Don't stop halfway just because you feel a little better.
How do we protect ourselves from Melioidosis?
In areas where B. pseudomallei bacteria are common, you can take these steps to protect yourself from this disease:
- If you have diabetes or chronic renal disease , avoid contact with soil and standing water as much as possible.
- Wear waterproof boots when walking in wet soil, standing water, or mud.
- Wear gloves when working in the garden or with soil.
- If you have any cuts or scrapes on your body, cover them with a waterproof covering . Do not allow soil or water to get into the wounds, which could contaminate them.
- Shower or wash thoroughly after working with soil, muddy water, or working outdoors.
- Wear a mask that covers your nose and mouth when mowing grass, cutting weeds, or using high-pressure water sprayers on the ground.
- If you think you may have been exposed to the bacteria `B. pseudomallei`, your doctor may recommend that you take antibiotics (post-exposure prophylaxis) to prevent melioidosis.
What can I expect if I develop melioidosis?
Most people who do not have other serious underlying conditions and who receive prompt treatment can recover completely from this disease. However, treatment may need to continue for months to completely eliminate the bacteria. Sometimes symptoms can recur even after treatment has finished (relapse). Therefore, it is very important to follow your doctor's instructions.
However, for those with underlying medical conditions, or those who were unable to receive early diagnosis and treatment, the situation may be more severe.
Can Melioidosis be cured?
Yes, melioidosis can be cured with a two-stage antibiotic treatment regimen. However, some infections can get worse quickly, and treatment may not always be successful. Therefore, early diagnosis and treatment are very important.
Can Melioidosis be fatal?
With prompt, appropriate treatment, the mortality rate is between 10% and 20% . However, the risk of severe illness and death from melioidosis increases with:
- Whether or not you have any other underlying disease.
- The ability to receive good quality health care.
- Which organs are infected?
How do I take care of myself as someone with Melioidosis?
If you are diagnosed with melioidosis, take all medications exactly as prescribed by your doctor . If you stop taking antibiotics too soon, you may get sick again.
Be sure to go to the doctor on the days you are given to see him. If your symptoms go away and then come back, or if new symptoms appear, or if your symptoms worsen, inform your doctor.
Complications of Melioidosis
Melioidosis can spread to many parts of your body and cause complications such as:
- Bone infection `(Osteomyelitis)`
- Joint infection `(Septic arthritis)`
- Collection of pus (abscesses) in the skin, lungs, liver, spleen, brain, or other organs
- Acute Respiratory Distress Syndrome (ARDS)
- Sepsis - This can be life-threatening, a severe response by the body to infection that damages organs.
When should I see a doctor?
If you have symptoms of melioidosis, especially if you live in an area where B. pseudomallei is common or have recently traveled, see a doctor right away . Prompt treatment gives you the best chance of a full recovery.
If you think you may have been recently exposed to the B. pseudomallei bacteria, see a doctor. He or she may be able to give you post-exposure prophylaxis to prevent you from getting the disease.
When should I go to an Emergency Treatment Unit (ETU) ?
If you have these severe symptoms, go to an emergency room immediately:
- High fever (over 103 Fahrenheit/39.4 Celsius)
- Sudden or severe difficulty breathing
- Severe stomach pain
- Confusion or other mental changes
- Chest pain
- Epileptic states (seizures)
What questions should I ask my doctor?
It may be helpful to ask your doctor these questions:
- How should I take my medicine?
- When should I come see you again?
- When will I get better?
- What symptoms should I go to the emergency room for?
- What can I do to manage my symptoms at home?
- Is this disease contagious? (I now know this is rare, but it's good to be sure)
Finally, what to remember (Take-Home Message)
Melioidosis is a disease that requires some attention and can be difficult to diagnose . Because its symptoms can be similar to those of other common, less serious illnesses. If left untreated, it can be life-threatening . So if you think you may have been exposed to the bacteria `B. pseudomallei`, or if you have symptoms of melioidosis, or if you are in a risk group that could be at risk for this disease, do not hesitate to see your doctor and discuss your concerns . Taking quick action is the best way to stay healthy!
` Melioidosis, Burkholderia pseudomallei, soil infection, water infection, bacterial infection, prevention
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