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Epidemiology, clinical manifestations, and diagnosis of melioidosis

Bart Currie, MBBS, FRACP
Nicholas M Anstey, MBBS, FRACP, PhD
Section Editor
Daniel J Sexton, MD
Deputy Editor
Allyson Bloom, MD


Melioidosis is an infection caused by the facultative intracellular gram-negative bacterium, Burkholderia pseudomallei [1-3]. This organism is a widely distributed environmental saprophyte in soil and fresh surface water in endemic regions [4].

The epidemiology, pathogenesis, clinical manifestations, and diagnosis of melioidosis will be presented here. The treatment and prognosis of this disease are discussed separately. (See "Treatment and prognosis of melioidosis".)


Geographic distribution — Melioidosis occurs predominantly in Southeast Asia, northern Australia, South Asia (including India), and China (figure 1) [2,5-8]. The majority of diagnosed cases are from Thailand [9-12], Malaysia [13-16], Singapore [17-23], and northern Australia [24-26]. Cases are also reported from Papua New Guinea [27] and New Caledonia [28]. Northeastern Thailand and parts of northern Australia are "hyperendemic" for melioidosis [10,24], with seasonal peaks in the wet seasons. In 2010, there was been an increase in incidence in both northeast Thailand and northern Australia as well as in south Asia [29-31].

Melioidosis has been described outside the classic endemic regions. Most of such cases are acquired by visitors to endemic areas, with symptoms arising later following departure from the endemic area [32,33]. However, sporadic human or animal cases and occasional environmental isolates of B. pseudomallei have been described from Africa, Indian Ocean countries (such as Mauritius), the Middle East, the Caribbean, and Central and South America [34-36]. Some of these reports represent incorrect species diagnosis, but others have been confirmed as B. pseudomallei, making the endemic boundaries of melioidosis less clear [7,8,37]. As an example, six cases of melioidosis were reported from eastern Puerto Rico between 1982 and 2012 [38]. During investigation of two of those cases, seropositivity to B. pseudomallei was identified in a subset of individuals who lived in proximity to the index patients, and B. pseudomallei was isolated from soil samples from a single site. These findings suggest endemicity of B. pseudomallei in Puerto Rico despite the rarity of reported cases there.

Melioidosis is rare in the United States. Between 2008 and 2013, 34 cases were reported; only three did not have documented travel to an area endemic for melioidosis [39]. Despite extensive investigation, the source of the infection in these three cases could not be identified [40].

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