Melioidosis

Pseudoglanders Whitmore Disease

Overview
Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control
Center for Food Security and Public Health, Iowa State University, 2011

The Organism

Organism
Burkholderia pseudomallei
Aerobic, gram-negative motile bacillus Found in water and moist soil Opportunistic pathogen Produces exotoxins Can survive in phagocytic cells
Latent infections common
Center for Food Security and Public Health, Iowa State University, 2011

History

History
1912, Burma Alfred Whitmore Organism isolated in humans
Glanders-like disease
Colony growth differed

No equine exposure Whitmore disease

Alfred Whitmore 1876-1941

Center for Food Security and Public Health, Iowa State University, 2011

History
1913, Malaysia Stanton and Fletcher Distemper-like outbreak in animals
Isolated B. pseudomallei
Ambrose Thomas Stanton

Pioneered serological tests for diagnosis

William Fletcher

Center for Food Security and Public Health, Iowa State University, 2011

History
1948-1954, Indo-China
Over 100 French soldiers

1973, Vietnam
Over 300 American soldiers Vietnamese time bomb
Infections reoccurred after latent period

Military dogs in Vietnam also affected

Fever, myalgia, dermal abscesses

Center for Food Security and Public Health, Iowa State University, 2011

History
1970s, France
Numerous horses and zoo animals affected Melioidosis in temperate climates

1989
Effective antibiotic treatment identified

Center for Food Security and Public Health, Iowa State University, 2011

Transmission

Transmission
Wound infection
Contact with contaminated soil or water

Ingestion
Contaminated water

Inhalation
Dust from contaminated soil

Rarely
Person-to-person Animal-to-person
Center for Food Security and Public Health, Iowa State University, 2011

Epidemiology

Epidemiology
Endemic in tropics and subtropics
Southeast Asia, China, India, parts of Australia

Also reported in:

Caribbean, Middle East, South America, Singapore, Taiwan May be present in Africa

U.S. cases linked with travel abroad

Center for Food Security and Public Health, Iowa State University, 2011

Distribution of Melioidosis

Center for Food Security and Public Health, Iowa State University, 2011

Epidemiology
Clinical disease uncommon
In endemic areas
Antibodies in 5 to 20% agricultural workers No history of clinical disease of

Wet season
Heavy rainfall High humidity or temperature
Center for Food Security and Public Health, Iowa State University, 2011

Disease in Humans

Human Disease
Incubation period: <1 day to years
Latent infection

Most infections asymptomatic Clinical forms

Acute pulmonary infection
Most common

Focal infection Septicemia Neurological (rare)

Center for Food Security and Public Health, Iowa State University, 2011

Acute Pulmonary Infection

Most common form High fever, headache Dull aching chest pain Cough, tachypnea, rales Chest X-rays
Upper lobe consolidation Nodular lesions Pleural effusion
Center for Food Security and Public Health, Iowa State University, 2011

Focal Infection
Abscess or granuloma formation
Skin Bone and/or muscle Joints Internal organs Genitourinary Nervous system (infrequent)
Center for Food Security and Public Health, Iowa State University, 2011

Septicemic Melioidosis
Acute onset
High fever, tachypnea, dyspnea, myalgia, hepatosplenomegaly, septic shock

Concurrent disease Mortality

90% without treatment 50% with treatment
Center for Food Security and Public Health, Iowa State University, 2011

Diagnosis and Treatment

Diagnosis
Isolation of organism Various serological tests

Treatment
Systemic antibiotics
Trimethoprim sulfa Ceftazidime

Surgical drainage of skin wounds

No vaccine available
Center for Food Security and Public Health, Iowa State University, 2011

Animals and Melioidosis

Species Affected
Severe disease in sheep, goats Pigs (chronic form) Occasional infection
Cattle, horses, dogs, cats, buffalo Monkeys, rodents, camels, alpacas Birds, tropical fish

Incubation period
Variable, days to years
Center for Food Security and Public Health, Iowa State University, 2011

Sheep, Goats, and Pigs

Sheep
Severe respiratory disease Arthritis, lameness Neurological disease

Goats
Moderate respiratory disease Lameness, mastitis, abortion

Pigs
Chronic splenic abscesses
Center for Food Security and Public Health, Iowa State University, 2011

Other Species
Horses and cattle
Neurologic signs Respiratory disease

Dogs (rare)
Dermal abscesses, epididymitis, lameness, leg swelling

Rodents
Very susceptible
Center for Food Security and Public Health, Iowa State University, 2011

Prevention and Control

Control and Prevention

Avoid contact with soil and water in endemic areas
Husbandry practices Drinking water
Use fresh sources Chlorination effective

Use care during necropsies Thorough cleaning of wounds No vaccine available

Center for Food Security and Public Health, Iowa State University, 2011

Melioidosis as a Bioweapon
CDC Category B Agent
Moderately easy to disseminate Moderate morbidity Low mortality Specific diagnostics required

Very stable in the environment Killed very easily by heat

Center for Food Security and Public Health, Iowa State University, 2011

Additional Resources
CDC
National Center for Zoonotic, VectorBorne, and Enteric Diseases http://www.cdc.gov/nczved/divisions/df bmd/diseases/melioidosis/

Center for Food Security and Public Health, Iowa State University, 2011

Additional Resources
World Organization for Animal Health (OIE)
www.oie.int

U.S. Department of Agriculture (USDA)

www.aphis.usda.gov

Center for Food Security and Public Health

www.cfsph.iastate.edu

USAHA Foreign Animal Diseases (The Gray Book)

www.usaha.org/pubs/fad.pdf

Center for Food Security and Public Health, Iowa State University, 2011

Acknowledgments
Development of this presentation was funded by grants from
the Centers for Disease Control and Prevention, the Iowa Homeland Security and Emergency Management Division, and the Iowa Department of Agriculture and Land Stewardship

to the Center for Food Security and Public Health at Iowa State University.

Authors: Glenda Dvorak, DVM, MS, MPH, DACVPM; Radford Davis, DVM, MPH, DACVPM Reviewers: Gayle Brown, DVM, PhD, Bindy Sornsin, BA; Jared Voge, MS; Kerry Leedom Larson, DVM, MPH, PhD

Center for Food Security and Public Health, Iowa State University, 2011