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Melioidosis – A Rare But Serious Tropical Disease Considered As An Emerging Problem

Nyoman Sri Budayanti Dept. of Microbiology, UNUD

MELIOIDOSIS • Emerging infectious diseases • Potentially fatal infection diseases severe ds. persist in the body for several years before emerging • Considered as potential agents for biological welfare & biological terrorism • Caused by Burkholderia pseudomallei  soil organism . high mortality.

Hong Kong. Vietnam. Taiwan. Guam. Philippine. Myanmar . Papua New Guinea.• Endemic in regions of Southeast Asia and Northern Australia (200 of equator) • Highly endemic in North-eastern part of Thailand • Reported from : Malaysia.

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8%).8-29%).4-31.8%).Seroprevalence : • Thailand (21-47%). Malaysia (1. Hong Kong (14%) • Bali 18.7% from CAP patient (Budayanti. Queensland (7. 2005) . Vietnam (6.9-15.

Incidence of Melioidosis in Indonesia ??? True absence of the disease in the region Lack of recognition by clinical Lack of facilities capable of isolating and identifying B. . pseudomallei.

mules.Burkholderia pseudomallei • A motile Gram negative bacillus • Family Pseudomonadaceae  Pseudomonas pseudomallei • Widely distributed in the soil and water  rice farming • Primarily a disease of animal : horse. donkey .

2000): 1. mimics tuberculosis • Four form of the diseases (CDC. Acute Pulmonary Infection 3. Acute Localized Infection 2.Clinical features • The Great Imitator : Broad spectrum of clinical sign.Chronic Suppurative Infection . latent for years. Acute Bloodstream Infection / Septicemic / Disseminated Melioidosis 4.

Clinical features The incubation period : 1-21 days (mean 9 days) 2 days – 26 years  the virulence of the strain. the immune status host. the size of inoculum .

Clinical features Mode of transmission : Inhalation Inoculation Ingestion Unusual modes of transmission perinatal transmission laboratory-acquired cased sexual transmission .

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Factor Disposisi • The occupational exposure to contaminated soil and water • Diabetes mellitus • Alcohol excess • Renal diseases .

Pathogenesis • • • • • Facultative intracellular pathogen Exopolysaccharides Lipase Phospholipase C Hemolysin .

Diagnosis • Culture  Gold standard Gram negative rods Oxidase positive Resistance to gentamicin and colistin Ashdown’s media : metallic sheen and characteristic coloni .

CULTURE .

Diagnosis • Antigen detection : ELISA. Immunofluoresence • Antibody detection : IHA. a rapid immunochromogenic test • Molecular methods .

Treatment Initial intensive therapy : Ceftazidime or meropenem with cotrimoxazole for more than 10 days Eradication therapy : Cotrimoxazole with doxycycline or chlorampenicol for more than 3 month .

A POTENTIAL BIOWEAPON • Low technological requirements and cost of production • High infectivity • Long environmental survival • Easy dissemination by aerosol • A substantial capacity to cause illness and death .

THANK YOU .