Chapter 4. Melioidosis Pneumonia

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Wattana Leowattana, MD, PhD
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand

Part of the book: Advances in Health and Disease. Volume 63

Abstract

Melioidosis is an emerging form of community-acquired pneumonia in the tropics, caused by the facultative intracellular gram-negative bacterium Burkholderia pseudomallei. Pneumonia is the primary symptom of melioidosis in more than half of all patients. In addition, 20% of individuals with additional symptoms developed secondary pneumonia, which was frequently linked to positive blood cultures. There are underlying comorbidities in about 80% of patients who acquire melioidosis pneumonia. Despite the availability of additional tests, the basis of diagnosis for this great mimicker remains culture, and issues persist in shortening time to diagnosis and preventing misdiagnosis. Overall mortality can be decreased by 10% with the use of effective antimicrobials like ceftazidime and supportive intensive care, while it can still be as high as 50% in places with limited resources. Furthermore, eradication therapy with oral antibiotics is recommended to avoid disease recrudescence. Trimethoprim-sulfamethoxazole is preferable, with coamoxiclav or doxycycline as an alternative. Although no human melioidosis vaccinations are presently available, certain vaccine candidates that provide partial protection against melioidosis in murine models have been studied in nonhuman primates and human volunteers. Modeling has shown that a melioidosis vaccination aimed at high-risk groups in endemic regions might be helpful in terms of disease burden reduction and cost effectiveness.

Keywords: melioidosis pneumonia, Burkholderia pseudomallei, ceftazidime, trimethoprim-sulfamethoxazole, co-amoxiclav, doxycycline, melioidosis vaccine


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