Melioidosis and diabetes

Melioidosis, something I did not learn as a medical student; recently read about on a friends wall.

Two things caught my attention:
1) high mortality
2) potential use in biological warfare

• Fahisham Taib Mine one survived with prolonged antibiotics

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• Mazlyn Mustapha Mortality rate 40% = scary...did your patient have any predisposing factors Dr Fahisham?

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• Fahisham Taib It was a toddler, may be post banjir I reckon

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• Mazlyn Mustapha How was the diagnosis confirmed?

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• Fahisham Taib My worst one for the time being is adenovirus pneumonia. 100% mortality in my experience!

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• Mazlyn Mustapha :( Any advice for the general population?

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• Fahisham Taib Based on suspicion on imaging and only one blood culture grew bukholderia. Nope not really. It is such a slow growing organism, not much out break plus we live in endemic area. To avoid people playing with flood or in the paddy field is even difficult

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  Nurman Yaman Meliodosis dulu diagnosis by exclusion. Difficult to treat. Even the antibiotic is nephrotoxic. This bukholderia pseudomalei had caused icu in hukm to close for a long time. Luckily the patient survived.

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• Nurman Yaman The patient had persistent pleural empyema needing chest tube most of the stay in icu. Persistent fever. Pity that patient. Hopefully still alive and well. Still remember this case even though has left clinical for a couple of years now.

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  Jimbo Jimbo Melioidosis * cough.. missed an 'i' there, cough...

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• Mazlyn Mustapha Any tips on prevention Dr James Jimbo Jimbo?

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• Jimbo Jimbo People who are immune compromised and young children are vulnerable. Most of the patients I have seen were diabetics. I tell them not to go out walking bare-footed (a very common habit among our people) and to use gloves when gardening. Good control of diabetes would be great!
  
  Melioidosis is also known as Nightcliff Gardener's disease. Nightcliff is a small down in the Northern Territory midway between Darwin and Casuarina. I passed by that town on my way to visit the nudist colony in Casuarina (heh heh).
  
  And oh by the way, crocodiles ( which are plenty in NT) are resistant to melioidosis. ;)

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• Mazlyn Mustapha What is their secret (the crocs)?

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• Jimbo Jimbo Thick skin naturally. Hmm...I've never seen a politician down with melioidosis. I wonder....

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• Ardita Dewi Roslani My masters thesis was on melioidosis in ppum pts.... Lots of melioid even in urban places like kl and spore..... Theory is construction sites n activity linked to churning of soil aerosolises the organism etc dunno how true. The majority of the pts were diabetic(67%) but diabetes per se is not a factor to getting severe melioidosis ( death, icu admission, ventilation)

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  Maznee Md Sapar Common in kedah and among the farmers

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  Hasrina Hassan There has been an outbreak in a private hospital due to laparoscopic equipments

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  Mohd Iqbal Iyen Have seen 1 neonatal@congenital meliodosis in sabah; 100% mortality...how the newborn got infection in utero? God only knows. ..

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• Muhamad Na'im Ab Razak Most of my paed pt with severe hypokalaemia positive for meliodosis

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  Siti Azlina Saw few weird cases of meliodosis while working in sabah...

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  Shaktivel Palanivel lousy disease. Offhand, I can remember 5 the names of 4 patients who died from it. The survivors had to take months of Augmentin. Do they still treat it that way?

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  Rima Marhayu Abdul Rashid seen quite a number of cases in UM as a med student years back...;) thought it's common worldwide... now I know it's not...:)

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• Mazlyn Mustapha Never heard of it in Ireland Rima :O

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  Ahmad Ramadzan If I'm not mistaken, Melidiosis first known and research by USAMRU (USA Medical Research Unit) due to high infection among the US soldiers in Vietnam war. It was postulated that the soldier had to crawl in their actions hence exposed to soil /dust inhalation that contain Psedomonas (now Bulkhoderia ?) pseudomallei.

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