see also: [[Aboriginal health]] see: [2024 revised Darwin Meliodosis Treatment Guideline](x-devonthink-item://CB19D082-5A3E-43E7-8BE7-4BAC2C4472CE?page=2) - [web link](https://digitallibrary.health.nt.gov.au/nthealthserver/api/core/bitstreams/88d2f610-e0e5-42c3-9770-a734f874ca98/content), [Deranged physiology - Melioidosis](https://derangedphysiology.com/main/required-reading/sepsis-and-infections/Chapter-3457/melioidosis) News: [2025 north QLD melidosis deaths](https://www.abc.net.au/news/2025-02-25/melioidosis-death-toll-rises-in-queensland/104979406), [The Conversation - QLD meliodosis outbreak](https://theconversation.com/the-queensland-melioidosis-outbreak-is-still-growing-whats-keeping-this-deadly-mud-bug-active-256794) ## Overview - Gram negative bacterium Burkholderia pseudomallei - found in: North Australia, Thailand/ SE Asia, Indian subcontinent - Contaminated soil or water - most people no symptoms - may occur in returned travellers, and not present for months or years later - diabetics and [[Alcohol-related disease|alcoholics]] at higher risk of serious illness - Severe: pneumonia, *abscesses*, [[bone and joint infection (paeds)|septic arthritis]], brain abscess, pericardial effusion, pyelonephritis, encephlomyelitis , brainstem encephelomyelitis, hepatic abscess - Can be similar to [[Tuberculosis|TB]] - ==Pneumonia most common feature==, with ==lung abscess== being particularly bad - ==Skin abscess and ulcers also common== - Parotid gland involved in 35% of cases in paeds ## Investigations - frequent culture of ulcers, sputum, pharynx and blood ## Treatment - ppx: trimoxazole - ==ceftazidime, meropenem or imipenem== - ​consider GSF in critically ill patients - co-trimoxazole with or without doxycycline for at least 3 months as relapses are common