Melioidosis

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Classification according to ICD-10
A24.1 Acute or fulminant melioidosis
A24.2 Subacute or chronic melioidosis
ICD-10 online (WHO version 2019)

When melioidosis , also called pseudo snot or Whitmore's Disease called, is a rare human infectious disease caused by the pathogen pseudomallei Burkholderia , a Gram-negative soil bacterium , is caused. The infection occurs through soil or water containing pathogens, so the disease is a geonosis .

Dissemination and transmission

The pathogen is widespread in the soil and surface water in the endemic areas of Southeast Asia and Northern Australia . The pathogen was carried to other areas by infected animals by the 1980s at the latest.

The number of infections worldwide is estimated at 165,000, killing 89,000 people.

Although pathogens repeatedly reach Central Europe through travel tourism, they have not yet been able to establish themselves here permanently, as they are inactivated at temperatures below 11 ° C. However, positive pathogen detection from drinking water wells is regularly provided in northern Italy.

Transmission can occur through direct contact of contaminated soil or water with broken skin. A recording via inhalation or ingestion is also possible.

Incubation period and disease

The incubation period is usually 1–21 days, but cases with an incubation period of several years have also been described. Diabetes mellitus , renal insufficiency and diseases of the immune system (but not AIDS ) favor disease.

The complaints and symptoms are diverse and range from chronic localized forms (for example as wound infection) to severe generalized diseases and sepsis . Abscesses are typical, especially lung abscesses, pneumonia and pleural effusions in acute illnesses ; differentiation from tuberculosis can be difficult. The disease can be life-threatening, from Thailand a lethality of up to 50% is reported in some cases despite treatment with antibiotics. Chronic courses are usually with various abscesses z. B. in the spleen, liver, muscles and skin.

Pathogen identification

The determination of B. pseudomallei in the laboratory can be very difficult, especially in the Western Hemisphere where B. pseudomallei is very rare. The large wrinkled colonies look like environmental contaminants and are often not considered clinically relevant. Even when the culture is considered relevant, the common identification systems often lead to misinterpretation of the organisms as Chromobacterium violaceum or other non-fermenting Gram-negative bacilli. Likewise, the rarity of the disease often means that the positive determination of B. pseudomallei in cell cultures is not correctly interpreted by doctors who are not familiar with the disease.

treatment

Numerous antibiotics have been reported to be often ineffective against B. pseudomallei , including ceftazidime , tetracycline , doxycycline , gentamicin and sulfamethoxazole . Also chloramphenicol -resistant strains have been reported.

In severe cases, treatment is given with intravenous antibiotics (for example carbapenems or ceftazidime ) for 14 days, followed by oral antibiotic prophylaxis for 5 to 6 months .

Can be used as a material for biological weapons

The pathogen of melioidosis can theoretically also be used as a biological weapon. The transferability was demonstrated under laboratory conditions by means of an aerosol containing the pathogen . Nothing is known about products suitable as weapons or their use (as of 2013).

literature

  • K. Göbels, D. Teichmann, J. Richter, G. Zysk, D. Häussinger: Diagnosis: Melioidosis. In: Deutsches Aerzteblatt. (Dtsch Arztebl) 2005, Volume 102, Issue 31-32, pp. A-2166 / B-1826 / C-1729.
  • SJ Peacock: Melioidosis. In: Curr. Opin. Infect. Dis. Volume 19, 2006, pp. 421-428.
  • Marianne Abele-Horn: Antimicrobial Therapy. Decision support for the treatment and prophylaxis of infectious diseases. With the collaboration of Werner Heinz, Hartwig Klinker, Johann Schurz and August Stich, 2nd, revised and expanded edition. Peter Wiehl, Marburg 2009, ISBN 978-3-927219-14-4 , p. 218 f.

Web links

Individual evidence

  1. ↑ a b Direk Limmathurotsakul, Nick Golding, David AB Dance: Predicted global distribution of 'Burkholderia pseudomallei' and burden of melioidosis. In: Nature Microbiology. No. 1, 2016, article number: 15008, doi: 10.1038 / nmicrobiol.2015.8
  2. ^ Heinrich Neubauer: Zoonoses in Germany. An overview of occurring and possible pathogens. In: Deutsches Tierärzteblatt. (Dt. Täbl.) 56, 2008, pp. 1342-1346.
  3. ^ TJ Inglis, D. Chiang, GS Lee, L. Chor-Kiang: Potential misidentification of Burkholderia pseudomallei by API 20NE . In: Pathology . tape 30 , no. 1 , 1998, p. 62-64 , PMID 9534210 .
  4. ^ P. Lowe, C. Engler, R. Norton: Comparison of automated and nonautomated systems for identification of Burkholderia pseudomallei . In: J Clin Microbiol . tape 40 , no. 12 , 2002, p. 4625-4627 , doi : 10.1128 / JCM.40.12.4625-4627.2002 .
  5. ↑ A. Kite-Powell, JR Livengood, J. Suarez et al .: Imported Melioidosis - South Florida, 2005 . In: CDC / MMWR . tape 55 , no. 32 , 2006, pp. 873-876 .
  6. ↑ Fabrice V. Biot, Eric Valade et al .: Involvement of the Efflux Pumps in Chloramphenicol Selected Strains of Burkholderia thailandensis: Proteomic and Mechanistic Evidence. In: PLoS ONE . Volume 6, No. 2, doi: 10.1371 / journal.pone.0016892
  7. ↑ FM Thibault, E. Hernandez et al: Antibiotic susceptibility of 65 isolates of Burkholderia pseudomallei and Burkholderia mallei to 35 antimicrobial agents. In: Journal of Antimicrobial Chemotherapy . December 2004, Volume 54, No. 6, pp. 1134-1138, doi: 10.1093 / jac / dkh471 .
  8. ↑ Archived copy ( memento of the original from March 7, 2016 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. AbiG at the Robert Koch Institute, last accessed January 15, 2016 @1@ 2Template: Webachiv / IABot / www.abig.rki.de