Melioidosis in aspects of epidemiology, clinic, and laboratory diagnostics

Melioidosis is a life-threatening infection caused by Burkholderia pseudomallei, an environmental Gram-negative bacterium, inhabitant of moist soils in the tropics and subtropics. There no licensed vaccine against melioidosis. The main routes B. pseudomallei are percutaneous inoculation, inhalation, or ingestion. Individual cases vertical, sexual, zoonotic, nosocomial transmission melioidosis described. Risk factors for contact with soil water (especially during rainy season). age over 45, type 2 diabetes, alcoholism, liver disease, chronic lung renal thalassemia, as well long-term use steroids immunosuppressive therapy, susceptibility Among affected adult residents endemic regions, 80% had one more predisposing factors, among children — about 20%. No significant influence concomitant diseases on development travelers was found. Less than 50% patients factors. incubation period ranges within 1—21 days; average, 9 days, case sizeable infectious dose, it can be less day. post-infectious immunity, reinfection occur different strain after successful treatment. facultative intracellular pathogen that invade multiply inside wide range cells, including phagocytic. acute form characterized pneumonia, multiple abscesses, bacteremia, systemic sepsis. Chronic, subacute, latent forms also possible. Antimicrobial therapy divided into initial intensive phase subsequent eradication phase. resistant to penicillins, first- second-generation cephalosporins, aminoglycosides, macrolides, chloramphenicol, fluoroquinolones, tetracyclines, trimethoprim, some co-trimoxazole, rarely ceftazidime. Early diagnosis appropriate management crucial reducing severe complications leading high mortality, preventing disease recurrences. However, there pathognomonic melioidosis-specific feature, not known physicians microbiologists. results serological tests detection specific antibodies ambiguous. bacterial load tested sample limits antigens. accelerated methods identifying causative agent melioidosis, PCR has highest sensitivity specificity. Automated identification using microbiological analyzers generally shows good results, but 15% isolates misidentified. Time-of-flight mass spectrometry matrix-assisted laser desorption ionization potentially useful rapid pseudomallei. existing databases require optimization adding reference spectra