Melioidosis or Whitmore's disease is an infectious disease caused by the bacteria Burkholderia pseudomallei. It is mainly a tropical disease with a variable presentation and appears mostly in southeast Asia and northern parts of Australia. The disease spreads to humans through direct contact with a contaminated source.
Melioidosis is an infectious disease caused by the Gram-negative bacteria Burkholderia pseudomallei. Several forms of melioidosis are seen clinically such as pulmonary, hematogenous, disseminated and localized forms but pneumonia is a common feature in . Symptoms depend on the form of the infection and include a cough, fever, chest pain and dyspnea in the pulmonary type; fever, headache, seizures, arthralgias, myalgias and abdominal pain in the disseminated type; and fever, headache, dyspnea, arthralgia, confusion and abdominal pain in the hematogenous type.
The presentation has been reported to vary based on the age and comorbidities of the patients as well as on the geographical region in which the patients are located . For example, a higher incidence of genitourinary infection, prostatic abscesses, and encephalomyelitis syndrome in Australian patients have been reported versus liver- splenic abscesses and suppurative parotitis with facial palsy in Thai patients  . The encephalomyelitis syndrome is characterized by brainstem involvement with flaccid paralysis and is associated with high rates of morbidity and mortality . Dermatological and soft tissue manifestations of melioidosis resemble necrotizing fasciitis . Other manifestations like thyroid and genital abscesses, ocular involvement with corneal ulcers and orbital cellulitis as well as endocarditis and myocardial abscesses have also been reported    .
Risk factors associated with a higher incidence of melioidosis include diabetes mellitus    , thalassemia, chronic renal disease, exposure to infected water , steroid usage , chronic obstructive lung disease, and chronic use of kava and alcohol . The majority of these risk factors are associated with neutrophil dysfunction which has been implicated in the pathophysiology of melioidosis   .
All patients presenting with fever and non-specific symptoms like a cough should be thoroughly and quickly investigated as they can rapidly deteriorate depending on the cause. History should elicit details of onset, duration, and progression of symptoms along with a specific history of exposure to contaminated source. The physician should inquire regarding recent travel to areas known to be endemic for melioidosis. Dermatological, pulmonary, cardiac, and neurological features of the infection must be looked for on physical examination.
Basic laboratory workup like complete blood count, erythrocyte sedimentation rate (ESR), liver function tests and Gram stain with blood, urine, skin lesion, cerebrospinal fluid, and sputum culture should be ordered in all patients depending on their clinical presentation. Results may reveal anemia, leukopenia, elevated liver enzymes, and elevated urea and creatinine levels. These results along with hypoglycemia and acidosis at presentation are indicators of a poor prognosis   .
The gold standard for diagnosis is the isolation of Burkholderia pseudomallei from body fluids of infected patients and modified Ashdown's selective medium is used for this purpose . Despite poor sensitivity and specificity, indirect hemagglutination (IHA), is currently the most commonly used test for diagnosis .
Chest radiography is performed to detect features of pneumonia or diffuse nodular shadows. Visceral melioidosis can be detected by ultrasonography and computed tomography which may show discrete hepatic and splenic abscesses . In disseminated melioidosis, plain X-rays and magnetic resonance imaging are obtained to detect bone and soft tissue involvement .