CHALLENGES IN THE DIAGNOSIS AND TREATMENT OF MELIOIDOSIS: A REVIEW

Ambed Mishra*, Shamshavali K., Savitha R. Sanathan, Srirama B. Rao, Bashar Talal and Sravanthi R.

ABSTRACT

Melioidosis is a disease of global concern which is caused by a gram-negative bacterium, Burkholderia pseudomallei. About 412,000 human infections of Melioidosis is estimated each year globally, from which nearly 89,000 people die (infection to death ratio = 5:1 nearly). The Centers for Disease Control and Prevention (CDC) has listed it as a potential bio-threat due to its undetected incidence and diagnosis with diverse clinical manifestations with a general lack of adequate diagnostic capabilities in most of the areas along with very high antibiotic-resistance of B. pseudomallei. It is a rarely reported disease probably due to the lack of awareness among the health-care professionals and public. It often mimics tuberculosis or other diseases during the initial presentation and is thus misdiagnosed due to the similarity in presenting signs & symptoms. Another concern with the disease is its clinical presentation, differential diagnosis and treatment. Melioidosis is a highly under-diagnosed disease but starting pharmacological treatment by suspecting the disease based upon clinical presentations and by ruling out all possible diseases can be life saving for the patients. This review provides an outline of clinical presentation, differential diagnosis and treatment. It also highlights the challenges faced in diagnosis by way of difficulty in confirmation by culture test due to the requirement of sophisticated laboratory & skilled technicians and methods to overcome high antibiotic resistance.

Keywords: Melioidosis, Whitmore disease, Burkholderia pseudomallei, Diagnosis, Antibiotic resistance, bio-threat.