Melioidosis Presentation - Iowa State University

Melioidosis Presentation - Iowa State University

Melioidosis Pseudoglanders Whitmore Disease Overview

Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control Center for Food Security and Public Health, Iowa State University, 2011

The Organism Organism Burkholderia pseudomallei Aerobic, gram-negative motile bacillus Found in water and moist soil Opportunistic pathogen Produces exotoxins Can survive in phagocytic cells

Latent infections common Center for Food Security and Public Health, Iowa State University, 2011 History History 1912, Burma Alfred Whitmore Organism isolated in humans Glanders-like disease

Colony growth differed No equine exposure Whitmore disease Alfred Whitmore 1876-1941 Center for Food Security and Public Health, Iowa State University, 2011 History Ambrose

Thomas Stanton 1913, Malaysia Stanton and Fletcher Distemper-like outbreak in animals Isolated B. pseudomallei Pioneered serological

tests for diagnosis William Fletcher Center for Food Security and Public Health, Iowa State University, 2011 History 1948-1954, Indo-China Over 100 French soldiers

1973, Vietnam Over 300 American soldiers Vietnamese time bomb Infections reoccurred after latent period Military dogs in Vietnam also affected Fever, myalgia, dermal abscesses Center for Food Security and Public Health, Iowa State University, 2011 History

1970s, France Numerous horses and zoo animals affected Melioidosis in temperate climates 1989 Effective antibiotic treatment identified Center for Food Security and Public Health, Iowa State University, 2011 Transmission

Transmission Wound infection Contact with contaminated soil or water Ingestion Contaminated water Inhalation Dust from contaminated soil

Rarely Person-to-person Animal-to-person Center for Food Security and Public Health, Iowa State University, 2011 Epidemiology Epidemiology Endemic in tropics and subtropics Southeast Asia, China, India, parts of Australia

Also reported in: Caribbean, Middle East, South America, Singapore, Taiwan May be present in Africa U.S. cases linked with travel abroad Center for Food Security and Public Health, Iowa State University, 2011 Distribution of Melioidosis

Center for Food Security and Public Health, Iowa State University, 2011 Epidemiology Clinical disease uncommon In endemic areas Antibodies in 5 to 20% agricultural workers No history of clinical disease of

Wet season Heavy rainfall High humidity or temperature Center for Food Security and Public Health, Iowa State University, 2011 Disease in Humans Human Disease Incubation period: <1 day to years Latent infection

Most infections asymptomatic Clinical forms Acute pulmonary infection Most common Focal infection Septicemia Neurological (rare) Center for Food Security and Public Health, Iowa State University, 2011

Acute Pulmonary Infection Most common form High fever, headache Dull aching chest pain Cough, tachypnea, rales

Chest X-rays Upper lobe consolidation Nodular lesions Pleural effusion Center for Food Security and Public Health, Iowa State University, 2011 Focal Infection Abscess or granuloma formation Skin Bone and/or muscle

Joints Internal organs Genitourinary Nervous system (infrequent) Center for Food Security and Public Health, Iowa State University, 2011 Septicemic Melioidosis Acute onset High fever, tachypnea, dyspnea, myalgia, hepatosplenomegaly,

septic shock Concurrent disease Mortality 90% without treatment 50% with treatment Center for Food Security and Public Health, Iowa State University, 2011 Diagnosis and Treatment Diagnosis

Isolation of organism Various serological tests Treatment Systemic antibiotics Trimethoprim sulfa Ceftazidime Surgical drainage of skin wounds No vaccine available

Center for Food Security and Public Health, Iowa State University, 2011 Animals and Melioidosis Species Affected Severe disease in sheep, goats Pigs (chronic form) Occasional infection Cattle, horses, dogs, cats, buffalo Monkeys, rodents, camels, alpacas Birds, tropical fish

Incubation period Variable, days to years Center for Food Security and Public Health, Iowa State University, 2011 Sheep, Goats, and Pigs Sheep Severe respiratory disease Arthritis, lameness Neurological disease

Goats Moderate respiratory disease Lameness, mastitis, abortion Pigs Chronic splenic abscesses Center for Food Security and Public Health, Iowa State University, 2011 Other Species Horses and cattle Neurologic signs

Respiratory disease Dogs (rare) Dermal abscesses, epididymitis, lameness, leg swelling Rodents Very susceptible Center for Food Security and Public Health, Iowa State University, 2011

Prevention and Control Control and Prevention Avoid contact with soil and water in endemic areas Husbandry practices Drinking water Use fresh sources Chlorination effective Use care during necropsies

Thorough cleaning of wounds No vaccine available Center for Food Security and Public Health, Iowa State University, 2011 Melioidosis as a Bioweapon CDC Category B Agent Moderately easy to disseminate Moderate morbidity Low mortality Specific diagnostics required

Very stable in the environment Killed very easily by heat Center for Food Security and Public Health, Iowa State University, 2011 Additional Resources CDC National Center for Zoonotic, VectorBorne, and Enteric Diseases http://www.cdc.gov/nczved/divisions/ dfbmd/diseases/melioidosis/

Center for Food Security and Public Health, Iowa State University, 2011 Additional Resources World Organization for Animal Health (OIE) www.oie.int U.S. Department of Agriculture (USDA) www.aphis.usda.gov Center for Food Security and Public Health www.cfsph.iastate.edu

USAHA Foreign Animal Diseases (The Gray Book) www.usaha.org/pubs/fad.pdf Center for Food Security and Public Health, Iowa State University, 2011 Acknowledgments Development of this presentation was funded by grants from the Centers for Disease Control and Prevention,

the Iowa Homeland Security and Emergency Management Division, and the Iowa Department of Agriculture and Land Stewardship to the Center for Food Security and Public Health at Iowa State University. Authors: Glenda Dvorak, DVM, MS, MPH, DACVPM; Radford Davis, DVM, MPH, DACVPM Reviewers: Gayle Brown, DVM, PhD, Bindy Sornsin, BA; Jared Voge, MS; Kerry Leedom Larson, DVM, MPH, PhD

Center for Food Security and Public Health, Iowa State University, 2011

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