Burkholderia - Causes and Management

Introduction

Burkholderia is also called Melioidosis or Whitmore’s disease. It is a deadly condition known to affect both humans and animals. The bacterium Burkholderia pseudomallei is considered to be the causative organism that can be spread via contact with contaminated water and soil. The epidemiology of this disease can be described as a rare disease in the United States but is considered to be a major public health concern in Southeast Asia, northern Australia, and other places with a tropical climate. Since Melioidosis is capable of spreading to areas where it is not usually found, B. pseudomallei is often mentioned to be a potential biological weapon.

What Are The Symptoms Of Melioidosis?

The symptoms of melioidosis depend mainly on the type of infection. Various types of melioidosis are lung, blood circulation, local, and disseminated infections. Usually, it takes two to four weeks for the symptoms to show post-exposure to the bacteria. But, it might take hours to years for the symptoms to subside.

Pulmonary Infection:

Following are the symptoms of pulmonary infection:

• Cough with normal saliva or sputum.

• Increased fever.

• Chest pain while breathing.

• Headache.

• Generalized pain in the muscles.

• Loss of weight.

Bloodstream Infection:

When the blood circulation is affected, it may lead to septic shock.

The septic shock usually happens rapidly and may show the following symptoms:

• Fever.

• Sore throat.

• Headache.

• Breathing issues like shortness of breath.

• Diarrhea (loose motions).

• Pain in the upper abdominal.

• Pain in Joints and muscle.

• Confusion.

• Sores with the presence of pus on the skin or internal organs.

Disseminated Infection:

This type includes sores in various internal organs but does not cause septic shock.

Following are the symptoms:

• Weight loss.

• Fever.

• Headache.

• Pain in the stomach or chest.

• Muscle or joint tenderness.

• Seizures.

The most commonly affected organs are the liver, spleen, lung, and prostate. Rarely, are the joints, bones, lymph nodes, or brain may be involved.

Local Infection:

This type affects the skin and organs present below the skin. Local infections have the potential to spread to the bloodstream and lead to local infections.

Following are the symptoms:

• Localized pain or swelling, often causing mumps in the parotid gland.

• Abscesses

• Fever

• Ulcers

How Is It Caused?

The most common cause of transmission of disease through direct contact have been mentioned below:

• A person who breathes in contaminated dust or water droplets.

• Touching contaminated soil with bare hands or feet.

• Drinking of contaminated non-chlorinated water.

What Are The Risk Factors?

Following are the risk factors for this condition (mostly those who can come in direct contact with contaminated soil, food, or water):

• Military personnel.

• Adventure travelers.

• Ecotourists.

• Construction workers.

• Farmers.

• Those who do fishing.

• Forestry.

Many animals can get affected by this infection. Hence, they can also be a source of infection. Animals can carry the bacteria from infected animals’ milk, feces, urine, secretions from the nose, and wounds. The most commonly affected animals include sheep, swine, and wine. Some cases have also been seen in cats, horses, dogs, chickens, cattle, tropical fish, etc. It has affected some of the zoo animals also.

How Can It Be Diagnosed?

Burkholderia can affect any organ in the body and shows features like various other diseases. Hence, it is also called “the great imitator.”A correct diagnosis is very important to deciding the treatment plan. Initially, the physician will ask questions regarding signs and symptoms, your family, and medical and personal history. Following this, certain examinations and tests will be carried out to confirm the diagnosis. The bacterium B. pseudomallei culture is the gold standard diagnostic test. The physician uses blood, pus, sputum, urine, synovial fluid, peritoneal fluid, or pericardial fluid samples to carry out the culture. The sample is then placed on a growing medium like agar, to check the growth of the bacteria. However, culturing is not always successful in the diagnosis of this disease.

How Can It Be Treated?

The treatment is dependent on the type of Burkholderia.

There are two stages of treatment as mentioned below:

The first stage of treatment is done for a duration of a minimum of 10 to 14 days. During this stage, an antibiotic is given through an intravenous (IV) line. This antibiotic therapy can continue for almost eight weeks.

Following are the antibiotics used:

• Ceftazidime is given every six to eight hours.

• Meropenem is given every eight hours.

The second stage of treatment goes for three to six months and one of these antibiotics is used:

• Sulfamethoxazole-trimethoprim is given every 12 hours.

• Doxycycline is given every 12 hours.

Relapses do not occur commonly. They are known to happen in people not completing the complete regime.

How Can It Be Prevented?

There are no vaccines available for humans to prevent Burkholderia. Research is still under process.

Some of the preventive measures can be used to prevent this disease, especially by those people who live in or are visiting areas affected by Burkholderia:

• Wearing waterproof boots and gloves while working in soil or water.

• Be careful about avoiding exposure through inhalation during severe weather conditions.

• Avoid contact with soil and standing water if the person has open wounds, chronic kidney disease, or diabetes.

• Meat cutters and processors should wear gloves and regularly disinfect their knives.

• While drinking dairy products, make sure that they are pasteurized.

• Healthcare workers should always wear gloves, masks, and gowns.

• If you are going to undergo immunosuppressive therapy, get yourself screened for this infection prior.

Conclusion

Burkholderia is a clinical condition caused due to bacterium Burkholderia pseudomallei and there are various types causing different symptoms. The diagnosis is mainly based on the culturing method and treatment is done using antibiotics. Online medical platforms have made the consultation process with a specialist easier than before. Hence, to know more about this condition, consult a specialist online through these platforms.