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Treatment for melioidosis

Question: What is the current treatment for melioidosis?

Answer: Melioidosis is an infectious disease caused by a bacterium called Pseudomonas pseudomallei. The disease has several forms depending on the location of the infection, each varying in severity.

Melioidosis is most frequently reported in Southeast Asia. The bacterium that causes the disease is found in the soil, rice paddies, and stagnant waters of the area. Humans contract the disease when the contaminated soil contacts skin abrasions (tears).

Melioidosis most commonly involves the lungs where the infection can form a cavity of pus (abscess). It can spread from the skin through the blood to affect the heart, brain, liver, kidneys, joints, and eyes. Patients can have associated headaches, fever, chills, cough, chest pain, and/or loss of appetite.

Melioidosis is diagnosed with a microscopic evaluation of a sputum sample in the laboratory. A blood test is useful to detect early acute cases of melioidosis, but it can not exclude the illness if it is negative.

The treatment of melioidosis involves antibiotics and depends on the location of the disease. For patients with more mild illness, antibiotics such as Chloramphenicol, doxycycline (Doryx), sulfisoxazole (Gantrisin), or trimethoprim-sulfamethoxazole (Bactrim) are considered. The conventional treatment regimen for patients who are more severely ill is a combination of chloramphenicol, doxycycline, and cotrimoxazole (Septra). Even more severely ill patients (such as those with active blood infection) may require intravenous antibiotics, including chloramphenicol, and others. If sputum cultures remain positive for 6 months, surgical removal of the lung abscess with lobectomy is considered. Antibiotic treatments may be necessary from 3 to 12 months.

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