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21. Melioidosis

Causative agent 
- Burkholderia (Pseudomonas) pseudomallei


Differential diagnosis 

- Tuberculosis
- Actinobacillosis
- Actinomyces pyogenes infection
- Corynebacterium pseudotuberculosis
  infection

1. History taking 
- High prevalence in wet season after heavy
  rainfall or flood with high humidity and
  temperature
- Transmission from contaminated
  environment, through wounds or
  cutaneous abrasion, inhalation or
  ingestion
- Outbreak originates from soilborn infection
  and the organism can survive for
  many months in soil and water
- Predisposed by starvation, parturition,
  abortion or other stresses
- Host : ruminants, horse, pig, pets various
  wild animals and man


2. Clinical examination 
- Loss of body weight, weakness, anorexia
  and recumbency
- Nervous signs : abnormal gait, posterior
  paresis, walk in circle or blindness
- Respiratory signs : coughing, occular or
  nasal discharge
- Mastitis, metritis, orchitis, arthritis or
  abortion

3. Necropsy 
- Multiple abscesses (size 0.1-5 cm) in lung,
  liver, spleen, kidney, uterus, udder lymph
  nodes trachea and joints
- Abscesses surrounded by thick wall and
  filled with caseous greenish yellow pus
- Large abscesses replace testicular tissue
  causing distention of scrotal sac
- Lung, consolidation with reddish
  atelectasis


4. Histopathological observation 
- Mixed purulent and granulomatous inflammation
  which consist of caseous center surrounded by
  inner capsule of epithelioid cells and outer capsule
  of fibrous tissue. No giant cells
- Microabscesses in brain and spinal cord


5. Microscopic examination 
- Pus, nasal discharge, spinal fluid, blood, serum,
  milk smear and stain : Gram negative bipolar rod


6. Bacterial isolation 
Specimen : Pus, nasal discharge, spinal fluid, blood,
                  milk, visceral organs, spinal cord, testis,
                  uterus and udder
Medium    : blood agar, MacConkey agar and
                  glyceral-base agar incubate 37°C
                  aerobically for 24 to 48 hr
- Colony    : β-hemolysis colonies on blood agar
  extremely rough to mucoid, cream or bright and
  shiny red cart wheel colonies in MacConkey agar

Table : Some biochemical difference between
B. pseudomallei and Ps. aeruginosa
  B.pseudomallei Ps.aeruginosa
Dextrose oxidation
+ +
MacConkey agar
+ +
Oxidase
+ +
Motility
+ +
Gelatinase
+ +
Cetrimide agar
- +
Nitrate reduction
+ +
Nitrite reduction
- +
Pigment
None

pyocyanin

    flnorecin

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