Melioidosis: Treatment, Cost and Side Effects

Melioidosis is a condition spread due to a bacterial infection (Burkholderia pseudomallei). The bacteria are present in soil and water. Melioidosis is a public health problem most common in Southeast Asia and northern Australia but can occur in other tropical climatic places too. The disease, though rare, is found in India also. The bacterium causing the disease has also been identified as a biological weapon. Symptoms of the disease are based on the type of infection like local, bloodstream, disseminated and pulmonary. Pulmonary infection is the most common infection and causes bronchitis and pneumonia, thereby causing septic shock in the blood. Pulmonary infection is coupled with chest pain while coughing, headache and soreness in the muscles, high fever, weight loss and persistent cough, with or without sputum. Infection of the bloodstream causes symptoms like pain in the upper abdomen, diarrhoea, muscle tenderness and joint pain, disorientation, fever with chills and sweating, coupled with sore throat and headache. People with thalassemia, diabetes, liver disease, kidney disease, cancer, HIV and alcohol abuse are at a higher risk of getting infection of the bloodstream. People more than 40 years of age are also at a higher risk of getting meliodioisis through blood infection. Bloodstream infection can also cause local infections like swelling and pain in the parotid glands causing mumps and abscesses and ulcer below the skin causing wounds. Even local infections can cause bloodstream infection. Disseminated infection is caused in several organs of the body like sore formation in lungs, liver, prostate and spleen. Symptoms due to disseminated infection are seizures, headaches, fever, stomach and chest pain, weight loss and joint and muscle pain. The disease is treated depending upon the type of infection. The treatment is commonly done in two different stages. The first stage involves an intensive therapy and the second stage is an eradication therapy. Surgical procedure may also be required if the infection is cause in the lungs.

The treatment for melioidosis involves two distinct stages: the first stage involves intensive therapy and the second stage in eradication therapy. The initial therapy is also known as intravenous intensive therapy as the treatment involves administering an intravenous drug, ceftazidime. Intravenous ceftazidime (Tazicef, Fortz) is administered for an initial period of 10 to 14 days after the infection. This injection is given every 6 to 8 hours. A combination of imipenem, cefoperazone-sulbactam and meropenem can also be an active treatment. In the absence of the above four drugs, IV amoxicillin-clavulanate (co-amoxiclav) can also be used. Any of the IV antibiotics is given for a period of 10 to 14 days till the fever comes down. The drug should be administered if the fever does not reduce after the 10 to 14 days treatment. The next stage that is the eradication stage, involves treatment with oral antibiotics that should be continued for 3 to 6 months. Mainly 2 antibiotics are used for the treatment and they are sulphamethoxazole-trimethoprim (Bactrim, Sulfatrim and Septra) for every 12 hours and also doxycycline (Alodox, Avidoxy, Monodox, Doryx and Adoxa) also for every 12 hours. In case IV antibiotic therapy is unresponsive to treat the disease, surgical removal like splenectomy can also be done. Surgical procedures for removal of infections of the lungs, prostate and sometimes even in bones have proved successful.

Patient showing symptoms for the disease and is tested positive on diagnosis are eligible for treatment. The disease is also known as ‘the great imitator’ and can be misdiagnosed. It can mimic some other disease at times. Hence, the evaluation must be done carefully to detect the disease for proper treatment.

Patient who does not show symptoms or who does not get diagnosed on testing for the disease is not eligible for the treatment.

The treatment is considered very safe and usually the drugs do not cause any side effect. Rarely, serious side effects like diarrhoea, seizures, allergy, mouth ulcers, discoloration of the skin of the fingers and swelling and soreness on the injection site can happen.

There is no specific guideline to be followed post treatment of meliodiosis, but sufficient rest, proper hydration of the body etc may be done for easy and quick recovery.

It may take a few months to recover completely from meliodioisis after the full treatment.

The price of treatment of meliodiosis in India ranges from Rs. 200 to Rs. 1,000.

Yes, the results are permanent. Only if the medication is stopped in the middle of the treatment, the symptoms can recur.

There is no alternative treatment for the disease.