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Melioidosis

Melioidosis is caused by a gram-negative bacillus, Burkholderia pseudomallei. Infections are endemic in Southeast Asia. The majority of cases are diagnosed in Thailand, Malaysia, Singapore, and northern Australia. Infections are probably acquired as percutaneous inoculations during the wet season from infected soil. Besides living in or traveling to an endemic area, risk factors include diabetes mellitus, alcoholism, and renal failure. Acute disease is defined by symptoms lasting less than 2 months, whereas chronic disease is defined by the presence of symptoms for more than 2 months. Like tuberculosis, melioidosis has the capacity to become latent and be reactivated at a later time.

Acute melioidosis can produce suppurative skin infections, pneumonia, or septicemia. Cutaneous lesions are not specific for melioidosis. They may take the form of multiple, superficial pustules or ecthyma gangrenosum. Regional lymphadenopathy is common.

Differential Diagnosis: Melioidosis can be distinguished from cutaneous anthrax in the following manner.

Melioidosis

Cutaneous anthrax

*Patient resides or has traveled to an endemic area

*Ulcer is painless

* Lesion is located on exposed parts of the body

*Lesion develops a vesicular stage

*Ulcer and eschar are surrounded by characteristic non-pitting edema

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