Inglis Timothy J J, Rolim Dionne B, Rodriguez Jorge L N
Division of Microbiology & Infectious Diseases, QEII Medical Centre, Nedlands, WA, Australia.
Rev Inst Med Trop Sao Paulo. 2006 Jan-Feb;48(1):1-4. doi: 10.1590/s0036-46652006000100001. Epub 2006 Mar 9.
Melioidosis is an emerging infection in Brazil and neighbouring South American countries. The wide range of clinical presentations include severe community-acquired pneumonia, septicaemia, central nervous system infection and less severe soft tissue infection. Diagnosis depends heavily on the clinical microbiology laboratory for culture. Burkholderia pseudomallei, the bacterial cause of melioidosis, is easily cultured from blood, sputum and other clinical samples. However, B. pseudomallei can be difficult to identify reliably, and can be confused with closely related bacteria, some of which may be dismissed as insignificant culture contaminants. Serological tests can help to support a diagnosis of melioidosis, but by themselves do not provide a definitive diagnosis. The use of a laboratory discovery pathway can help reduce the risk of missing atypical B. pseudomallei isolates. Recommended antibiotic treatment for severe infection is either intravenous Ceftazidime or Meropenem for several weeks, followed by up to 20 weeks oral treatment with a combination of trimethoprim-sulphamethoxazole and doxycycline. Consistent use of diagnostic microbiology to confirm the diagnosis, and rigorous treatment of severe infection with the correct antibiotics in two stages; acute and eradication, will contribute to a reduction in mortality from melioidosis.
类鼻疽在巴西及南美洲邻国正成为一种新发感染病。其临床表现多样，包括严重的社区获得性肺炎、败血症、中枢神经系统感染以及不太严重的软组织感染。诊断很大程度上依赖临床微生物学实验室进行培养。类鼻疽的病原菌——伯克霍尔德菌可轻易从血液、痰液及其他临床样本中培养出来。然而，伯克霍尔德菌可能难以可靠鉴定，且可能与密切相关的细菌混淆，其中一些可能被当作无足轻重的培养污染物而被忽略。血清学检测有助于支持类鼻疽的诊断，但仅凭其本身无法提供确诊依据。采用实验室发现途径有助于降低漏检非典型伯克霍尔德菌分离株的风险。对于严重感染，推荐的抗生素治疗方案是静脉注射头孢他啶或美罗培南数周，随后口服甲氧苄啶 - 磺胺甲恶唑和多西环素联合用药长达20周。持续运用诊断微生物学来确诊，并分两个阶段（急性期和根除期）用正确的抗生素对严重感染进行严格治疗，将有助于降低类鼻疽的死亡率。
