Melioidosis in the Northern Territory of Australia.

Melioidosis is being diagnosed with increasing frequency in the northern part of the Northern Territory, but the mortality rate remains high in the acute septicaemic form of the disease largely because of associated chronic debilitating illnesses. This paper reviews epidemiological and clinical features of human melioidosis in 37 cases seen between 1960 and 1979. Infection with Pseudomonas pseudomallei is most often contracted during the wet season by persons who have regular contact with soil or ground water, probably through pre-existing skin lesions or penetrating wounds and, occasionally, through the genitourinary tract. The clinical features of melioidosis are protean, and definitive diagnosis can only be made by bacterial culture. Certain strongly indicative features, however, may justify vigorous early treatment with antibiotics (tetracycline or doxycycline in some combination with chloramphenicol, kanamycin or trimethoprim/sulphamethoxazole) which can be life-saving in fulminant septicaemic melioidosis. These indicative features are a severely prostrating fever with signs of respiratory tract infection in a patient with a chronic debilitating condition (particularly chronic alcoholism, diabetes mellitus, malnutrition or leprosy), with regular soil contact, and with chronic or recurrent skin lesions or a recent history of a penetrating wound. In subacute or chronic forms of melioidosis, which usually localize in an organ system, the diagnosis is commonly an unexpected bacteriological finding and the prognosis is generally good.