Over the last week, news from Townsville in North Queensland following the catastrophic flooding in the region and north west Queensland rural areas about the recent outbreak of Melioidosis and sadly, one fatality from this disease, it is important for the NQ community to receive accurate public and environmental health advice to hopefully, prevent the spread of this disease.
What is melioidosis? Melioidosis is a bacterial disease caused by bacteria known as Burkholderia pseudomallei. Melioidosis is also known as Whitmore’s Disease. These bacteria live below the soil’s surface during the dry season but after heavy rainfall, they are found in surface water, mud and may become airborne. In the environment, it can be dormant for years or kill within 48 hours.
How is it spread? The bacteria that causes Melioidosis usually enters the body via cuts and sores in the skin or via inhalation of dust or droplets and very rarely by ingestion of contaminated water. The disease has been found among some domestic and farm animals. Melioidosis does not usually spread from one person to another or from animals to humans.
Where does melioidosis usually occur? Melioidosis is predominately a disease of the tropical and subtropical climates throughout the world, particularly in South East Asia and northern Australia. In Australia, cases typically occur in the Northern Territory (NT), far north Queensland and the Kimberley region of Western Australia.
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What are the symptoms? The symptoms/signs of Melioidosis depend on the site of the infection and therefore may vary. Often it starts as a chest infection with shortness of breath, productive cough and fever. Other possible presentations include fever with headache and confusion, pain or difficulty passing urine. People can become ill from 1 to 21 days after being infected as the onset of symptoms may be sudden or gradual.
The infection can be fatal. Melioidosis requires urgent medical attention and treatment with specific antibiotics. In some cases, the illness may come on much more slowly with weight loss, intermittent fever, chest pain and a cough. Some people may present with skin ulcers, boils or joint or bone infections. There have also been cases where the disease has caused illness many years after the initial infection. In these cases, the bacteria have been carried by the person and have become active due to a weakening of their immune system.
The diagnosis of Melioidosis is made by growing the bacteria with laboratory testing of blood, sputum, urine or a swab from an abscess or non-healing ulcer.
Who is at risk? People most at risk are those with conditions such as
- Heavy alcohol consumption (>20 standard drinks per week or binge drinking)
- Kidney disease
- Lung disease
- Receiving immunosuppressive therapy, including steroids
- Cuts or sores in your skin, particularly on hands/feet.
Healthy people can also get the disease if they work in muddy soil without proper hand and foot protection. Children are at a lower risk for acquiring Melioidosis compared with adults. However, it is still possible for children to acquire Melioidosis during the wet season, particularly those with chronic diseases or weakened immune systems.
What is the treatment? All patients should be admitted to hospital initially. They are treated with antibiotics, which usually have to be continued for at least 3 months. If treatment is started early, recovery is usually complete. It is important to complete all antibiotics to prevent a relapse.
How can Melioidosis be prevented? There is currently no vaccine against Melioidosis. Therefore, preventive measures are the key to avoiding infection. People with past exposure to Melioidosis can be infected again after new exposure.
- Waterproof shoes or boots will protect your feet when you walk in wet soil where there is pooled water or muddy conditions, for example, when gardening or working in excavations. Open footwear such as sandals are not appropriate protection.
- Protective gloves should be worn when handling soil, particularly during the wet season. Wounds should be promptly and thoroughly washed clean and covered.
- People using high pressure hoses around soil, should cover their mouths and noses with a mask to avoid inhalation of bacteria.
- Children should avoid playing in muddy areas, wet sandpits or places where water has pooled in grassy areas or where grassed areas are boggy. Sandpits which are dry or dry enough to comfortably play in, are a low risk.
If you would like further information on this disease or any other occupational and environmental health matter, please contact our rooms.
Phone: (07) 3348 9611
- nt.gov.au/ health
- Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology and management. Clin Microbiol Rev2005; 18: 383-416.
- Heymann D (Ed). 2008. Control of Communicable Diseases Manual, 19th edition. American Public Health Association: Washington.