Melioidosis is increasingly recognized around the world. Despite several decades of clinical research, the mortality rate for melioidosis remains high. This review focuses on studies that relate to patient management, including risk factors, diagnosis, treatment and prediction of the outcome. A brief summary of studies relating to genomics and genotyping, immunology and pathogenesis is provided.
Involvement in the tsunami of December 2004 is a risk factor for melioidosis, and risk may extend to individuals who were uninjured bystanders. Several standard microbiological techniques used to culture and identify Burkholderia pseudomallei have been evaluated. Polymerase chain reaction has been developed for bacterial identification, although limited evaluation has been performed in the clinical setting. Two trials of antimicrobial therapy provide evidence with which to refine existing treatment protocols. Inexpensive clinical and laboratory predictors for poor outcome have been described. Several putative vaccine candidates have been proposed and studied in animals, but no vaccine is on the immediate horizon.
None of the studies reviewed here report strategies that reduce mortality. A key area for future research is the identification of affordable interventions that lower the death rate, and are applicable to low-resource settings.
Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Center for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
Correspondence to Sharon Peacock, Wellcome Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok, 10400, Thailand Tel: +66 2 354 9172; fax: +66 2 354 9169; e-mail: email@example.com
Sponsorship: S.J.P. is supported by a Wellcome Trust Career Development Award in Clinical Tropical Medicine.