RT Journal Article SR Electronic T1 Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions JF European Respiratory Journal JO Eur Respir J FD European Respiratory Society SP 542 OP 550 DO 10.1183/09031936.03.00006203 VO 22 IS 3 A1 B.J. Currie YR 2003 UL http://erj.ersjournals.com/content/22/3/542.abstract AB Melioidosis is endemic in South East Asia, Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. While 20–36% of melioidosis cases have no evident predisposing risk factor, the vast majority of fatal cases have an identified risk factor, the most important of which are diabetes, alcoholism and chronic renal disease. Half of all cases present with pneumonia, but there is great clinical diversity, from localised skin ulcers or abscesses without systemic illness to fulminant septic shock with multiple abscesses in the lungs, liver, spleen and kidneys. At least 10% of cases present with a chronic respiratory illness (sick >2 months) mimicking tuberculosis and often with upper lobe infiltrates and/or cavities on chest radiography. As with tuberculosis, latency with reactivation decades after infection can also occur, although this is rare. Confirmation of diagnosis is by culture of B. pseudomallei from blood, sputum, throat swab or other samples. Microbiology laboratories need to be informed of the possibility of melioidosis, as those not familiar with it can misidentify the organism. Antibiotic therapy is initial intensive therapy with i.v. ceftazidime or meropenem or imipenem +/− cotrimoxazole for ≥10 days, followed by eradication therapy with cotrimoxazole +/− doxycycline +/− chloramphenicol (first 4 weeks only) for ≥3 months. Melioidosis has been increasingly recognised in returning travellers in Europe and recently melioidosis and colonisation with B. pseudomallei have been documented in cystic fibrosis patients visiting or resident in endemic areas.