Melioidosis: An Emerging Infection in Taiwan?

Melioidosis is an infectious disease of humans and animals caused by Burkholderia pseudomallei (1). This organism is widely distributed in rice field soil and in stagnant water throughout the tropics (1-8). Although a major disease in Southeast Asia and northern Australia, melioidosis occurs sporadically throughout the world (often in patients with a history of residence in these disease-endemic areas) (1). Humans are usually infected by traumatic inoculation of the organism from the soil or, rarely, by inhalation or ingestion (1,7). Clinical manifestations are protean, ranging from benign and localized abscess, to severe, community-acquired pneumonia to fatal septicemia The two biotypes of B. pseudomallei are categorized by their ability to assimilate L-arabinose (9). The arabinose nonassimilators (Ara-) are virulent and can be isolated from both clinical specimens and the environment, whereas the arabinose assimilators (Ara+) are usually avirulent and mainly found in the environment (9,10). Relapse, recrudescence, or reinfection may occur in immunocompromised patients under inappropriate antimicrobial treatment or after resolution of primary infection