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Melioidosis and Glanders

(Pseudomonas pseudomallei)
What are melioidosis?

Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei or Pseudomonas pseudomallei. These harmful bacteria are found in unsanitary water or moist soil. They are transmitted to animals and r humans by ingestion or inhalation. Melioidosis is uncommon in the United States, but occurs more frequently elsewhere in the world, primarily in Southeast Asia, the South Pacific and northern Australia. Persons with diabetes, kidney or liver disease or compromised immune systems are especially susceptible to this disease. It also can occur in health care settings.

What are the symptoms of melioidosis?

Symptoms include acute pulmonary infection, localized infection of the skin and fatal septicemia (blood poisoning that takes over the whole body and shuts down vital organs). Symptoms are similar to glanders, an infectious disease caused by the bacterium Burkholderia mallei or Pseudomonas mallei. Areas of infection depend on where bacteria entered the body. The disease can cause little to no illness or it can be severe and lead to death. Infections can be worse in persons who have diabetes, alcoholism, liver or kidney problems or compromised immune systems.

What types of infections can occur?

Skin infectionscan occur where the bacteria entered through a break in the skin. A nodule (pimple) can turn into a draining ulcer. Fever and muscle aches commonly occur at the same time as skin infection. Swollen lymph glands may also occur.  A pus-filled infection of the parotid gland (parotid abscess) has been reported frequently in Southeast Asian children.


Pulmonary (lung) infections cause fever, muscle aches, headache, chest pain and a dry cough. Pneumonia or bronchitis can occur.


Bloodstream infections can lead to rapid death. Once in the bloodstream, the bacteria can quickly spread throughout the body. Symptoms include fever, breathing difficulty, severe headache, diarrhea, muscle tenderness and disorientation. If the patient survives, pus-filled pockets of infection (abscesses) are usually found in the skin, muscles and internal organs. Brain infections (encephalitis) also can occur.


Chronic infections involve draining abscesses within the muscles, joints of the arms and legs, lymph glands and internal organs.

How soon after infections do symptoms appear?

Symptoms can begin as soon as a few days or as long as a few weeks after exposure to the bacteria.

Who gets melioidosis?

Anyone can get melioidosis if they come in contact with the bacteria. People are more likely to contract melioidosis if they have diabetes or work in or visit wet Southeast Asian environments, such as rice paddies.

How is melioidosis spread?

Burkholderia pseudomallei, the bacterium that causes melioidosis, is found in the wet soil and water of Southeast Asia, the South Pacific, China, India and Pakistan and, to a lesser extent, in Central and South America. People become infected when the bacteria enter skin wounds, abrasions or other breaks in the skin, if contaminated water is swallowed or by breathing in contaminated dust or small droplets of contaminated water. Melioidosis can spread from person to person by contact with the blood and body fluids of an infected person. Sexual transmission of the disease can occur. Health care workers can transmit the bacteria to other patients if they fail to wash their hands between patients. Bacteria can be spread to another patient’s skin, and from there it can cause infection if it enters through breaks in the skin or through plastic tubes inserted into veins or a patient’s mouth or nose.  

It is possible that the Burkholderia pseudomallei bacteria could be used by terrorists as a weapon to make people sick.
Is melioidosis contagious?

Person to person transmission of melioidosis has been reported, but it is rare.

How is melioidoisis diagnosed?

The bacterium that causes melioidosis is confirmed through laboratory tests. It grows easily in a laboratory from samples of blood, sputum, urine or pus.

What is the treatment for melioidosis?

The bacteria that cause melioidosis are resistant to many antibiotics and are difficult to kill. Up to five months of antibiotic therapy is recommended to cure melioidosis and prevent the disease from recurring.   Most patients are treated with a combination of intravenous and oral antibiotics.

What do I do if I suspect I’ve been exposed to Burkholderia pseudomallei bacteria and think I may have melioidosis?

Contact your health care provider immediately. Report exactly how you think you may have been exposed.

Is there a way to prevent melioidosis infection?

Persons with diabetes and skin lesions should avoid contact with soil and standing water in areas where melioidosis occurs. Wearing boots during agricultural work can prevent infection through the feet and lower legs. Hospital infections or infections through health care workers or equipment can be prevented by wearing gloves, masks and eye shields, and cleaning equipment regularly and using new equipment for every patient interaction. There is no vaccine to prevent melioidosis.

What is bioterrorism?
Bioterrorism is the intentional use of biological agents, or germs, to cause illness. Bioterrorism has occurred in NYC only in 2001, when several media outlets received letters that were intentionally contaminated with anthrax bacteria.

 

Is melioidosis a potential bioterrorism threat?

The United States government considers Burkholderia pseudomallei, the bacterium that causes melioidosis, to be a potential agent for biological warfare and of biological terrorism.

What has New York City done to address the threat of melioidosis as a result of a bioterrorist attack?

Many federal, state, and city agencies, including the New York City Department of Health and Mental Hygiene (DOHMH), have been working together for several years to prepare for the detection and response to a bioterrorist event . In cooperation with other emergency response agencies, the Health Department has established systems to improve its ability to detect and respond to public health emergencies caused by the intentional release of a biological agent, including the bacterium that causes melioidosis.

How Will I Cope?
A melioidosis outbreak in NYC can be very stressful, especially if it is large scale event. It can disrupt your everyday life and make you and those around you feel less safe. You may experience fear and uncertainty. Learning about stress and strategies to manage it can help you cope.

Prepare Today, Cope better Tomorrow - Stress during Disasters provides basic information and practical advice on dealing with the stress and anxiety caused by disasters.  It is available in seven languages.

If there is a melioidosis outbreak in the city and you feel overwhelmed and unable to cope, or if you are concerned about someone else, you can find help by calling 1-800 LIFENET. LIFENET is a free, confidential helpline for New York City residents, available 24/7, with trained staff ready to take your calls and offer advice: 1-800-LifeNet 1-800-543-3638 (English), 1-877-Ayudese 1-877-298-3373 (Spanish), 1-877-990-8585 (Chinese), 1-212-982-5284 (TTY).

Where can I get more information?
For more information about melioidosis, visit:

Centers for Disease Control and Prevention (CDC)