https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/181 Tue, 11 Apr 2017 16:11:09 +0000 Melioidosis is a disease of public health importance in Thailand, Vietnam, Malaysia, Laos, Myanmar and northern Australia where it is associated with high case-fatality rates. In endemic areas, sero-epidemiological surveys have showed that the infection is fairly common in childhood as 80% of children had antibodies by the age of four years.2 In infected individuals the organism may remain dormant inside the phagocytic cells for months, years or decades.3 The factors that provoke reactivation of this latent, dormant “time bomb” are stress and alteration of immune status. Diabetes mellitus, chronic renal failure, cirrhosis of liver, AIDS, hematological malignancies seem to predispose the activation of the disease in an otherwise dormant latent infection. The manifestations are highly diverse ranging from acute pulmonary infection, septicemia, acute or chronic suppurative infections involving almost all organ systems to meningitis.4 Fulminant sepsis is much more common and is associated with high mortality. B.pseudomallei is inherently resistant to a number of antibiotics and even with aggressive antibiotic therapy, the mortality rate remains high and the incidence of relapse is common. Mortality in disseminated septicemic melioidosis is 82-87%. However, with ceftazidime therapy, the mortality rate was cut by half to 35-40%. Fatalities are related to the speed of diagnosis and initiation of treatment. With prolonged maintenance treatment with cotrimoxazole relapse occurs in 4-23%.4 Melioidosis is rarely diagnosed in Bangladesh. In Bangladesh, the first case of melioidosis was reported in 1988 by ICDDR, B.6 Subsequently, between 1988 to 1999 five more cases were detected in United Kingdom among Bangladeshi immigrants from Sylhet region.7 Later on, in 2001 and in 2009 we have detected and reported 3 more cases of melioidosis among diabetic patients. All the three cases were from greater Mymensingh area.8-11   Md. Shariful Alam Jilani Ibrahim Medical College J Ashraful Haq Ibrahim Medical College Reference 2.   Kanaphun P, Thirawattanasuk N, Suputtamongkol Y, et al. Serology and carriage of Pseudomonas pseudomallei: a prospective study in 1000 hospitalized children in noreast Thailand. J Infect Dis; 167: 230-3. 4.   Leelarasamee A. Burkholderia pseudomallei: the unbeatable foe? Southeast Asian J Trop Med Public Health 1998; 29(2): 410-5. 6.   Streulenes MJ, Mondol G, et al. Melioidosis in Bangladesh – a case report. Trans R S Trop Med Hyg 1988; 82: 778-79. 8.    Halder D, Nik Zainal and Haq J Ashraful. Neonatal meningitis and septicaemia caused by Pseudomonas pseudomallei. Annals of Tropical Pediatrics 1998; 18: 161-164. 10.Haq JA. Melioidosis in Bangladesh. Presented in Scientific Seminar, Mymensingh Medical College 2009; 10. 2026 Ibrahim Medical College. All rights reserved.