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Melioidosis A032

Last amended 
8 April 2021
Current RMA Instruments
Reasonable Hypothesis SOP
60 of 2014
Balance of Probabilities SOP
61 of 2014
Changes from previous Instruments

SOP Bulletin 176

ICD Coding
  • ICD-9-CM Codes: 025
  • ICD-10-AM Codes: A24.1, A24.2, A24.3, A24.4
Brief description

This is a infection with a specific type of bacteria, Burkholderia pseudomallei, which normally acts as a saprophyte in the soil and water of endemic areas such as Northern Australia, Southeast Asia, India, China, Thailand, Malaysia, Singapore, Papua New Guinea, New Caledonia.  The normal route of infection is via percutaneous inoculation of the skin surface or via inhalation and occasionally ingestion. The incubation period is from 1 to 24 days with an average of nine days.  The commonest manifestation is pneumonia or skin infection.

Aysmptomatic infections by the causative bacterium can also occur and these are not covered by the SOP, which requires a clinical illness.

Confirming the diagnosis

This diagnosis is based on microbiological confirmation of the infection through microscopy, and culture, plus an appropriate pattern of clinical illness. 

The relevant medical specialist is an infectious disease physician.

Additional diagnoses covered by SOP
  • Infection by Burkholderia pseudomalli
  • Whitmore’s disease
Conditions excluded from SOP
  • Infection by Burkholderia mallei#
  • Glanders#
  • sub-clinical infection with Burkholderia pseudomallei - not a disease or injury

# non-SOP condition

Clinical onset

In most symptomatic cases this is an acute infection lasting less than two months.  The most common presentation is with pneumonia, followed by skin ulcers or abscesses.  Bacteraemia and septicaemia are also common and are assocaited with a significant mortality rate. 

Clinical onset will typically be able to be backdated from the time of confirmation of diagnosis, based on time of onset of relevant symptoms.

Clinical worsening

The infection can become chronic and can also be clincially similar to tuberculosis, including with latent infection and reactivation.