Current RMA Instruments
| Reasonable Hypothesis SOP | 55 of 2023 |
| Balance of Probabilities SOP | 56 of 2023 |
Changes from previous Instruments
ICD Coding
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 (on dead or decaying organic matter) in the soil and water of endemic areas such as Northern Australia, Southeast Asia, India, China, Thailand, Malaysia, Singapore, Papua New Guinea, and New Caledonia. The normal route of infection is via inoculation of the skin surface. Inhalation and ingestion of the organism can also occur. 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
- Illness from 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 associated with a significant mortality rate. Latent (subclinical) infection with a prolonged delay from exposure to onset of symptoms can occur.
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.