Melioidosis and worldwide travel

• Melioidosis is a bacterial infection that can be life-threatening.
• It is found in tropical areas, in particular Southeast Asia, Northern Australia, the Indian subcontinent, and China. But it’s being found in more places, too. These include places across Africa, South America, Central America, the Pacific islands, and the Caribbean.
• It is more common in the rainy season.
• Melioidosis can cause sepsis and pneumonia, as well as other infections. It can cause chronic infection in people with CF.
• Before you travel, you should speak to your CF team. They can discuss the risks with you and explain how to reduce them.

Melioidosis is an infection that can be life-threatening. It is caused by the bacterium Burkholderia pseudomallei. This is a close relative of the Burkholderia cepacia complex, which also affects people with CF.

Melioidosis can cause:

• pneumonia – infection in the lung
• abscesses – collections of infected pus
• sepsis – a life-threatening condition, where the body’s response to an infection damages its own tissues and organs.

Melioidosis can affect people who don’t have CF, too. This is especially true for people who have other risk factors, such as diabetes.

You can become infected if you visit tropical areas, especially: 

• Southeast Asia
• Northern Australia
• the Indian subcontinent
• China. 

We’re learning more about melioidosis. We now know of people getting the infection in South America. We also know there may be risk across Africa, the Caribbean, Central America, the Pacific islands, and isolated areas in Texas.

In the UK, there are imported cases of melioidosis. These are seen in people who have travelled to countries where the infection is found.

Risk factors in the environment

The bacteria that cause melioidosis live in soil and surface water. They’re especially common in rural areas, such as rice paddy fields. Contact with contaminated soil and water are major infection risks. For example, this could be: 

• if you get mud in a wound
• following near-drowning in fresh water.

Most cases occur during the rainy season. If there has been flooding, the risk is higher. The monsoon season has very heavy rains and strong winds. These can disturb infected dust and water. This means there’s a greater risk of inhaling contaminated soil.

It is extremely rare for the infection to pass from one person to another.

Risk factors for specific people

Evidence suggests you may be more likely to develop melioidosis if you:

• are older than 50 years of age
• have diabetes
• consume too much alcohol
• have chronic lung disease
• have chronic kidney disease.

You may also have a higher risk if you:

• have cancer
• are immunocompromised – including due to therapy, such as steroids
• have rheumatic heart disease or congestive heart failure
• have thalassaemia
• have too much iron in your body (iron overload)
• have a chronic granulomatous disorder
• have tuberculosis.

Types of infection

Melioidosis can cause:

• pneumonia
• skin and soft tissue infections
• urinary tract infections
• abscesses
• sepsis
• bone and/or joint infection
• infection in the brain.

Infections can be:

• acute – happening within 4 weeks of exposure to the bacteria
• chronic – lasting more than 2 months
• latent – with no signs or symptoms appearing until months or years later.

There is also some evidence the bacteria can colonise the lungs of some people with CF.

Diagnosis

To diagnose melioidosis, doctors will take a sample of body tissue or fluid. This might be:

• blood
• sputum
• urine
• skin lesions
• pus from abscesses.

Treatment

The bacteria that cause this infection do not respond to many commonly used antibiotics. Your CF team will look at the laboratory results to decide the best treatment. You may be able to access treatment whilst you are travelling, but this will depend on the country you are in and the availability of the right drugs – you should look into this before you travel.

Treatment usually includes drugs, such as ceftazimide or meropenem. You have these by injection. If the infection is severe, you will have them for at least three weeks. Sometimes you might need to have them for a much longer period. 

After this, most people will need to take antibiotics – co-trimoxazole, doxycycline or co-amoxiclav. You’ll take these as tablets for several months. It’s very common for the infection to come back. But the antibiotics reduce that risk.

A small number of people with CF have had a Burkholderia pseudomallei infection diagnosis after travelling. They have generally had long-term lung infections that have progressed over months or years. This is different to the short but overwhelming infections that people without cystic fibrosis get.

It's usually very difficult to get rid of the infection once you have it. There have been reports of melioidosis passing from one person with CF to another. But this is extremely rare. So there’s no need to change the standard cross-infection advice for mixing with other people with CF.

We can’t know exactly how risky travel will be for a specific person.  You should avoid rural areas, particularly during the rainy season, if you’re travelling to:

• Southeast Asia
• Northern Australia
• the Indian subcontinent
• China
• parts of Africa
• South America
• Central America
• the Pacific islands
• the Caribbean.

You should also avoid: 

• exposure to flooded areas
• going outside during heavy storms.

If your respiratory health gets worse after you’ve travelled to these areas, contact your CF team immediately. Make sure you give them full details of your travel history.