|Classification and external resources|
Melioidosis is an infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water. It is of public health importance in endemic areas, particularly in Vietnam and northern Australia. It exists in acute and chronic forms. Signs and symptoms may include pain in chest, bones, or joints; cough; skin infections, lung nodules, and pneumonia.
B. pseudomallei was previously classed as part of the Pseudomonas genus; until 1992, it was known as Pseudomonas pseudomallei. It is phylogenetically related closely to Burkholderia mallei which causes glanders, an infection primarily of horses, donkeys, and mules. The name melioidosis is derived from the Greek melis (μηλις) meaning "a distemper of asses" with the suffixes -oid meaning "similar to" and -osis meaning "a condition", that is, a condition similar to glanders.
- 1 Signs and symptoms
- 2 Diagnosis
- 3 Treatment
- 4 Prognosis
- 5 Prevention
- 6 Biological warfare potential
- 7 Epidemiology
- 8 History
- 9 Synonyms
- 10 References
- 11 External links
Signs and symptoms
In the subgroup of patients where an inoculating event was noted, the mean incubation period of acute melioidosis was 9 days (range 1–21 days). Patients with latent melioidosis may be symptom-free for decades; the longest period between presumed exposure and clinical presentation is 62 years. The potential for prolonged incubation was recognized in US servicemen involved in the Vietnam War, and was referred to as the "Vietnam time-bomb". A wide spectrum of severity exists; in chronic presentations, symptoms may last months, but fulminant infection, particularly associated with near-drowning, may present with severe symptoms over hours.
A patient with active melioidosis usually presents with fever. Pain or other symptoms may be suggestive of a clinical focus, which is found in around 75% of patients. Such symptoms include cough or pleuritic chest pain suggestive of pneumonia, bone or joint pain suggestive of osteomyelitis or septic arthritis, or cellulitis. Intra-abdominal infection (including liver and/or splenic abscesses, or prostatic abscesses) do not usually present with focal pain, and imaging of these organs using ultrasound or computed tomography should be performed routinely. In one series of 214 patients, 27.6% had abscesses in the liver or spleen (95% confidence interval, 22.0% to 33.9%). B. pseudomallei abscesses may have a characteristic "honeycomb" or "swiss cheese" architecture (hypoechoic, multiseptate, multiloculate) on CT.
Regional variations in disease presentation are seen: parotid abscesses characteristically occur in Thai children, but this presentation has only been described once in Australia. Conversely, prostatic abscesses are found in up to 20% of Australian males, but are rarely described elsewhere. An encephalomyelitis syndrome is recognised in northern Australia.
Patients with melioidosis usually have risk factors for disease, such as diabetes, thalassemia, hazardous alcohol use, or renal disease, and frequently give a history of occupational or recreational exposure to mud or pooled surface water. However, otherwise healthy patients, including children, may also get melioidosis.
In up to 25% of patients, no focus of infection is found and the diagnosis is usually made on blood cultures or throat swab. Melioidosis is said to be able to affect any organ in the body except the heart valves (endocarditis). Although meningitis has been described secondary to ruptured brain abscesses, primary meningitis has not been described. Less common manifestations include intravascular infection, lymph node abscesses (1.2–2.2%), pyopericardium and myocarditis, mediastinal infection, and thyroid and scrotal abscesses and ocular infection.
Chronic melioidosis is usually defined by a duration of symptoms greater than two months and occurs in about 10% of patients. The clinical presentation of chronic melioidosis is protean and includes such presentations as chronic skin infections, chronic lung nodule, and pneumonia. In particular, chronic melioidosis closely mimics tuberculosis, and has sometimes been called "Vietnamese tuberculosis".
A definitive diagnosis is made by culturing the organism from any clinical sample, because the organism is never part of the normal human flora.
A definite history of contact with soil may not be elicited, as melioidosis can be dormant for many years before manifesting. Attention should be paid to a history of travel to endemic areas in returned travellers. Some authors recommend considering possibility of melioidosis in every febrile patient with a history of traveling to and/or staying at endemic areas.
A complete screen (blood culture, sputum culture, urine culture, throat swab, and culture of any aspirated pus) should be performed on all patients with suspected melioidosis (culture on blood agar as well as Ashdown's medium). A definitive diagnosis is made by growing B. pseudomallei from any site. A throat swab is not sensitive, but is 100% specific if positive, and compares favourably with sputum culture. The sensitivity of urine culture is increased if a centrifuged specimen is cultured, and any bacterial growth should be reported (not just growth above 104 organisms/ml which is the usual cutoff). Very occasionally, bone marrow culture may be positive in patients who have negative blood cultures for B. pseudomallei, but these are not usually recommended. A common error made by clinicians unfamiliar with melioidosis is to only send a specimen from the affected site (which is the usual procedure for most other infections) instead of sending a full screen.
Ashdown's medium, a selective medium containing gentamicin, may be required for cultures taken from nonsterile sites. Burkholderia cepacia medium may be a useful alternative selective medium in nonendemic areas, where Ashdown's is not available. A new medium derived from Ashdown, known as Francis medium, may help differentiate B. pseudomallei from B. cepacia and may help in the early diagnosis of melioidosis, but has not yet been extensively clinically validated.
Many commercial kits for identifying bacteria may misidentify B. pseudomallei (see Burkholderia pseudomallei for a more detailed discussion of this topic).
A serological test for melioidosis (indirect haemagglutination) is available, but not commercially in most countries. A high background titre may reduce the positive predictive value of serological tests in endemic countries. A specific direct immunofluorescent test and latex agglutination, based on monoclonal antibodies, are used widely in Thailand, but are not available elsewhere. Cross-reactivity with B. thailandensis is almost complete. A commercial ELISA kit for melioidosis appears to perform well. but no ELISA test has yet been clinically validated as a diagnostic tool.
It is not possible to make the diagnosis on imaging studies alone (X-rays and scans), but imaging is routinely performed to assess the full extent of disease. Imaging of the abdomen using CT scans or ultrasound is recommended routinely, as abscesses may not be clinically apparent and may coexist with disease elsewhere. Australian authorities suggest imaging of the prostate specifically due to the high incidence of prostatic abscesses in northern Australian patients. A chest X-ray is also considered routine, with other investigations as clinically indicated. The presence of honeycomb abscesses in the liver are considered characteristic, but are not diagnostic.
The treatment of melioidosis is divided into two stages, an intravenous high-intensity phase and an eradication phase to prevent recurrence.
- Intravenous intensive phase
- Intravenous ceftazidime is the current drug of choice for treatment of acute melioidosis. Meropenem, imipenem and the cefoperazone-sulbactam combination (Sulperazone) are also active. Intravenous amoxicillin-clavulanate (co-amoxiclav) may be used if none of the above four drugs is available, but it produces inferior outcomes. Intravenous antibiotics are given for a minimum of 10 to 14 days, and are not usually stopped until the patient's temperature has returned to normal for more than 48 hours. Even with appropriate antibiotic therapy, fevers often persist for weeks or months, and patients may continue to develop new lesions even while on appropriate treatment. The median fever clearance time in melioidosis is 10 days: and failure of the fever to clear is not a reason to alter treatment. It is not uncommon for patients to require parenteral treatment continuously for a month or more.
- Intravenous meropenem is routinely used in Australia; outcomes appear to be good and meropenem is currently being tested with ceftazidime in a Thai clinical trial.
- Theoretical reasons are given for believing mortality might be lower in patients treated with imipenem: first, less endotoxin is released by dying bacteria during imipenem treatment, and the minimum inhibitory concentration (MIC) for imipenem is lower than for ceftazidime. However, no clinically relevant difference was found in mortality between imipenem and ceftazidime treatments. The MIC of meropenem is higher for B. pseudomallei than for many other organisms, and patients being haemofiltered will need more frequent or higher doses.
- Moxifloxacin, cefepime, tigecycline, and ertapenem do not appear to be effective in vitro. Piperacillin-sulbactam, doripenem and biapenem appear to be effective in vitro, but no clinical experience exists on which to recommend their use.
- Adjunctive treatment with granulocyte colony-stimulating factor or co-trimoxazole were not associated with decreased fatality rates in trials in Thailand.
- Eradication phase
- Following the treatment of the acute disease, eradication (or maintenance) treatment with co-trimoxazole and doxycycline is recommended to be used for 12 to 20 weeks to reduce the rate of recurrence. Chloramphenicol is no longer routinely recommended for this purpose. Co-amoxiclav is an alternative for those patients who are unable to take co-trimoxazole and doxycycline (e.g., pregnant women and children under the age of 12), but is not as effective. Single agent treatment with a fluoroquinolone (e.g., ciprofloxacin) or doxycycline for the oral maintenance phase is ineffective.
- In Australia, co-trimoxazole is used on its own for eradication therapy, with relapse rates that are lower than those seen in Thailand; in vitro evidence also suggests co-trimoxazole and doxycycline are antagonistic, and co-trimoxazole on its own may be preferable. Results from a randomised controlled trial (MERTH) support the use of co-trimoxazole alone. Studies reinforce the need for adequate follow-up and good adherence to the eradication phase of therapy. Dosing for co-trimoxazole is based on weight: (<40 kg: 160/800 mg every 12 hours; 40–60kg: 240/1200 mg every 12 hours, >60 kg: 320/1600 mg every 12 hours).
Surgical drainage is usually indicated for prostatic abscesses and septic arthritis, may be indicated for parotid abscesses, and is not usually indicated for hepatosplenic abscesses. In bacteraemic melioidosis unresponsive to intravenous antibiotic therapy, splenectomy has been attempted, but only anecdotal evidence supports this practice.
Prior to 1989, the standard treatment for acute melioidosis was a three-drug combination of chloramphenicol, co-trimoxazole and doxycycline; this regimen is associated with a mortality rate of 80% and is no longer be used unless no other alternatives are available. All three drugs are bacteriostatic (they stop the bacterium from growing, but do not kill it) and the action of co-trimoxazole antagonizes both chloramphenicol and doxycycline.
Without access to appropriate antibiotics (principally ceftazidime or meropenem), the septicemic form of melioidosis exceeds 90% in mortality rate. With appropriate antibiotics, the mortality rate is about 10% for uncomplicated cases but up to 80% for cases with bacteraemia or severe sepsis. It seems certain that access to intensive care facilities is also important, and probably at least partially explains why total mortality is 20% in Northern Australia but 40% in Northeast Thailand. Response to appropriate antibiotic treatment is slow, with the average duration of fever following treatment being 5–9 days.
Recurrence occurs in 10 to 20% of patients, but with co-trimoxazole eradication therapy, this can be reduced to 4%. While molecular studies have established the majority of recurrences are due to the original infecting strain, a significant proportion of recurrences (perhaps up to a quarter) in endemic areas may be due to reinfection, particularly after two years. Risk factors include severity of disease (patients with positive blood cultures or multifocal disease have a higher risk of relapse), choice of antibiotic for eradication therapy (doxycycline monotherapy and fluoroquinolone therapy are not as effective), poor compliance with eradication therapy and duration of eradication therapy less than 8 weeks.
Person-to-person transmission is exceedingly unusual; and patients with melioidosis should not be considered contagious. Lab workers should handle B. pseudomallei under BSL-3 isolation conditions, as laboratory-acquired melioidosis has been described.
In endemic areas, people (rice-paddy farmers in particular) are warned to avoid contact with soil, mud, and surface water where possible. Case clusters have been described following flooding and cyclones and probably relate to exposure. Other case clusters have related to contamination of drinking water supplies. Populations at risk include patients with diabetes mellitus, chronic renal failure, chronic lung disease, or an immune deficiency of any kind. The effectiveness of measures to reduce exposure to the causative organism have not been established. A vaccine is not yet available.
After exposure to B. pseudomallei (particularly following a laboratory accident) combined treatment with co-trimoxazole and doxycycline is recommended. Trovafloxacin and grepafloxacin have been shown to be effective in animal models.
Further information: Burkholderia_pseudomallei § Vaccine_candidates
No vaccines are licensed for the prevention of melioidosis.
Biological warfare potential
Interest in melioidosis has been expressed because it has the potential to be developed as a biological weapon. It is classed by the US Centers for Disease Control (CDC) as a category B agent. B. pseudomallei, like B. mallei which causes glanders, was studied by the US as a potential biological warfare agent, but never weaponized. The Soviet Union was reported to have also experimented with B. pseudomallei as a biological warfare agent.
Melioidosis is endemic in parts of southeast Asia (including Thailand, Laos, Singapore, Brunei, Malaysia, Burma and Vietnam), China, Taiwan and northern Australia. Flooding can increase its extent, including flooding in central Australia. Multiple cases have also been described in Hong Kong and Brunei India, and sporadic cases in Central and South America, the Middle East, the Pacific and several African countries. Although only one case of melioidosis has ever been reported in Bangladesh, at least five cases have been imported to the UK from that country. Recent news reports indicate B. pseudomallei has been isolated from soil in Bangladesh, but this remains to be verified scientifically. This suggests melioidosis is endemic to Bangladesh and a problem of underdiagnosis or under-reporting exists there. most likely due to a lack of adequate laboratory facilities in affected rural areas. A high isolation frequency (percentage of positive soil samples) was found in east Saravan in rural Lao PDR distant from the Mekong River, thought by the investigators to be the highest geometric mean concentration in the world (about 464 (25-10,850 CFU/g soil).
A statistical model indicated that the incidence will be 165,000 cases per year in 2016 (95% confidence interval, 68,000 to 412,000), with 138,000 of those occurring in East and South Asia and the Pacific. About half of those cases will die. Northeast Thailand has the highest incidence of melioidosis recorded in the world (an average incidence of 12.7 cases per 100,000 people per year). In Northeast Thailand, 80% of children are positive for antibodies against B. pseudomallei by the age of 4; the figures are lower in other parts of the world.
Melioidosis is a recognised disease in animals, including cats, goats, sheep, and horses. Cattle, water buffalo, and crocodiles are considered to be relatively resistant to melioidosis despite their constant exposure to mud. An outbreak at the Paris Zoo in the 1970s ("L’affaire du jardin des plantes") was thought to have originated from an imported panda.
B. pseudomallei is normally found in soil and surface water; a history of contact with soil or surface water is, therefore, almost invariable in patients with melioidosis; that said, the majority of patients who do have contact with infected soil suffer no ill effects. Even within an area, the distribution of B. pseudomallei within the soil can be extremely patchy, and competition with other Burkholderia species has been suggested as a possible reason. Contaminated ground water was implicated in one outbreak in northern Australia. Also implicated are severe weather events such as flooding tsunamis and typhoons.
Based on whole genome sequencing, humans may play a role in moving B. pseudomallei from place to place.
The single most important risk factor for developing melioidosis is diabetes mellitus, followed by hazardous alcohol use, chronic kidney disease, and chronic lung disease. Other risk factors include thalassaemia, occupation (rice paddy farmers), and cystic fibrosis. The mode of infection is believed to be either through a break in the skin, or through the inhalation of aerosolized B. pseudomallei cells. Person-to-person spread has been described, but is extremely unusual. HIV infection does not predispose to melioidosis.
Pathologist Alfred Whitmore and assistant Krishnaswami first reported the disease among beggars and morphine addicts at autopsy in Rangoon, present-day Myanmar, in a report published in 1912. They distinguished it from glanders, a disease of humans and animals that is similar in presentation, but caused by a different micro-organism. B. pseudomallei, also known as the Whitmore bacillus, was identified in 1917 in Kuala Lumpur. Arthur Conan Doyle may have read the 1912 report before writing a short story that involved the fictitious tropical disease "tapanuli fever" in a Sherlock Holmes adventure.
- Whitmore's disease (after Captain Alfred Whitmore, who first described the disease)
- Nightcliff gardener's disease (Nightcliff is a suburb of Darwin, Australia where melioidosis is endemic)
- Paddy-field disease
- Morphia injector's septicaemia
- Stanton AT, Fletcher W (1921). "Melioidosis, a new disease of the tropics". Far Eastern Association of Tropical Medicine: Transactions of the Fourth Congress. Batavia, Dutch East Indies: Javasche Boekhandel en Drukkerij.
- A J Simpson; Suputtamongkol Y; Smith MD; et al. (1999). "Comparison of imipenem and ceftazidime as therapy for severe melioidosis". Clin Infect Dis. 29 (2): 381–387. doi:10.1086/520219. PMID 10476746.
- Ngauy V, Lemeshev Y, Sadkowski L, Crawford G (2005). "Cutaneous Melioidosis in a Man Who Was Taken as a Prisoner of War by the Japanese during World War II". J Clin Microb. 43 (2): 970–2. doi:10.1128/JCM.43.2.970-972.2005. PMC . PMID 15695721.
- Apisarnthanarak A, Apisarnthanarak P, Mundy LM (2006). "Computer tomography characteristics of Burkholderia pseudomallei liver abscess". Clin Infect Dis. 42 (7): 989–93. doi:10.1086/501017. PMID 16511765.
- Laopaiboon V, Chamadol N, Buttham H, Sukeepaisarnjareon W (2009). "CT findings of liver and splenic abscesses in melioidosis: comparison with those in non-melioidosis". J Med Assoc Thai. 92 (11): 1476–84. PMID 19938740.
- Dance DA, Davis TM, Wattanagoon Y, et al. (1989). "Acute suppurative parotitis caused by Pseudomonas pseudomallei in children". J Infect Dis. 159 (4): 654–60. doi:10.1093/infdis/159.4.654. PMID 2926159.
- Raja, NS; Ahmed MZ; Singh NN (1 April 2005). "Melioidosis: an emerging infectious disease". Journal of Postgraduate Medicine. 51 (2): 140–45. PMID 16006713.
- Chlebicki, MP; Tan BH (2006). "Six cases of suppurative lymphadenitis caused by Burkholderia pseudomallei infection". Trans R Soc Trop Med Hyg. 100 (8): 798–801. doi:10.1016/j.trstmh.2005.10.004. PMID 16542691.
- Currie BJ, Fisher DA, Howard DM, et al. (2000). "Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature". Clin Infect Dis. 31 (4): 981–986. doi:10.1086/318116. PMID 11049780.
- Falade OO, Antonarakis ES, Kaul DR, Saint S, Murphy PA (2008). "Clinical problem-solving. Beware of first impressions". N Engl J Med. 359 (6): 628–634. doi:10.1056/NEJMcps0708803. PMID 18687644.
- Chetchotisakd, P; Anunnatsiri, S; Kiatchoosakun, S; Kularbkaew, C (2010). "Melioidosis pericarditis mimicking tuberculous pericarditis". Clin Infect Dis. 51 (5): e46–9. doi:10.1086/655699. PMID 20645861.
- Suntornsut P, Kasemsupat K, Silairatana S, et al. (2013). "Prevalence of Melioidosis in Patients with Suspected Pulmonary Tuberculosis and Sputum Smear Negative for Acid-Fast Bacilli in Northeast Thailand". Am J Trop Med Hyg. 89 (5): 983–5. doi:10.4269/ajtmh.13-0286. PMC . PMID 24062474.
- Ngauy V, Lemeshev Y, Sadkowski L, Crawford G (2005). "Cutaneous Melioidosis in a Man Who Was Taken as a Prisoner of War by the Japanese during World War II". J Clin Microbiol. 43 (2): 970–972. doi:10.1128/JCM.43.2.970-972.2005. PMC . PMID 15695721.
- Wuthiekanun V, Suputtamongkol Y, Simpson AJ, Kanaphun P, White NJ (2001). "Value of Throat Swab in Diagnosis of Melioidosis". J Clin Microbiol. 39 (10): 3801–02. doi:10.1128/JCM.39.10.3801-3802.2001. PMC . PMID 11574624.
- Limmathurotsakul D, Wuthiekanun V, Chierakul W, et al. (2005). "Role and Significance of Quantitative Urine Cultures in Diagnosis of Melioidosis". J Clin Microb. 43 (5): 2274–76. doi:10.1128/JCM.43.5.2274-2276.2005. PMC . PMID 15872255.
- Dance DA, White NJ, Suputtamongkol Y, Wattanagoon Y, Wuthiekanun V, Chaowagul W (1990). "The use of bone marrow culture for the diagnosis of melioidosis". Trans R Soc Trop Med Hyg. 84 (4): 585–7. doi:10.1016/0035-9203(90)90050-O. PMID 2091358.
- Peacock SJ, Chieng G, Cheng AC, et al. (2005). "Comparison of Ashdown's Medium, Burkholderia cepacia Medium, and Burkholderia pseudomallei Selective Agar for Clinical Isolation of Burkholderia pseudomallei". J Clin Microbiol. 43 (10): 5359–61. doi:10.1128/JCM.43.10.5359-5361.2005. PMC . PMID 16208018.
- Francis A, Aiyar S, Yean C, Naing L, Ravichandran M (2006). "An improved selective and differential medium for the isolation of Burkholderia pseudomallei from clinical specimens". Diagn Microbiol Infect Dis. 55 (2): 95–99. doi:10.1016/j.diagmicrobio.2005.11.008. PMID 16626918.
- Puthucheary SD, Anuar AS, Tee TS (2010). "Burkholderia thailandensis whole cell antigen cross-reacts with B. pseudomallei antibodies from patients with melioidosis in an immunofluorescent assay". The Southeast Asian journal of tropical medicine and public health. 41 (2): 397–400. PMID 20578523.
- Limmathurotsakul D, Chantratita N, Teerawattanasook N, et al. (2011). "Enzyme-Linked Immunosorbent Assay for the Diagnosis of Melioidosis: Better Than We Thought". Clin Infect Dis. 52 (8): 1024–8. doi:10.1093/cid/cir080. PMC . PMID 21460318.
- Peacock SJ, Cheng AC, Currie BJ, Dance DA (2011). "The Use of Positive Serological Tests as Evidence of Exposure to Burkholderia pseudomallei". Am J Trop Med Hyg. 84 (6): 1021–2. doi:10.4269/ajtmh.2011.11-0114a. PMC . PMID 21633045.
- Lim KS, Chong VH (2010). "Radiological manifestations of melioidosis". Clin Radiol. 65 (1): 66–72. doi:10.1016/j.crad.2009.08.008. PMID 20103424.
- Muttarak M, Peh WC, Euathrongchit J, Lin SE, Tan AG, Lerttumnongtum P, Sivasomboon C (2008). "Spectrum of imaging findings in melioidosis". Br J Radiol. 82 (978): 514–21. doi:10.1259/bjr/15785231. PMID 19098086.
- White NJ, Dance DA, Chaowagul W, et al. (1989). "Halving of mortality of severe melioidosis by ceftazidime". Lancet. 2 (8665): 697–701. doi:10.1016/S0140-6736(89)90768-X. PMID 2570956.
- Chierakul W, Anunnatsiri S, Chaowagul W, et al. (2007). "Addition of trimethoprim-sulfamethoxazole to ceftazidime during parenteral treatment of melioidosis is not associated with a long-term outcome benefit". Clin Infect Dis. 45 (4): 521–523. doi:10.1086/520010. PMID 17638209.
- Cheng AC, Fisher DA, Anstey NM, et al. (2004). "Outcomes of Patients with Melioidosis Treated with Meropenem". Antimicrob Agents Chemother. 48 (5): 1763–65. doi:10.1128/AAC.48.5.1763-1765.2004. PMC . PMID 15105132.
- Chetchotisakd P, Porramatikul S, Mootsikapun P, Anunnatsiri S, Thinkhamrop B (2001). "Randomized, double-blind, controlled study of cefoperazone-sulbactam plus cotrimoxazole versus ceftazidime plus cotrimoxazole for the treatment of severe melioidosis". Clin Infect Dis. 33 (1): 29–3. doi:10.1086/320878. PMID 11389491.
- Dance DA, Wuthiekanun V, White NJ, Chaowagul W (1988). "Antibiotic resistance in Pseudomonas pseudomallei". Lancet. 1 (8592): 994–5. doi:10.1016/S0140-6736(88)91810-7. PMID 2896855.
- Suputtamongkol Y, Rajchanuwong A, Chaowagul W, et al. (1994). "Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis". Clin Infect Dis. 19 (5): 846–53. doi:10.1093/clinids/19.5.846. PMID 7893868.
- University of Oxford (18 December 2007). "A randomized double blinded comparison of ceftazidime and meropenem in severe melioidosis (ATOM)". ClinicalTrials.gov. National Institutes of Health. Retrieved 27 Jan 2011.
- Simpson, A. J. H.; Opal, S. M.; Angus, B. J.; Prins, J. M.; Palardy, J. E.; Parejo, N. A.; Chaowagul, W.; White, N. J. (2000). "Differential antibiotic-induced endotoxin release in severe melioidosis". J Infect Dis. 181 (3): 1014–9. doi:10.1086/315306. PMID 10720525.
- Bilgrami, I.; Roberts, J. A.; Wallis, S. C.; Thomas, J.; Davis, J.; Fowler, S.; Goldrick, P. B.; Lipman, J. (2010). "Meropenem Dosing in Critically Ill Patients with Sepsis Receiving High-Volume Continuous Venovenous Hemofiltration". Antimicrobial Agents and Chemotherapy. 54 (7): 2974–2978. doi:10.1128/AAC.01582-09. PMC . PMID 20479205.
- Shih H-I; Chuang Y-C; Cheung BM-H; et al. (February 2008). "Sporadic and outbreak cases of melioidosis in southern Taiwan: clinical features and antimicrobial susceptibility". Infection. 37 (1): 9–15. doi:10.1007/s15010-008-7324-8. PMID 18854938.
- Harris P, Engler C, Norton R (2011). "Comparative in vitro susceptibility of Burkholderia pseudomallei to doripenem, ertapenem, tigecycline and moxifloxacin". Int J Antimicrob Agents. 37 (6): 547–9. doi:10.1016/j.ijantimicag.2011.02.001.
- Thamlikitkul V, Trakulsomboon S (2010). "In vitro activity of biapenem against Burkholderia pseudomallei". Int J Antimicrob Agents. 35 (5): 514. doi:10.1016/j.ijantimicag.2010.01.002. PMID 20188524.
- Cheng AC, Limmathurotsakul D, Chierakul W, et al. (2007). "A randomized controlled trial of granulocyte colony-stimulating factor for the treatment of severe sepsis due to melioidosis in Thailand". Clin Infect Dis. 45 (3): 308–14. doi:10.1086/519261. PMID 17599307.
- Chierakul W, Anunnatsiri S, Short JM, et al. (2005). "Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis". Clin Infect Dis. 41 (8): 1105–13. doi:10.1086/444456. PMID 16163628.
- Chierakul W, Anunnatsiri S, Chaowagul W, Peacock SJ, Chetchotisakd P, Day NP (2007). "Addition of trimethoprim-sulfamethoxazole to ceftazidime during parenteral treatment of melioidosis is not associated with a tong-term outcome benefit". Clin Infect Dis. 45 (4): 521–3. doi:10.1086/520010. PMID 17638209.
- Chaowagul W, Simpson AJ, Suputtamongkol Y, et al. (1999). "A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis". Clin Infect Dis. 29 (2): 375–80. doi:10.1086/520218. PMID 10476745.
- Rajchanuvong A, Chaowagul W, Suputtamongkol Y, Smith MD, Dance DA, White NJ (1995). "A prospective comparison of co-amoxiclav and the combination of chloramphenicol, doxycycline, and co-trimoxazole for the oral maintenance treatment of melioidosis". Trans R Soc Trop Med Hyg. 89 (5): 546–9. doi:10.1016/0035-9203(95)90104-3. PMID 8560537.
- Cheng AC, Chierakul W, Chaowagul W, et al. (2008). "Short Report: Consensus Guidelines for Dosing of Amoxicillin-Clavulanate in Melioidosis". Am J Trop Med Hyg. 78 (2): 208–9. PMC . PMID 18256414.
- Chaowagul W, Supputtamongkul Y, Smith MD, White NJ (1997). "Oral fluoroquinolones for maintenance treatment of melioidosis". Trans R Soc Trop Med Hyg. 91 (5): 599–601. doi:10.1016/S0035-9203(97)90044-4. PMID 9463680.
- Chetchotisakd P, Chaowagul W, Mootsikapun P, Budhsarawong D, Thinkamrop B (Jan–Feb 2001). "Maintenance therapy of melioidosis with ciprofloxacin plus azithromycin compared with cotrimoxazole plus doxycycline". Am J Trop Med Hyg. 64 (1–2): 24–7. PMID 11425157.
- Chaowagul W,; Simpson, Andrew J. H.; Suputtamongkol, Yupin; Smith, Michael D.; Angus, Brian J.; White, Nicholas J. (August 1999). "Clin Infect Dis". Clinical Infectious Diseases. 29 (2): 375–380. doi:10.1086/520218. PMID 10476745.
- Limmathurotsakul D; Chaowagul W; Chierakul Wirongrong; et al. (2006). "Risk factors for recurrent melioidosis in Northeastern Thailand". Clin Infect Dis. 43 (8): 979–86. doi:10.1086/507632. PMID 16983608.
- Dance DA, Wuthiekanun V, Chaowagul W, White NJ (1989). "Interactions in vitro between agents used to treat melioidosis". J Antimicrob Chemother. 24 (3): 311–6. doi:10.1093/jac/24.3.311. PMID 2681117.
- Chetchotisakd, P; Chierakul, W; Chaowagul, W; Anunnatsiri, S; Phimda, K; Mootsikapun, P; Chaisuksant, S; Pilaikul, J; Thinkhamrop, B; Phiphitaporn, S; Susaengrat, W; Toondee, C; Wongrattanacheewin, S; Wuthiekanun, V; Chantratita, N; Thaipadungpanit, J; Day, NP; Limmathurotsakul, D; Peacock, SJ (1 March 2014). "Trimethoprim-sulfamethoxazole versus trimethoprim-sulfamethoxazole plus doxycycline as oral eradicative treatment for melioidosis (MERTH): a multicentre, double-blind, non-inferiority, randomised controlled trial.". Lancet (London, England). 383 (9919): 807–14. doi:10.1016/S0140-6736(13)61951-0. PMC . PMID 24284287.
- Cheng AC, McBryde ES, Wuthiekanun V, Chierakul W, Amornchai P, Day NP, Peacock SJ (2009). "Dosing Regimens of Cotrimoxazole (Trimethoprim-Sulfamethoxazole) for Melioidosis". Antimicrob Agents Chemother. 53 (10): 4193–9. doi:10.1128/AAC.01301-08. PMC . PMID 19620336.
- TJ Inglis; CL Golledge; A Clair; J Harvey (2001). "Case report: recovery from persistent septicemic melioidosis". Am J Trop Med Hyg. 65 (1): 76–82. PMID 11504412.
- Dance DA, Wuthiekanun V, Chaowagul W, White NJ (1989). "Interactions in vitro between agents used to treat melioidosis". J Antimicrob Chemother. 24 (3): 311–6. doi:10.1093/jac/24.3.311. PMID 2681117.
- Couture E (1935). "La Melioidosis Etat actuel de la question". Rev Hyg Méd Prèv. 57: 190.
- Warner JM, Pelowa DB, Currie BJ, Hirst RG (2007). "Melioidosis in a rural community of Western Province, Papua New Guinea". Trans R Soc Trop Med Hyg. 101 (8): 809–13. doi:10.1016/j.trstmh.2007.02.024. PMID 17499321.
- White NJ (2003). "Melioidosis". Lancet. 361 (9370): 1715–22. doi:10.1016/S0140-6736(03)13374-0. PMID 12767750.
- Chaowagul W, White NJ, Dance DA, et al. (1989). "Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand". J Infect Dis. 159 (5): 890–9. doi:10.1093/infdis/159.5.890. PMID 2708842.
- Sarovich DS, Ward L, Price EP, et al. (2014). "Recurrent melioidosis in the Darwin Prospective Melioidosis Study: improving therapies mean that relapse cases are now rare.". J Clin Microbiol. 52 (2): 650–3. doi:10.1128/JCM.02239-13. PMID 24478504.
- Maharjan B, Chantratita N, Vesaratchavest M, et al. (2005). "Recurrent Melioidosis in Patients in Northeast Thailand Is Frequently Due to Reinfection Rather than Relapse". J Clin Microbiol. 43 (12): 6032–4. doi:10.1128/JCM.43.12.6032-6034.2005. PMC . PMID 16333094.
- Chaowagul W, Suputtamongkol Y, Dance DA, Rajchanuvong A, Pattara-arechachai J, White NJ (1993). "Relapse in melioidosis: incidence and risk factors". J Infect Dis. 168 (5): 1181–85. doi:10.1093/infdis/168.5.1181. PMID 8228352.
- Holland DJ, Wesley A, Drinkovic D, Currie BJ (2002). "Cystic fibrosis and Burkholderia pseudomallei infection: an emerging problem?". Clin Infect Dis. 35 (12): e138–40. doi:10.1086/344447. PMID 12471591.
- McCormick J B (1975). "Human-to-human transmission of Pseudomonas pseudomallei". Annals of Internal Medicine. 83 (4): 512–513. doi:10.7326/0003-4819-83-4-512.
- Kunakorn M, Jayanetra P, Tanphaichitra D (1991). "Man-to-man transmission of melioidosis". Lancet. 337 (8752): 1290–1. doi:10.1016/0140-6736(91)92962-2. PMID 1674089.
- Centers for Disease Control and Prevetion (2009). Biosafety in Microbiological and Biomedical Laboratories (5th ed.). Atlanta, Georgia: National Institutes of Health.
- Sivalingam SP, Sim SH, Jasper LC, et al. (2008). "Pre- and post-exposure prophylaxis of experimental Burkholderia pseudomallei infection with doxycycline, amoxicillin/clavulanic acid and co-trimoxazole". J Antimicrob Chemother. 61 (3): 674–8. doi:10.1093/jac/dkm527. PMID 18192684.
- Peacock SJ, Schweizer HP, Dance DA, et al. (2008). "Management of Accidental Laboratory Exposure to Burkholderia pseudomallei and B. mallei". Emerg Infect Dis. 14 (7): e2. doi:10.3201/eid1407.071501. PMC . PMID 18598617.
- Kenny DJ, Sefton AM, Brooks TJ, Laws TR, Simpson AJ, Atkins HS (2010). "Evaluation of azithromycin, trovafloxacin and grepafloxacin as prophylaxis for experimental murine melioidosis". Int J Antimicrob Agents. 36 (1): 87–9. doi:10.1016/j.ijantimicag.2010.03.019. PMID 20462743.
- CDC Disease Info melioidosis
- Withers MR (ed.) (2014). USAMRIID's Medical Management of Biological Casualties Handbook (PDF) (8th ed.). Fort Detrick, Maryland: U.S. Army Medical Institute of Infectious Diseases. p. 53.
- V Vuddhakul; et al. (1999). "Epidemiology of Burkholderia pseudomallei in Thailand". Am J Trop Med Hyg. 60 (3): 458–461.
- Wuthiekanun V, Mayxay M, Chierakul W, Phetsouvanh R, Cheng AC, White NJ, Day NP, Peacock SJ (2005). "Detection of Burkholderia pseudomallei in soil within the Lao People's Democratic Republic". J Clin Microbiol. 43 (2): 923–4. doi:10.1128/JCM.43.2.923-924.2005. PMC . PMID 15695707.
- Rattanavong S, Wuthiekanun V, Langla S, Amornchai P, Sirisouk J, Phetsouvanh R, Moore CE, Peacock SJ, Buisson Y, Newton PN (2010). "Randomized Soil Survey of the Distribution of Burkholderia pseudomallei in Rice Fields in Laos". Applied and Environmental Microbiology. 77 (2): 532–6. doi:10.1128/AEM.01822-10. PMC . PMID 21075883.
- Vongphayloth K, Rattanavong S, Moore CE, Phetsouvanh R, Wuthiekanun V, Sengdouangphachanh A, Phouminh P, Newton PN, Buisson Y (2012). "Burkholderia pseudomallei detection in surface water in southern Laos using Moore's swabs.". Am J Trop Med Hyg. 86 (5): 872–7. doi:10.4269/ajtmh.2012.11-0739. PMC . PMID 22556090.
- Lo TJ, Ang LW, James L, Goh KT (2009). "Melioidosis in a Tropical City State, Singapore". Emerg Infect Dis. 15 (10): 1645–7. doi:10.3201/eid1510.090246. PMC . PMID 19861063.
- Kadir KA, Satyavani M, Pande K (2014). "Melioidosis: Antibiogram of cases in Brunei Darussalam." (PDF). Brunei International Medical Journal. 10 (1): 19–24.
- Yang S (2000). "Melioidosis research in China". Acta Tropica. 77 (2): 157–165. doi:10.1016/S0001-706X(00)00139-X.
- Ko, WC; Cheung, BM; Tang, HJ; Shih, HI; Lau, YJ; Wang, LR; Chuang, YC (2007). "Melioidosis Outbreak after Typhoon, Southern Taiwan". Emerg Infect Dis. 13 (6): 896–8. doi:10.3201/eid1306.060646. PMC . PMID 17553230.
- Chen YS, Lin HH, Mu JJ, Chiang CS, Chen CH, Buu LM, Lin YE, Chen YL (2010). "Distribution of Melioidosis Cases and Viable Burkholderia pseudomallei in Soil: Evidence for Emerging Melioidosis in Taiwan". J Clin Microbiol. 48 (4): 1432–4. doi:10.1128/JCM.01720-09. PMC . PMID 20147639.
- Cheng AC, Currie BJ (2005). "Melioidosis: Epidemiology, Pathophysiology, and Management". Clin Microbiol Rev. 18 (2): 383–416. doi:10.1128/CMR.18.2.383-416.2005. PMC . PMID 15831829.
- Chong VH (2010). "Changing spectrum of microbiology of liver abscess: Now Klebsiella, next Burkholderia pseudomallei". J Emerg Med. 41 (6): 676–677. doi:10.1016/j.jemermed.2009.10.027. PMID 20079999.
- Chugh TD (2008). "Emerging and re-emerging bacterial diseases in India". J Biosci. 33 (4): 549–55. doi:10.1007/s12038-008-0073-0. PMID 19208980.
- Antony B, Pinto H, Dias M, Shetty AK, Scaria B, Kuruvilla T, Boloor R (2010). "Spectrum of melioidosis in the suburbs of Mangalore, S West Coast of India". Southeast Asian J Trop Med Public Health. 41 (1): 169–74.
- Vidyalakshmi K, Chakrapani M, Shrikala B, Damodar S, Lipika S, Vishal S (2008). "Tuberculosis mimicked by melioidosis". Int J Tuberc Lung Dis. 12 (10): 1209–15.
- Prakash A, Thavaselvam D, Kumar A et al. (2014). "Isolation, identification and characterization of Burkholderia pseudomallei from soil of coastal region of India.". Springerplus. 3: 438. doi:10.1186/2193-1801-3-438. PMC . PMID 25187882.
- Inglis TJ, Rolim DB, De Queroz Sousa A (2006). "Melioidosis in the Americas". Am J Trop Med Hyg. 75 (5): 947–954. PMID 17123994.
- O'Sullivan BP, Torres B, Conidi G, et al. (2011). "Burkholderia pseudomallei infection in a child with cystic fibrosis: acquisition in the western hemisphere". Chest. 140 (1): 239–42. doi:10.1378/chest.10-3336. PMID 21729895.
- Brilhante RS, Bandeira TJ, Cordeiro RA, et al. (2012). "Clinical-epidemiological features of 13 cases of melioidosis in Brazil". J Clin Microbiol. 50 (10): 3349–52. doi:10.1128/JCM.01577-12. PMID 22814457.
- Katangwe T, Purcell J, Bar-Zeev N, Denis B, Montgomery J, Alaerts M, Heyderman RS, Dance DA, Kennedy N, Feasey N, Moxon CA (2013). "Human melioidosis, Malawi, 2011.". Emerg Infect Dis. 19 (6): 981–4. doi:10.3201/eid1906.120717. PMID 23735189.
- Morosini MI, Quereda C, Gil H, Anda P, Núñez-Murga M, Cantón R, López-Vélez R (2013). "Melioidosis in traveler from Africa to Spain". Emerging Infect. Dis. 19 (10): 1656–9. doi:10.3201/eid1910.121785. PMC . PMID 24047798.
- Struelens MJ, Mondol G, Bennish M, Dance DA (1998). "Melioidosis in Bangladesh: a case report". Trans R Soc Trop Med Hygiene. 82 (5): 777–78. doi:10.1016/0035-9203(88)90234-9.
- Hosen, Akram (30 Jul 2013). "Deadly bacteria in Gozipur soil". The Daily Star. Dhaka, Bangladesh. Archived from the original on 30 Aug 2013. Retrieved 30 Aug 2013.
- Dance DA, Smith MD, Aucken HM, Pitt TL (1999). "Imported melioidosis in England and Wales". Lancet. 353 (9148): 208. doi:10.1016/S0140-6736(05)77217-2. PMID 9923882.
- "Burkholderia pseudomallei" (PDF). Mahout Microbiology Review. 7: 4. 2013. Retrieved 24 April 2016.
- Limmathurotsakul, Direk; Golding, Nick; Dance, David A. B.; Messina, Jane P.; Pigott, David M.; Moyes, Catherine L.; Rolim, Dionne B.; Bertherat, Eric; Day, Nicholas P. J.; Peacock, Sharon J.; Hay, Simon I. (11 January 2016). "Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis". Nature Microbiology. 1 (1): 15008. doi:10.1038/nmicrobiol.2015.8. PMC . PMID 26877885.
- Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N (2010). "Increasing Incidence of Human Melioidosis in Northeast Thailand". Am J Trop Med Hyg. 82 (6): 1113–7. doi:10.4269/ajtmh.2010.10-0038. PMC . PMID 20519609.
- Kanaphun P, Thirawattanasuk N, Suputtamongkol Y, et al. (1993). "Serology and carriage of Pseudomonas pseudomallei: a prospective study in 1000 hospitalized children in northeast Thailand". J Infect Dis. 167 (1): 230–3. doi:10.1093/infdis/167.1.230. PMID 7678106.
- Vuddhakul V, Tharavichitkul P, Na-Ngam N, et al. (March 1999). "Epidemiology of Burkholderia pseudomallei in Thailand". Am. J. Trop. Med. Hyg. 60 (3): 458–61. PMID 10466977.
- Kanai K, Dejsirilert S (August 1988). "Pseudomonas pseudomallei and melioidosis, with special reference to the status in Thailand". Jpn. J. Med. Sci. Biol. 41 (4): 123–57. doi:10.7883/yoken1952.41.123. PMID 3075004.
- Yang S, Tong S, Mo C, et al. (1998). "Prevalence of human melioidosis on Hainan Island in China". Microbiol. Immunol. 42 (9): 651–4. doi:10.1111/j.1348-0421.1998.tb02335.x. PMID 9802565.
- Chen YS, Chen SC, Wu TR, Kao CM, Chen YL (October 2004). "Seroprevalence of anti-flagellin antibody against Burkholderia pseudomallei in Taiwan". Jpn. J. Infect. Dis. 57 (5): 224–5. PMID 15507783.
- Parkes, Helen M.; Shilton, Catherine M.; Jerrett, Ian V.; Benedict, Suresh; Spratt, Brian G.; Godoy, Daniel; O'Brien, Carolyn R.; Krockenberger, Mark B.; et al. (2009). "Primary ocular melioidosis due to a single genotype of Burkholderia pseudomallei in two cats from Arnhem Land in the Northern Territory of Australia". J Feline Med Surg. 11 (10): 856–63. doi:10.1016/j.jfms.2009.02.009. PMID 19428280.
- Sprague LD, Neubauer H (2004). "Melioidosis in Animals: A review on epizootiology, diagnosis and clinical presentation". J Vet Med B Infect Dis Vet Public Health. 51 (7): 305–20. doi:10.1111/j.1439-0450.2004.00797.x. PMID 15525357.
- Mollaret HH (1988). ""L'affaire du Jardin des plantes" ou comment le mélioïdose fit son apparition en France". Médecine et Maladies Infectieuses. 18 (Suppl 4): 643–54. doi:10.1016/S0399-077X(88)80175-6.
- Corkeron ML, Norton R, Nelson PN (2010). "Spatial analysis of melioidosis distribution in a suburban area". Epidemiol Infect. 138 (9): 1346–1352. doi:10.1017/S0950268809991634. PMID 20092666.
- Chantratita N, Wuthiekanun V, Limmathurotsakul D, et al. (2008). Currie B, ed. "Genetic Diversity and Microevolution of Burkholderia pseudomallei in the Environment". PLoS Negl Trop Dis. 2 (2): e182. doi:10.1371/journal.pntd.0000182. PMC . PMID 18299706.
- Lin HH; Chen YS; Li YC; e al. (2011). "Burkholderia multivorans acts as an antagonist against the growth of Burkholderia pseudomallei in soil". Microbiol Immunol. 55 (9): 616–24. doi:10.1111/j.1348-0421.2011.00365.x. PMID 21752084.
- Inglis TJ, Garrow SC, Henderson M, Clair A, Sampson J, O'Reilly L, Cameron B (2000). "Burkholderia pseudomallei traced to water treatment plant in Australia". Emerg Infect Dis. 6 (1): 56–59. doi:10.3201/eid0601.000110. PMC . PMID 10653571.
- Apisarnthanarak A, Khawcharoenporn T, Mundy LM (2012). "Flood-associated melioidosis in a non-endemic region of Thailand". Int J Infect Dis. 16 (5): e409–10. doi:10.1016/j.ijid.2012.01.013. PMID 22421023.
- Chierakul W, Winothai W, Wattanawaitunechai C, et al. (2005). "Melioidosis in 6 tsunami survivors in southern Thailand". Clin Infect Dis. 41 (7): 982–90. doi:10.1086/432942. PMID 16142663.
- Ko WC, Cheung BM, Tang HJ, Shih HI, Lau YJ, Wang LR, Chuang YC (2007). "Melioidosis outbreak after typhoon, southern Taiwan". Emerg Infect Dis. 13 (6): 896–8. doi:10.3201/eid1306.060646. PMC . PMID 17553230.
- Inglis TJ, O'Reilly L, Merritt AJ, Levy A, Heath CH (2011). "The aftermath of the Western Australian melioidosis outbreak.". Am J Trop Med Hyg. 84 (6): 851–7. doi:10.4269/ajtmh.2011.10-0480. PMID 21633018.
- Baker A, Pearson T, Price EP, et al. (2011). "Molecular Phylogeny of Burkholderia pseudomallei from a Remote Region of Papua New Guinea". PLoS ONE. 6 (3): e18343. doi:10.1371/journal.pone.0018343. PMC . PMID 21483841.
- Suputtamongkol Y, Chaowagul W, Chetchotisakd P, et al. (1999). "Risk factors for melioiosis and bacteremic melioidosis". Clin Infect Dis. 29 (2): 408–13. doi:10.1086/520223. PMID 10476750.
- Phe T, Vlieghe E, Reid T, et al. (2013). "Does HIV status affect the aetiology, bacterial resistance patterns and recommended empiric antibiotic treatment in adult patients with bloodstream infection in Cambodia?". Trop Med Int Health. 18 (4): 485–94. doi:10.1111/tmi.12060. PMID 23294446.
- Kanai K, Kurata T, Akksilp S, et al. (1992). "A preliminary survey for human immunodeficient virus (HIV) infections in tuberculosis and melioidosis patients in Ubon Ratchathani, Thailand.". Jpn J Med Sci Biol. 45 (5-6): 247–53. doi:10.7883/yoken1952.45.247. PMID 1306871.
- Chierakul W, Wuthiekanun V, Chaowagul W, et al. (2005). "Short report: disease severity and outcome of melioidosis in HIV coinfected individuals.". Am J Trop Med Hyg. 73 (6): 1165–6. PMID 16354832.
- Suputtamongkol Y, Hall AJ, Dance DA, et al. (1994). "The epidemiology of melioidosis in Ubon Ratchatani, Northeast Thailand". Int J Epidemiol. 23 (5): 1082–89. doi:10.1093/ije/23.5.1082. PMID 7860160.
- Currie BJ, Jacups SP (December 2003). "Intensity of Rainfall and Severity of Melioidosis, Australia". Emerging Infect. Dis. 9 (12): 1538–42. doi:10.3201/eid0912.020750. PMC . PMID 14720392.
- Liu Y, Loh JP, Aw LT, Yap EP, Lee MA, Ooi EE (2006). "Rapid molecular typing of Burkholderia pseudomallei, isolated in an outbreak of melioidosis in Singapore in 2004, based on variable-number tandem repeats". Trans Roy Soc Trop Med Hyg. 100 (7): 687–92. doi:10.1016/j.trstmh.2005.08.017. PMID 16343569.
- Sam IC, Puthucheary SD (2007). "Melioidosis and rainfall in Kuala Lumpur, Malaysia". J Infect. 54 (5): 519–20. doi:10.1016/j.jinf.2006.07.007. PMID 16965821.
- Baker, Anthony L.; Ezzahir, Jessica; Gardiner, Christopher; Shipton, Warren; Warner, Jeffrey M.; Wooten, R. Mark (23 September 2015). "Environmental Attributes Influencing the Distribution of Burkholderia pseudomallei in Northern Australia". PLOS ONE. 10 (9): e0138953. doi:10.1371/journal.pone.0138953.
- Whitmore, A; Krishnaswami, CS (1912). "An account of the discovery of a hitherto undescribed infectious disease among the population of Rangoon". Indian Med Gazette. 47: 262–267.
- Strong, Richard P (1944). Stitt's Diagnosis, Prevention and Treatment of Tropical Diseases (7th ed.). Philadelphia: The Blakiston Company. p. 732.
- Vora SK (February 2002). "Sherlock Holmes and a biological weapon". J R Soc Med. 95 (2): 101–103. doi:10.1258/jrsm.95.2.101. PMC . PMID 11823558.
- Whitmore A, Krishnaswami CS (1912). "An account of the discovery of a hitherto undescribed infective disease occurring among the population of Rangoon". Indian Med Gaz. 92: 262–7.
- Barker A (19 June 2005). "Rise in melioidosis rates in NT". Australian Broadcasting Corporation. Retrieved 2007-06-24.
- Orellana C (November 2004). "Melioidosis strikes Singapore". Lancet Infect Dis. 4 (11): 655. doi:10.1016/S1473-3099(04)01190-9. PMID 15534940.
- C S Krishnaswami. "Morphia injectors' septicaemia". Indian Medical Gazette. 52 (1917): 296–299.
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