Melioidosis in Travelers: Review of the Literature

Abstract

Background: Melioidosis is a bacterial infection endemic essentially in Southeast Asia and northern Australia. In temperate areas, the infection is extremely rare and is almost always imported by travelers or immigrants. The infection may affect almost any organ in the body, with various degrees of severity.

Methods: We reviewed the literature on melioidosis in travelers. For this purpose we searched PubMed and Google for relevant articles up to July 2015.

Results: We have identified 72 cases of melioidosis in travelers published in the literature. Melioidosis in travelers was acquired mostly in Thailand (46% of cases). The mean duration of stay in the endemic area was 36 days (range 7-330 days). Symptoms usually started at 23 days (range 1-360 days) after leaving the endemic area. The clinical presentation was varied, sepsis being the most common (34%) followed by pneumonia (29%) and abscess formation (25%). Melioidosis in travelers was less often associated with predisposing risk factors (37.5%), diabetes mellitus being the most common (21%), and had lower mortality (17%) than had the infection in autochthonous cases in Southeast Asia.

Conclusions: Melioidosis in travelers has its own characteristics, which distinguish it from other autochthonous diseases in indigenous populations. The possibility of melioidosis should be considered not only in patients originating from endemic areas, but also in patients returning from travel in those regions.