Burkholderia pseudomallei, (B. pseudomallei) is a bacteria found mainly in the tropics; it sickens and kills humans and animals. Anyone directly exposed to tropical soil and water can become infected if there is an opening in skin; ingestion (food/fluids); inhalation (soil dust or water droplet); person-to-person via infected blood and bodily fluids. Or by subcutaneous inoculation (shots).
Bp isn’t usually diagnosed by imaging alone; it can be cultured from skin, blood, pus, rectal swabs, throat swabs, respiratory secretions, and urine. Why aren’t veterans being routinely screened for “The Vietnamese Time Bomb?” (LINK) Researchers believe it is grossly underreported because Melioidosis mimics many other diseases–localized and systemic.
Military personnel exposures were and are impossible to avoid.
“As helicopters deposited troops throughout the tropical nation, their blades kicked up dirt, exposing soldiers and pilots to hidden pathogens in the soil.” (LINK) Major General Spurgeon Neel stated that after 1967, the Surgeon General set up melioidosis treatment centers (PA, and CO).
L—O—N—G latent periods–BVA has learned about them with HCV and didn’t waste this veteran’s time. Between 1975-1976, the vet was stationed in Korat Royal Thai Air Force Base and had not traveled out of the country since then.
Citation Nr: 19123328 Decision Date: 03/27/19 (LINK–BVA)
…In August 2015, the Veteran was hospitalized and melioidosis was diagnosed. He has not been afforded any VA examination to ascertain the etiology of melioidosis. However, the Board does not find that an examination is warranted. An August 2015 private treatment record notes the Veteran was seen by an infectious disease physician during his hospitalization for melioidosis. The physician noted that melioidosis is found in Southeast Asia, has an incubation period of many years (described as 20 or more years) and can present at any time in the future.
This next case, reported in 2005, takes infectious disease latency periods to a whole new level (LINK). Incredible–it struck 62 years later when the veteran was 82 years old. “His present medical problems include diabetes, hypertension, osteoarthritis, chronic renal insufficiency, benign prostatic hypertrophy treated with transurethral resection of the prostate, and coronary artery disease.” And now, after all these years, with his immune system plum tuckered out, this new nightmare?
Cutaneous Melioidosis in a Man Who Was Taken as a Prisoner of War by the Japanese during World War II
In the [medical] literature, there are only two case reports of reactivation of melioidosis after primary exposure to a region where melioidosis is endemic after 18 and 28 years in a Vietnam veteran and a World War II veteran, respectively (7, 8). We report a case of reactivated melioidosis in a World War II veteran 62 years after exposure.
What might symptoms look like?
Table 1 (LINK)
“Clinical presentations of melioidosis
Commonest acute presentations
Pneumonia with septicaemia
Soft tissue infection: cellulitis, fasciitis, skin abscess/ulcer
Bone and joint infection: osteomyelitis, septic arthritis
Genitourinary: prostatic abscess
CNS infection: cerebral abscess, meningoencephalitis,
Facial: suppurative parotitis
Ocular infection: conjunctival ulcer, hypopyon, orbital cellulitis
Bp can infect blood; swell tissues, cause ulcers and abscesses in the liver, spleen, kidney, lungs, brain, muscles, bones, GI track (heavy colonization), prostate tissues, anywhere–visible or invisible. And it can hide for decades.
Electronic Code of Federal Regulations (LINK current as of September 30, 2019)
Title 38 → Chapter I → Part 4 → Subpart B → §4.89
- Title 38: Pensions, Bonuses, and Veterans’ Relief
PART 4—SCHEDULE FOR RATING DISABILITIES
Subpart B—Disability Ratings
§4.88b Schedule of ratings—infectious diseases, immune disorders and nutritional deficiencies.
6318 Melioidosis: Evaluate under the General Rating Formula.
- Note 1: Confirm by culture or other specific diagnostic laboratory tests the initial diagnosis and any relapse or chronic activity of infection.
- Note 2: Rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, arthritis, lung lesions, or meningitis.
General Rating Formula for Infectious Diseases: For active disease- 100
After active disease has resolved, rate at 0 percent for infection. Rate any residual disability of infection within the appropriate body system.
This case from 2004, decided in the vets favor, shows how broadly the bacteria attacks human body parts:
- Citation Nr: 0404516 Decision Date: 02/18/04 (LINK)
SC granted to Vietnam vet, secondary, degenerative joint
disease (DJD) of the cervical spine, lumbosacral spine, right and left knees, and pulmonary embolium
The takeaway–If you know someone who has EVER set foot in Southeast Asia or anywhere in the CDC map bp danger zones, who has a condition that eludes a diagnosis, get tested for >>
melioidosis. The lesions may not be visible like those in the above photos. If a veteran has served in endemic areas, and has melioidosis, and hasn’t vacationed in endemic tropical areas, chances are good that SC can be granted depending on health status. Screening might also solve some current elusive medical mysteries.
It would be a good idea for screening at the time of death by a medical examiner even if a veteran didn’t serve in a danger zone because the veteran may have had a blood transfusion or shot.
Why? The Red Cross doesn’t test blood for melioidosis. (LINK-List infectious disease
- The Lancet, Melioidosis, (LINK — VOLUME 361, ISSUE 9370, P1715-1722, MAY 17, 2003) Online-Seminar p 1715.
- Mosaic, This disease kills half the people it infects. So why isn’t more being done? (LINK-2/2018)
- Wikipedia, Melioidosis (LINK)
- Saudi J Med Med Sci May 2018 Melioidosis: Can Tropical Infections Present in Nonendemic Areas? A Case Report and Review of the Literature (LINK)
- Twitter #Melioidosis (LINK)
- Vaccination research (LINK)
- CDC (LINK)
- 2020 CDC Traveler’s Yellow Book (LINK to Ch. 4)
- CAVC-I don’t see any cases yet. (LINK)
(Many common antibiotics are inefficient in killing bp.)
Laura (Kiedove- guest author)