2% in Thailand.[12, 28] Overall mortality rates are reported to be around 40% in Thailand and 14% in Australia.[4, 12] Recurrent melioidosis following completion of therapy was once seen in up to 30% of cases but is now much less common. Most cases have been due to poor compliance with therapy or inadequate duration of therapy (see below).[12, 24, 29] Around three-fourths of recurrent infections

have been attributed to relapse of the original organism and the remainder have been due to reinfection with a new strain of B. pseudomallei.[30] Melioidosis can potentially cause sepsis-induced acute kidney injury which has been described in a single retrospective study comprising of 220 patients with melioidosis, out of which, 77 patients with septicaemia were complicated by acute kidney injury which was defined in that study as impairment of creatinine LY2606368 nmr to over 177 μmol/L along with failure to improve renal function with volume expansion.[31] In that series, acute tubular necrosis, interstitial nephritis

and microabscess formation were seen with limited numbers of histopathologies studied. A case of nephrotic syndrome with hypocomplementaemia with predominantly low C3 and mildly low C4 components in a patient with solitary kidney and melioidosis VX-770 has been reported. The nephrotic syndrome resolved rapidly and spontaneously during antimicrobial therapy, and kidney biopsy was not performed. The postulated mechanism Thymidine kinase was immune-complex mediated glomerular injury with possible alternative

pathway activation of the complement system.[32] Melioidosis should be suspected in any febrile patient with underlying risk factors residing in, or travelling from, an endemic area. Early diagnosis is prudent to prevent mortality as empirical antibiotic regimens used for suspected bacterial sepsis often do not cover B. pseudomallei adequately. Depending on clinical presentation, diagnosis is confirmed by microbial culture of sputum, blood, urine, skin lesion swab or pus derived from abscesses. Microbial cultures of rectal and throat swabs placed into Ashdown’s selective medium are useful in patients suspected to have melioidosis. Direct immunofluorescence microscopy of infected body fluid in Thailand allowed diagnosis to be made within 30 min with 98% specificity and 70% sensitivity compared with culture, but this methodology is not commercially available.[33] Despite being widely used, serology testing with indirect haemagglutination assay is unreliable for diagnosis due to high false negativity rates in acute sepsis[34] and high positive antibody titres in healthy individuals in endemic areas due to repeated natural exposure to B. pseudomallei and antigenically related saprophytic organisms.