Pseudomonas pseudomallei and melioidosis, with special reference to the status in Thailand.

Melioidosis is a long-known disease since 1912, but only quite recently we have obtained the knowledges about its actual clinical and epidemiological features. The disease is so unique in having a wide spectrum of disease course and clinical manifestation. The causative agent, P. pseudomallei, is free-living bacterium in the natural environments (soil and surface water) of tropical and subtropical areas. Just like legionnaires' disease, melioidosis is a good example of infectious disease in which pneumonia is produced by inhalation of contaminated soil dusts or water droplets. The infection becomes dormant for years, but with a chance of recrudescence under a variety of insults to the host resistance. The disease, may it be acute or chronic, will be symptomatically confused with malaria, typhoid fever, leptospirosis, septicemia caused by other gram-negative bacteria, tuberculosis and mycotic infections. Isolation of the causative agent from clinical specimens is the only reliable method for diagnosis. Because of the increasing clinical awareness and the development of diagnostic methods, the reported cases of melioidosis have numbered almost one thousand in Thailand during the past 20 years. This country has now the most ample clinical experiences on melioidosis. We have reviewed the history of melioidosis research from bacteriological, immunological, clinical and epidemiological viewpoints, especially including the recent reports in Thailand.