Infectious Disease Compendium



Gram negative rod. Burkholderia cepacia complex that includes B. cepacia, B. multivorans, B. cenocepacia, B. vietnamiensis, B. stabilis, B. ambifaria, B. dolosa, B. anthina, B. pyrrocinia and B. ubonensis. Burkholderia mallei, Burkholderia pseudomallei (NEJM Review). Can actually be misidentified and really be an Herbaspirillum. Burkholderia gladioli pathovar cocovenenans,

Epidemiologic Risks

Ubiquitous in water, soil, plants, and decaying organic material.

Burkholderia pseudomallei is endemic in the rice fields of SE Asia (esp N. Thailand) and Northern Australia and perhaps Madagascar(PubMed).

Diabetes is a risk for disease.

Under the right conditions it can be spread by aerosols (PubMed).

It is also endemic in Puerto Rico (PubMed).

There was a case of melioidosis in Arizona, another in Ohio (PubMed), and a smattering of others and they don't know were the Burkholderia came from.

It has been found in unchlorinated domestic bore water in tropical Northern Australia (the source of the taste of Fosters?) and in imported birds from endemic areas. Also found in tomatoes.

Be the way, the word is from the Greek for an abnormal distemper of asses. Sounds like Fox news commentary.


Burkholderia cepacia: nosocomial infections and pneumonia. Common in patients with cystic fibrosis and chronic granulomatous disease.

Burkholderia mallei: glanders in horses.

Burkholderia pseudomallei (review): melioidosis; bacteremia and sepsis, soft tissue infections (children), occasionally traumatic osteomyelitis, in people who have been in the rice fields of SE Asia. Pneumonia, and it may be inhalational during the wet season. Risk factors for melioidosis included diabetes (39%) (although curiously, Glyburide has a protective effect, perhaps due to immunomodulation (PubMed), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%).

B. pseudomallei from Australia has increased virulence and potential for dissemination to the CNS. It is due to a B. mallei–like sequence variation of the actin-based motility gene, bimA (PubMed).

Burkholderia gladioli pathovar cocovenenans makes bongkrekic acid, a toxin, which causes " abdominal pain, diarrhea, vomiting, and generalized malaise. Death was preceded by psychomotor agitation and abnormal posturing." It is a problem in Africa and has caused a fatal outbreak from drinking pombe, a traditional alcoholic beverage (PubMed).


Burkholderia cepacia: trimethoprim-sulfamethoxazole (the best option if sensitivities are not known, other agents have reasonable odds of resistance (PubMed)), piperacillin, third-generation cephalosporins, quinolones or carbapenem.

Burkholderia mallei: doxycycline OR ciprofloxacin, streptomycin, novobiocin, gentamicin OR imipenem OR ceftazidime, and the sulfonamides.

Burkholderia pseudomallei: imipenem OR penicillin OR doxycycline OR amoxicillin./clavulanate acid OR ceftazidime OR ticarcillin/clavulanate OR ceftriaxone OR aztreonam.

"The current recommended management for all forms of melioidosis in Australia, including skin melioidosis, is generally a minimum of 10–14 days of intravenously administered antibiotics (ceftazidime or a carbapenem) and a prolonged eradication course of oral antibiotics (e.g. 3 months of high-dose trimethoprim/sulfamethoxazole)(PubMed)."

From NEJM Review.

Initial intensive therapy (2 weeks)

ceftazidime 50 mg/kg of body weight (up to 2 g), every 6–8 hr

meropenem 25mg/kg(up to 1g),every 8 hr

imipenem 25 mg/kg (up to 1 g), every 6 hr


Oral eradication therapy (3-6 months)


Body weight

>60kg 2×160 mg of TMP–800 mg of SMX (960 mg), every 12 hr

40–60 kg 3 × 80 mg of TMP–400 mg of SMX (480 mg), every 12 hr

<40 kg, adult 1 × 160 mg of TMP–800 mg of SMX (960 mg) or 2×80mg of TMP–400mg of SMX(480mg), every 12 hr.

In another trial (PubMed) trimethoprim/sulfamethoxazole is not inferior to trimethoprim/sulfamethoxazole plus doxycycline for the oral phase of treatment.

Relapse is common in diabetics and with shorter courses of antibiotics.


Discovered by Walter Burkholder as the cause of onion skin rot (PubMed).

Curious Cases

Relevant links to my Medscape blog

Bad bug, bad bug. Watcha gonna do, watcha gonna do when I come for you?

Last Update: 04/28/18.