MANY SYSTEMIC infections have cutaneous presentations that sometimes are unspecific. These cutaneous signs and symptoms may be helpful in making the proper diagnosis, prescribing the appropriate therapy, and assisting in prevention. Some clinical manifestations of systemic infections highlight the possible infectious etiology for unusual cutaneous lesions.

Bacterial systemic infections may be more common in remote areas of the world; these same bacterial diseases also may be seen, however, in travelers or immigrants from these areas. Some of these infections, such as plague and melioidosis, are potential biological weapons used for bioterrorism.

MELIOIDOSIS

Melioidosis is a highly invasive and resistant infection caused by the gram-negative bacterium Burkholderia pseudomallei, which is synonymous with the old nomenclature Pseudomonas pseudomallei.

The first reported cases of P. pseudomallei were initially known as Whitmore disease. In 1911, a British pathologist, Captain Alfred Whitmore, described a case of pneumonia in a young boy in Burma, where P. pseudomallei was isolated as the causative agent. The term “melioidosis” was subsequently used in 1921. It is derived from the Greek word “melis” meaning “a distemper of donkeys,” because it resembles glanders, which causes mainly pulmonary disease in asses. This infection is endemic in Southeast Asia and North and Central Australia, and peaks during the monsoon seasons. The disease in those regions often causes septicemia and death. Melioidosis also occurs sporadically in temperate countries and is mostly imported by travelers.