Last reviewed: 25 Oct 2020
Last updated: 10 Nov 2020



History and exam

Key diagnostic factors

  • presence of risk factors
  • fever/sweats
  • cough
  • septic shock
  • regional lymphadenitis/parotitis
  • non-healing skin sore/ulcer or abscess
  • bacteraemia without evident clinical focus
  • lower motor neuron cranial nerve palsies (especially cranial nerves VII and VIII)
  • flaccid paralysis

Other diagnostic factors

  • shortness of breath
  • abdominal pain/diarrhoea
  • dysuria
  • urinary retention
  • other signs of organ abscess
  • altered conscious state
  • arthritis/osteomyelitis
  • mycotic pseudo-aneurysms

Risk factors

  • travel to endemic area
  • occupational/recreational environmental exposure
  • diabetes
  • hazardous alcohol use
  • chronic renal or liver disease
  • malignancy and immunosuppressive therapy
  • thalassaemia
  • cystic fibrosis and other chronic lung disease
  • bioterrorism

Diagnostic investigations

1st investigations to order

  • blood culture
  • sputum culture
  • urine culture
  • culture of pus/swab from skin lesion, abscess, lymphadenitis, drained internal abscess (e.g., liver abscess)
  • chest x-ray
  • computer tomography (CT) abdomen and pelvis ± CT chest
  • abdominal/pelvis ultrasound
More 1st investigations to order

Investigations to consider

  • throat swab in/on Ashdown's selective broth/agar
  • rectal swab in/on Ashdown's selective broth/agar
  • cerebrospinal fluid (CSF) culture
  • CSF microscopy, protein and glucose
  • polymerase chain reaction (PCR)
More investigations to consider

Emerging tests

  • rapid antigen detection test
More emerging tests

Treatment algorithm


Professor in Medicine

Northern Territory Medical Program

Royal Darwin Hospital

Head of Tropical and Emerging Infectious Diseases

Menzies School of Health Research

Charles Darwin University




BJC is the author of several references cited in this topic.

David A.B. Dance

Senior Clinical Research Fellow/Consultant Microbiologist

Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit



Centre for Tropical Medicine and Global Health

University of Oxford


Honorary Professor

Faculty of Infectious and Tropical Diseases

London School of Hygiene and Tropical Medicine




DABD is the author of several references cited in this topic. DABD has acted as a consultant to Soligenix Inc. and has worked with InBios on the evaluation of diagnostic tests for melioidosis.

Peer reviewersVIEW ALL

Director of Microbiology

Townsville Hospital




RN declares that he has no competing interests.

Professor of Medicine

Faculty of Medicine

Khon Kaen University

Khon Kaen



PC declares that he has no competing interests.

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