Melioidosis, caused by a gram-negative aerobic bacillus B. pseudomallei and endemic to Australia and parts of Southeast Asia, can be challenging to distinguish from tuberculosis both clinically and histologically.
Chronic melioidosis may produce necrotizing granulomas that are indistinguishable from those of tuberculosis; thus, this diagnosis should be considered, especially when the presentation or course of a chronic infection is atypical for tuberculosis.
The clinical manifestations of melioidosis range from localized cutaneous abscesses to multiorgan involvement to septic shock. Intravenous ceftazidime, imipenem, or meropenem can be used for the acute phase of treatment. Long-term treatment with high-dose bactrim, given together with doxycycline given for at least 20 weeks is recommended.
New England Journal of Medicine - Vol. 359, No. 6, August 7, 2008