Fatal melioidosis outbreak continues to grow

With Queensland cases of melioidosis on the rise following severe flooding in the Far North, GPs in flood-stricken areas are being urged to lookout for symptoms in the wake of Cyclone Alfred.
 
Data from Queensland Health collected since the beginning of 2025 shows notifications for melioidosis have risen to 111 as of 2 March – more than three times the cases reported in the same period of the previous year. There have also reportedly been 16 deaths from the disease.
 
Most notifications were for residents in the Cairns and Hinterland (54%) and Townsville (35%) Hospital and Health Service areas.
 
The surge follows devastating flooding in North Queensland this month, which saw hundreds of residents seeking safety in evacuation centres and up to 600 mm of rain falling in some areas.
 
Melioidosis presents in varied ways, including skin infections, where a break in the skin combines with exposure to mud or floodwaters, and respiratory symptoms triggered by airborne bacteria that churns up from soil following heavy rains.
 
With Cyclone Alfred expected to soon impact southern Queensland and northern New South Wales, there are renewed calls for GPs to be vigilant – particularly those in areas where melioidosis presentations are less familiar.
 
Townsville GP and RACGP Rural Chair Associate Professor Michael Clements says most infections are seen in the weeks, not hours, after an event like this.
 
‘In North Queensland, we consider and suspect melioidosis in every wet season and even more after flooding and cyclones,’ he told newsGP.
 
‘We have lots of bugs up here that cause prolonged fevers and people being particularly unwell, so we have a good radar for when we need to test for things like melioidosis, Q fever or leptospirosis. 
 
‘The key hallmark is really febrile illness or severe illness that doesn’t follow usual patterns, including wounds that don’t respond to normal treatment. You have to specify the tropical bugs on any swabs and serology.’
 
Associate Professor Clements advises GPs to consider the potential for tropical bugs if presentations appear unusual.
 
‘GPs have good understanding of patterns of illness. After an event like this we need to be aware that the patterns of illness can change, so we need to consider some of the rarer bugs, and test and refer early if the patient’s condition isn’t making sense,’ he said.
 
‘We need to ensure we are swabbing where we can, giving ADT boosters where needed, and considering the tropical bugs in unusual cases and discussing with public health.’
 
According to the Cairns and Hinterland Hospital and Health Service (CHHHS), which handles an increasing number of cases, melioidosis is usually seen in patients with underlying health conditions such as diabetes, which increases the risk of the life-threatening infection.
 
Melioidosis can lead to sepsis that, without appropriate treatment, can kill someone within hours.
 
CHHHS infectious disease specialist Dr Josh Hanson and colleagues recently studied 119 melioidosis cases which required admission to the Cairns Hospital intensive care unit between 1998 and 2023.
 
‘[It] showed a very clear increase in the number of cases, but a sharp decline in the number of cases that proved fatal,’ Dr Hanson said.
 
‘Because we are seeing more cases, our doctors are recognising it earlier and starting appropriate antibiotics promptly.
 
‘Major advances in the management of sepsis have also significantly improved the survival of people with melioidosis requiring ICU care in FNQ over the last 25 years.’
 
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