Melioidosis is a bacterial infection caught from soil and water. It is common in Malaysia and can increase after heavy rain and floods. It often looks like pneumonia, with fever, cough and chest pain, and can spread through the body. People with diabetes or kidney disease are at higher risk. It is treated with a long course of antibiotics, so see a doctor early if you get a fever after contact with floodwater or mud. This guide explains the tanda melioidosis, how it spreads, who is most at risk, how it differs from kencing tikus, treatment, and how to protect your family during the monsoon flood season.
Had contact with floodwater, mud or soil? If you develop a fever, cough, chest pain or a sore that will not heal in the following weeks, see a doctor and tell them about the exposure, especially if you have diabetes. Call 999 if someone has signs of sepsis, such as confusion or slurred speech, difficulty breathing, uncontrollable shivering, or blue, pale or blotchy skin or lips.
Apa itu melioidosis?
Melioidosis is caused by bacteria called Burkholderia pseudomallei. According to the US Centers for Disease Control and Prevention (CDC), the bacteria live in soil and water and are found mostly in tropical climates, especially Southeast Asia and northern Australia, where they cause widespread melioidosis.
The CDC says cases may increase after heavy rain and severe weather, because the bacteria rise to the surface of the soil. Melioidosis has many different symptoms and is often mistaken for other diseases, which makes it hard to diagnose.
A global study estimated about 165,000 cases and 89,000 deaths each year worldwide, and found that melioidosis is badly underreported in the countries where it is common.
Melioidosis in Malaysia
Melioidosis is found across Malaysia. Studies from state melioidosis registries and hospitals show:
| State or hospital | What the study found |
|---|---|
| Negeri Sembilan (registry, 2018 to 2022) | 185 cases; about 3.1 cases per 100,000 people a year; 8.7% to 16.7% of patients died each year. Three in four patients had been exposed to soil-related activities, and 41.1% had diabetes |
| Kedah and Perlis (2 hospitals, 2014 to 2017) | 510 patients with culture-confirmed melioidosis; 50.1% died in hospital; 69.8% had diabetes |
| Sabah (Queen Elizabeth Hospital, 2016 to 2018) | 246 cases; about 5 cases per 100,000 people a year; 28% died |
| Pahang (registry, 2020 to 2024) | 466 cases; 14.6% died |
| Kelantan (Hospital Universiti Sains Malaysia emergency department, 2001 to 2011) | 86 cases; 55.8% came in during the rainy season; 79.1% had diabetes; 36% died, half of them within 48 hours of admission |
Floods matter. After a major flood in Kelantan, researchers found B. pseudomallei in soil samples collected in January 2015. Although the detection rate was low, they concluded that flood victims should know the symptoms of melioidosis and that doctors should suspect it in people with fever. MetMalaysia expected the 2025/2026 northeast monsoon to start on 13 November, with heavy rain usually starting in Kelantan, Terengganu, Pahang and Johor from November to January.
Most patients in Malaysian studies were men in their 40s and 50s who worked with soil, but women can also be infected, for example through gardening, farming, or cleaning up mud after a flood.
Punca: how melioidosis spreads
According to the CDC, people can get melioidosis by:
- breathing in contaminated dust or water droplets;
- eating or drinking contaminated food or water, including untreated drinking water;
- contact with contaminated soil or water, especially through cuts, scrapes and other skin breaks, or getting it in the mouth.
It is very rare to catch melioidosis from another person. Animals such as goats, sheep, cattle, cats and dogs can also be infected.
Tanda-tanda melioidosis (symptoms)
The CDC says symptoms usually start 1 to 3 weeks after infection, but some people develop symptoms months or even years later. Melioidosis can affect one part of the body or the whole body:
| Type | What it can look like |
|---|---|
| Lung infection (most common) | Cough, chest pain, high fever, headache and loss of appetite. The CDC says it can range from mild bronchitis to severe pneumonia, and a chest X-ray can look like tuberculosis |
| Localised infection | An ulcer, lump or skin abscess, with fever, swelling and muscle aches |
| Spread through the body | Abscesses in the liver, spleen or prostate, or infection of joints, bones, lymph nodes, skin or brain |
| Bloodstream infection (sepsis) | A dangerous, fast-developing illness that needs emergency care |
The CDC lists these general symptoms: fever, headache, trouble breathing, stomach or chest pain, muscle pain, confusion and seizures. It also says around 10% of people have chronic melioidosis, an illness that lasts at least 2 months.
Because melioidosis has so many different symptoms, the CDC says it can be mistaken for other diseases. Its lung infection can look like radang paru-paru (pneumonia), and the chest X-ray can look like tibi (TB). Other common causes of fever in Malaysia include demam denggi and kencing tikus. For ordinary skin boils, see our guide to bisul.
Who is at higher risk?
Healthy people can get melioidosis, but according to the CDC the risk is higher if you have:
- diabetes: in the Malaysian studies above, diabetes was found in 32% to 79% of patients;
- kidney disease or liver disease;
- thalassaemia;
- chronic lung disease, such as COPD or bronchiectasis;
- cancer or another condition that weakens the immune system;
- heavy alcohol use.
Activities that raise the chance of exposure include farming, gardening and construction, wading or swimming in floodwater, rivers or ponds, helping with flood clean-up, and drinking untreated water.
Melioidosis vs kencing tikus (leptospirosis)
Both infections can follow floods and both can start with a fever, so it helps to know the difference. Only a doctor and laboratory tests can tell them apart.
| Melioidosis | Kencing tikus (leptospirosis) | |
|---|---|---|
| Cause | Burkholderia pseudomallei bacteria living in soil and water (CDC) | Leptospira bacteria spread in the pee of infected animals, most commonly rats (NHS) |
| How you catch it | Breathing in contaminated dust or droplets, drinking contaminated water, or contact through skin breaks | Contaminated soil or freshwater getting into your mouth, eyes or a cut |
| Common symptoms | Fever, cough, chest pain, skin sores or abscesses; can spread through the body | High temperature, headache, body aches, red eyes; jaundice in severe cases (NHS) |
| Treatment | Antibiotics for months (CDC) | A course of antibiotics; most people recover in a few days or weeks (NHS) |
See our full guide to kencing tikus.
When to see a doctor
See a doctor soon if, in the weeks or months after contact with floodwater, mud or soil, you develop:
- a fever that does not go away, especially with a cough or chest pain;
- a skin sore, lump or abscess that does not heal;
- tummy pain with fever.
Tell the doctor about the exposure and any long-term conditions such as diabetes, because this helps them think of melioidosis early.
Call 999 or go to the emergency department if someone has signs of sepsis. The NHS lists confusion or slurred speech, uncontrollable shivering, muscle pain, difficulty breathing, blue, pale, grey or blotchy skin, lips or tongue, a high or low temperature, and peeing very little. Sepsis develops quickly over a few hours. In the Kelantan emergency department study, half of the deaths from melioidosis happened within 48 hours of admission.
Diagnosis and rawatan (treatment)
Diagnosis. The CDC says melioidosis is diagnosed by growing the bacteria from samples such as blood, urine, sputum, pus from an abscess or a skin sore, or by detecting antibodies in the blood. Doctors may start treatment before the results are back if they strongly suspect melioidosis.
Treatment, according to the CDC, has 2 stages:
- intensive phase: antibiotics given into a vein (intravenous) for 2 to 8 weeks or longer, depending on how severe the infection is;
- eradication phase: antibiotic tablets for 3 to 6 months or longer, to clear the bacteria completely.
Finish the whole course. The CDC warns that if antibiotics are not taken for the full time, the infection can come back, usually within 1 to 2 years. Go to all your follow-up appointments.
Cara mencegah melioidosis, especially after floods
The CDC recommends these steps in areas where melioidosis is common:
- if you have open wounds or a long-term condition such as diabetes or kidney disease, avoid contact with soil and standing water;
- wear boots when farming, gardening or doing other work that involves soil and water, to protect your feet and lower legs;
- do not drink untreated water.
During and after floods, practical steps include:
- wear boots when clearing mud, and keep cuts and scrapes covered and away from mud and floodwater;
- avoid wading in floodwater, and keep children from playing in it;
- drink only clean, treated water;
- if you have diabetes or kidney disease, take extra care to avoid contact with floodwater and soil, and see a doctor early if you get a fever.
Frequently asked questions (FAQ)
Apa itu melioidosis (what is melioidosis)?
Melioidosis is an infection caused by bacteria called Burkholderia pseudomallei, which live in soil and water. According to the US Centers for Disease Control and Prevention (CDC), it is common in Southeast Asia, including Malaysia, and cases may increase after heavy rain and other severe weather. It is treated with antibiotics, but it can be serious if treatment is delayed.
Apa tanda-tanda melioidosis (what are the symptoms)?
Symptoms usually start 1 to 3 weeks after infection, but sometimes months or years later. The CDC lists fever, headache, trouble breathing, stomach or chest pain, muscle pain, confusion and seizures. It most often shows up as a lung infection with cough, chest pain and high fever, but it can also cause a skin sore or abscesses in organs such as the liver and spleen.
Bagaimana melioidosis berjangkit (how do you catch it)?
You can catch melioidosis by breathing in contaminated dust or water droplets, by eating or drinking contaminated food or water, or through contact with contaminated soil or water, especially through cuts and scrapes. The CDC says it is very rare to catch it from another person.
Who is most at risk of melioidosis?
Healthy people can get melioidosis, but the CDC says the risk is higher if you have diabetes, kidney disease, liver disease, thalassaemia, chronic lung disease, cancer or another condition that weakens the immune system, or if you drink a lot of alcohol. In Malaysian hospital studies, diabetes was found in 32% to 79% of patients.
Can melioidosis kill?
Yes. Melioidosis can cause a dangerous bloodstream infection (sepsis). In Malaysian studies, the share of patients who died ranged from about 9% to 17% in Negeri Sembilan to around 28% in Sabah and 50% of hospital patients in Kedah and Perlis. Early diagnosis and the right antibiotics are key, so tell your doctor if you have a fever after floods or contact with soil.
How is melioidosis treated?
According to the CDC, treatment usually starts with antibiotics given into a vein for 2 to 8 weeks, followed by antibiotic tablets for 3 to 6 months. It is important to finish the whole course, because the infection can come back, usually within 1 to 2 years, if treatment is stopped early.
How can I protect myself from melioidosis during floods?
The CDC advises avoiding contact with soil and standing water if you have open wounds or a long-term condition such as diabetes or kidney disease, wearing boots when working with soil or water, and not drinking untreated water. Avoid wading in floodwater, keep cuts covered, and see a doctor if you develop a fever in the weeks after a flood.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- About melioidosis — US Centers for Disease Control and Prevention (CDC)
- Clinical overview of melioidosis — CDC
- Leptospirosis (Weil's disease) — NHS
- Sepsis — NHS
- MTL dijangka bermula 13 November ini — Berita RTM
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- Hussin A, et al. Improving the clinical recognition, prognosis, and treatment of melioidosis through epidemiology and clinical findings: the Sabah perspective. PLoS Negl Trop Dis. 2023;17(10):e0011696
- Md Yusof AA, et al. Factors associated with melioidosis mortality in Pahang from 2020-2024. Trop Biomed. 2025;42(4):415-421
- Yazid MB, et al. An 11-year analysis of emergency presentations of melioidosis in northeastern Malaysia. J Immigr Minor Health. 2017;19(3):774-777
- Shaharudin R, et al. Detection of Burkholderia pseudomallei from post-flood soil samples in Kelantan, Malaysia. Southeast Asian J Trop Med Public Health. 2016;47(5):951-956
