Endemic Melioidosis in Tropical Northern Australia: A 10-Year Prospective Study and Review of the Literature

• Published in: Clinical infectious diseases Vol. 31; no. 4; pp. 981 - 986
• Main Authors: Currie, Bart J., Fisher, Dale A., Howard, Diane M., Burrow, James N. C., Lo, David, Selva-nayagam, Sid, Anstey, Nicholas M., Huffam, Sarah E., Snelling, Paul L., Marks, Paul J., Stephens, Diane P., Lum, Gary D., Jacups, Susan P., Krause, Vicki L.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.10.2000; University of Chicago Press
• Subjects: Abscesses; Adolescent; Adult; Aged; Aged, 80 and over; Arthritis; Bacterial diseases; Biological and medical sciences; Child; Child, Preschool; Cholera; Chronic kidney failure; Diabetes; Female; Granulocyte Colony-Stimulating Factor - therapeutic use; Human bacterial diseases; Humans; Infant; Infections; Infectious diseases; Major Articles; Male; Medical sciences; Melioidosis; Melioidosis - drug therapy; Melioidosis - epidemiology; Melioidosis - mortality; Middle Aged; Mortality; Northern Territory - epidemiology; Predisposing factors; Prospective Studies; Risk Factors; Septic shock; Shock, Septic - drug therapy; Shock, Septic - epidemiology; Shock, Septic - mortality; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Tropical bacterial diseases; Tropical Climate; Tropical medicine; Type 2 diabetes mellitus; Australia; Northern Territory; Oceania; Infection; Human; Melioidosis; Follow up study; Risk factor; Bacteriosis; Diagnosis; Tropical climate; Endemy; Public health; Bibliographic review
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/318116

In a prospective study of melioidosis in northern Australia, 252 cases were found over 10 years. Of these, 46% were bacteremic, and 49 (19%) patients died. Despite administration of ceftazidime or carbapenems, mortality was 86% (43 of 50 patients) among those with septic shock. Pneumonia accounted for 127 presentations (50%) and genitourinary infections for 37 (15%), with 35 men (18%) having prostatic abscesses. Other presentations included skin abscesses (32 patients; 13%), osteomyelitis and/or septic arthritis (9; 4%), soft tissue abscesses (10; 4%), and encephalomyelitis (10; 4%). Risk factors included diabetes (37%), excessive alcohol intake (39%), chronic lung disease (27%), chronic renal disease (10%), and consumption of kava (8%). Only 1 death occurred among the 51 patients (20%) with no risk factors (relative risk, 0.08; 95% confidence interval, 0.01–0.58). Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication therapy with trimethoprim-sulfamethoxazole, was associated with decreased mortality. Strategies are needed to decrease the high mortality with melioidosis septic shock. Preliminary data on granulocyte colony-stimulating factor therapy are very encouraging.