title: Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature.
abstract: 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.
authors.affiliation: Division of Medicine and Pathology Department, Royal Darwin Hospital, Northern Territory Clinical School, Flinders University, Casaurina, Northern Territory, Australia. bart@menzies.edu.au
authors.forename: B J
authors.initials: BJ
authors.lastname: Currie
authors.forename: D A
authors.initials: DA
authors.lastname: Fisher
authors.forename: D M
authors.initials: DM
authors.lastname: Howard
authors.forename: J N
authors.initials: JN
authors.lastname: Burrow
authors.forename: D
authors.initials: D
authors.lastname: Lo
authors.forename: S
authors.initials: S
authors.lastname: Selva-Nayagam
authors.forename: N M
authors.initials: NM
authors.lastname: Anstey
authors.forename: S E
authors.initials: SE
authors.lastname: Huffam
authors.forename: P L
authors.initials: PL
authors.lastname: Snelling
authors.forename: P J
authors.initials: PJ
authors.lastname: Marks
authors.forename: D P
authors.initials: DP
authors.lastname: Stephens
authors.forename: G D
authors.initials: GD
authors.lastname: Lum
authors.forename: S P
authors.initials: SP
authors.lastname: Jacups
authors.forename: V L
authors.initials: VL
authors.lastname: Krause
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D008554:Melioidosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014329:Tropical Climate
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D015662:Trimethoprim, Sulfamethoxazole Drug Combination