Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature.
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.
Currie
B J
BJ
Division of Medicine and Pathology Department, Royal Darwin Hospital, Northern Territory Clinical School, Flinders University, Casaurina, Northern Territory, Australia. bart@menzies.edu.au
Fisher
D A
DA
Howard
D M
DM
Burrow
J N
JN
Lo
D
D
Selva-Nayagam
S
S
Anstey
N M
NM
Huffam
S E
SE
Snelling
P L
PL
Marks
P J
PJ
Stephens
D P
DP
Lum
G D
GD
Jacups
S P
SP
Krause
V L
VL
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
D016179:Granulocyte Colony-Stimulating Factor; D015662:Trimethoprim, Sulfamethoxazole Drug Combination