Sporadic and outbreak cases of melioidosis in southern Taiwan: clinical features and antimicrobial susceptibility.
BACKGROUND
Melioidosis has been well known to be endemic in Thailand and Northern Australia, and was reported sporadically in Taiwan before 2005.


METHODS
We retrospectively analyzed 58 patients with melioidosis in southern Taiwan from 2000 to 2005, including 40 clustered and 18 sporadic cases, for clinical characteristics and antimicrobial susceptibility.


RESULTS
Fifty-one (88%) cases were found during the rainy season, and there was a significant correlation between the average monthly rainfalls and the case number (r = 0.37; p = 0.001). Diabetes mellitus was the most common underlying disease (35 cases, 60%). The majority (52 cases, 90%) had never traveled abroad before illness, indicating indigenous acquisition of Burkholderia pseudomallei. In comparison, clustered cases were older, less often had underlying diabetes mellitus and had a shorter duration of clinical symptoms before admission than sporadic cases. Acute form of melioidosis predominated, and shock at admission was independently associated with a grave prognosis. Overall, 22% of 58 patients died in hospitals. Ceftazidime, imipenem, meropenem, amoxicillin/clavulanic acid, co-trimoxazole, and doxycycline, as previously recommended, were the potentially therapeutic choices. The role of piperacillin/ tazobactam for melioidosis remains undefined.


CONCLUSIONS
Melioidosis can occur sporadically or in a cluster in diabetic patients during rainy seasons in Taiwan.
Department of Internal Medicine, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.
H-I
HI
Shih
Y-C
YC
Chuang
B M-H
BM
Cheung
J-J
JJ
Yan
C-M
CM
Chang
K
K
Chang
N-Y
NY
Lee
H-C
HC
Lee
C-J
CJ
Wu
P-L
PL
Chen
C-C
CC
Lee
L-R
LR
Wang
N-Y
NY
Ko
W-C
WC
Ko
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016957:Burkholderia pseudomallei / Q000187:drug effects* / Q000302:isolation & purification; D002980:Climate; D048909:Diabetes Complications; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012621:Seasons; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
D000900:Anti-Bacterial Agents