title: Clinical characteristics and outcomes of bacteraemic melioidosis in a teaching hospital in a northeastern state of Malaysia: a five-year review.
abstract: BACKGROUND
  Melioidosis is an important public health problem causing community acquired sepsis in the northeastern part of Malaysia.
  
  
  METHODS
  From January 2001 to December 2005, we reviewed case reports of all bacteraemic melioidosis admitted to a tertiary teaching hospital, Hospital Universiti Sains Malaysia.
  
  
  RESULTS
  Thirty-five patients had positive blood culture for meliodosis and 27 case reports were traceable for further analysis. The mean age was 46.8 + 20.0 years. Twenty patients (74.1%) were male. The main clinical presentation was fever that occurred in 23 (85.2%) patients. Eighteen patients (66.7%) had lung involvement and three patients had liver abscess. Two patients presented with scrotal swelling, one of whom further developed Fournier's Gangrene. Nineteen (70.4%) patients had underlying diabetes, five of whom were newly diagnosed during the admission. Thirteen (48.1%) patients were treated with high-dose ceftazidime and six (22.2%) patients were treated with imipenem. Eight (29.6%) patients were not given anti-melioidosis therapy because the causative agents were not identified until after the patients died. The patients were admitted 16.8 days + 18.1. Seventeen patients (63.0%) died in this series, 13 patients of whom died within four days of admission.
  
  
  CONCLUSIONS
  The wide range of clinical presentations and the fatal outcomes of melioidosis require a high level of suspicion among physicians to develop an early appropriate therapy and reduce the mortality rate.
authors.affiliation: Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia. zakuan@kb.usm.my
authors.forename: Zakuan Zainy
authors.initials: ZZ
authors.lastname: Deris
authors.forename: Habsah
authors.initials: H
authors.lastname: Hasan
authors.forename: Mohd Noor
authors.initials: MN
authors.lastname: Siti Suraiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016957:Burkholderia pseudomallei / Q000302:isolation & purification*; D002442:Ceftazidime / Q000627:therapeutic use; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D015378:Imipenem / Q000627:therapeutic use; D008100:Liver Abscess / Q000473:pathology; D008296:Malaysia; D008297:Male; D008554:Melioidosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000473:pathology; D006848:Testicular Hydrocele / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015378:Imipenem; D002442:Ceftazidime