title: Pulmonary melioidosis in Cambodia: a prospective study.
abstract: BACKGROUND
  Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes.
  
  
  METHODS
  We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome.
  
  
  RESULTS
  During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs.
  
  
  CONCLUSIONS
  The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.
authors.affiliation: Institut Pasteur - Cambodia, Phnom Penh, Cambodia.
authors.forename: Blandine
authors.initials: B
authors.lastname: Rammaert
authors.forename: Julien
authors.initials: J
authors.lastname: Beauté
authors.forename: Laurence
authors.initials: L
authors.lastname: Borand
authors.forename: Sopheak
authors.initials: S
authors.lastname: Hem
authors.forename: Philippe
authors.initials: P
authors.lastname: Buchy
authors.forename: Sophie
authors.initials: S
authors.lastname: Goyet
authors.forename: Rob
authors.initials: R
authors.lastname: Overtoom
authors.forename: Cécile
authors.initials: C
authors.lastname: Angebault
authors.forename: Vantha
authors.initials: V
authors.lastname: Te
authors.forename: Patrich Lorn
authors.initials: PL
authors.lastname: Try
authors.forename: Charles
authors.initials: C
authors.lastname: Mayaud
authors.forename: Sirenda
authors.initials: S
authors.lastname: Vong
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use; D016957:Burkholderia pseudomallei; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008554:Melioidosis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents