title: Imported Melioidosis in South Korea: A Case Series with a Literature Review.
abstract: OBJECTIVE
  Melioidosis is a potentially fatal infectious disease caused by the environmental anaerobic Gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic to areas of northern Australia and Southeast Asia. With increasing international travel and migration, imported cases of melioidosis are being reported regularly. Here, we summarize the 11 cases of melioidosis reported in South Korea from 2003 to 2014.
  
  
  METHODS
  Tracing epidemiological investigations were performed on every patient reported to the National Surveillance System since 2011. A systematic literature search was performed to identify melioidosis cases that occurred prior to 2011.
  
  
  RESULTS
  The overall fatality rate was 36.4%. All the patients had visited Southeast Asia where melioidosis is endemic. The stay in the endemic region ranged from 4 days to 20 years. Of the seven patients who developed initial symptoms after returning to South Korea, the time interval between returning to South Korea and symptom onset ranged from 1 day to 3 years. The remaining four patients developed symptoms during their stay in the endemic region and were diagnosed with melioidosis in South Korea. Seven (63.6%) patients possessed at least one risk factor, all of whom were diabetic. Pneumonia was the most frequent clinical manifestation, but the patients showed a wide spectrum of clinical features, including internal organ abscesses, a mycotic aneurysm of the aorta, and coinfection with tuberculosis.
  
  
  CONCLUSIONS
  An early diagnosis and initiation of the appropriate antibiotics can reduce the mortality of melioidosis. Consequently, increased awareness of the risk factors and clinical features of melioidosis is required.
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
authors.forename: Seung Woo
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Division of HIV and Tuberculosis Control, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
authors.forename: Geun-Yong
authors.initials: GY
authors.lastname: Kwon
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
authors.forename: Bongyoung
authors.initials: B
authors.lastname: Kim
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
authors.forename: Donghyok
authors.initials: D
authors.lastname: Kwon
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
authors.forename: Jaeseung
authors.initials: J
authors.lastname: Shin
authors.affiliation: Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Cheongju, Korea.
authors.forename: Geun-Ryang
authors.initials: GR
authors.lastname: Bae
keywords: Burkholderia pseudomallei; diabetes complications; melioidosis
references.citation: J Infect Dis. 2005 Nov 15;192(10):1845-50
references.pmid: 16235187
references.citation: Clin Infect Dis. 2000 Oct;31(4):981-6
references.pmid: 11049780
references.citation: Clin Infect Dis. 2006 Oct 15;43(8):979-86
references.pmid: 16983608
references.citation: Med J Aust. 1971 Sep 18;2(12):618-21
references.pmid: 5114173
references.citation: Acta Trop. 2000 Feb 5;74(2-3):121-7
references.pmid: 10674639
references.citation: Clin Microbiol Rev. 2005 Apr;18(2):383-416
references.pmid: 15831829
references.citation: Am J Trop Med Hyg. 2010 Jun;82(6):1113-7
references.pmid: 20519609
references.citation: Chest. 1975 Aug;68(2):261-3
references.pmid: 1149556
references.citation: Korean J Lab Med. 2009 Apr;29(2):140-4
references.pmid: 19411781
references.citation: Infection. 2009 Feb;37(1):9-15
references.pmid: 18854938
references.citation: PLoS Negl Trop Dis. 2010 Nov 30;4(11):e900
references.pmid: 21152057
references.citation: Ann Thorac Med. 2010 Apr;5(2):113-5
references.pmid: 20582178
references.citation: J Infect Dis. 1989 May;159(5):890-9
references.pmid: 2708842
references.citation: Int J Tuberc Lung Dis. 2008 Oct;12(10):1209-15
references.pmid: 18812053
references.citation: Trop Med Int Health. 2004 Nov;9(11):1167-74
references.pmid: 15548312
references.citation: Trans R Soc Trop Med Hyg. 2003 Sep-Oct;97(5):577-81
references.pmid: 15307431
references.citation: J Korean Med Sci. 2005 Feb;20(1):139-42
references.pmid: 15716619
references.citation: Trans R Soc Trop Med Hyg. 1992 Nov-Dec;86(6):683-5
references.pmid: 1287945
references.citation: Rev Infect Dis. 1989 May-Jun;11(3):413-25
references.pmid: 2665001
references.citation: N Engl J Med. 2012 Sep 13;367(11):1035-44
references.pmid: 22970946
references.citation: Clin Infect Dis. 2005 Jan 1;40(1):193-8
references.pmid: 15614712
references.citation: Trans R Soc Trop Med Hyg. 2005 Nov;99(11):856-60
references.pmid: 16111729
references.citation: Clin Infect Dis. 1999 Aug;29(2):408-13
references.pmid: 10476750