title: The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management.
abstract: The epidemiology, clinical presentation and management of melioidosis vary around the world. It is essential to define the disease's local features to optimise its management.
  
  
  
  Between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in Far North Queensland; 154 (78%) presented in the December-April wet season. 145 (74%) patients were bacteraemic, 58 (29%) were admitted to the Intensive Care Unit and 27 (14%) died; nine (33%) of these deaths occurred within 48 hours of presentation. Pneumonia was the most frequent clinical finding, present in 101 (61%) of the 166 with available imaging. A recognised risk factor for melioidosis (diabetes, hazardous alcohol use, chronic renal disease, chronic lung disease, immunosuppression or malignancy) was present in 148 (91%) of 162 patients with complete comorbidity data. Despite representing only 9% of the region's population, Aboriginal and Torres Strait Island (ATSI) people comprised 59% of the cases. ATSI patients were younger than non-ATSI patients (median (interquartile range): 46 (38-56) years versus 59 (43-69) years (p<0.001) and had a higher case-fatality rate (22/117 (19%) versus 5/80 (6.3%) (p = 0.01)). In the 155 patients surviving the initial intensive intravenous phase of treatment, eleven (7.1%) had disease recurrence, despite the fact that nine (82%) of these patients had received prolonged intravenous therapy. Recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. The case fatality rate declined from 12/44 (27%) in the first five years of the study to 7/76 (9%) in the last five (p = 0.009), reflecting national improvements in sepsis management.
  
  
  
  Melioidosis in Far North Queensland is a seasonal, opportunistic infection of patients with specific comorbidities. The ATSI population bear the greatest burden of disease. Although the case-fatality rate is declining, deaths frequently occur early after hospitalisation, reinforcing the importance of prompt, targeted therapy in high-risk patients.
authors.affiliation: Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.
authors.forename: James D
authors.initials: JD
authors.lastname: Stewart
authors.affiliation: Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.|James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: Smith
authors.affiliation: Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.
authors.forename: Enzo
authors.initials: E
authors.lastname: Binotto
authors.affiliation: James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia.
authors.forename: William J
authors.initials: WJ
authors.lastname: McBride
authors.affiliation: Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.|Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
authors.affiliation: Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.|Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.|The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Josh
authors.initials: J
authors.lastname: Hanson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005006:Ethnicity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008554:Melioidosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D008875:Middle Aged; D009026:Mortality; D011793:Queensland / Q000453:epidemiology; D012307:Risk Factors; D012621:Seasons; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents