TY - JOUR
T1 - Endemic melioidosis in tropical northern Australia
T2 - A 10-year prospective study and review of the literature
AU - Currie, Bart J.
AU - Fisher, Dale A.
AU - Howard, Diane M.
AU - Burrow, James N.C.
AU - Lo, David
AU - Selva-Nayagam, Sid
AU - Anstey, Nicholas M.
AU - Huffam, Sarah E.
AU - Snelling, Paul L.
AU - Marks, Paul J.
AU - Stephens, Diane P.
AU - Lum, Gary D.
AU - Jacups, Susan P.
AU - Krause, Vicki L.
PY - 2000/10/1
Y1 - 2000/10/1
N2 - In a prospective study of melioidosis in northern Australia, 252 cases were found over 10 years. Of these, 46% were bacteremic, and 49 (19%) patients died. Despite administration of ceftazidime or carbapenems, mortality was 86% (43 of 50 patients) among those with septic shock. Pneumonia accounted for 127 presentations (50%) and genitourinary infections for 37 (15%), with 35 men (18%) having prostatic abscesses. Other presentations included skin abscesses (32 patients; 13%), osteomyelitis and/or septic arthritis (9; 4%), soft tissue abscesses (10; 4%), and encephalomyelitis (10; 4%). Risk factors included diabetes (37%), excessive alcohol intake (39%), chronic lung disease (27%), chronic renal disease (10%), and consumption of kava (8%). Only 1 death occurred among the 51 patients (20%) with no risk factors (relative risk, 0.08; 95% confidence interval, 0.01-0.58). Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication therapy with trimethoprim-sulfamethoxazole, was associated with decreased mortality. Strategies are needed to decrease the high mortality with melioidosis septic shock. Preliminary data on granulocyte colony-stimulating factor therapy are very encouraging.
AB - In a prospective study of melioidosis in northern Australia, 252 cases were found over 10 years. Of these, 46% were bacteremic, and 49 (19%) patients died. Despite administration of ceftazidime or carbapenems, mortality was 86% (43 of 50 patients) among those with septic shock. Pneumonia accounted for 127 presentations (50%) and genitourinary infections for 37 (15%), with 35 men (18%) having prostatic abscesses. Other presentations included skin abscesses (32 patients; 13%), osteomyelitis and/or septic arthritis (9; 4%), soft tissue abscesses (10; 4%), and encephalomyelitis (10; 4%). Risk factors included diabetes (37%), excessive alcohol intake (39%), chronic lung disease (27%), chronic renal disease (10%), and consumption of kava (8%). Only 1 death occurred among the 51 patients (20%) with no risk factors (relative risk, 0.08; 95% confidence interval, 0.01-0.58). Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication therapy with trimethoprim-sulfamethoxazole, was associated with decreased mortality. Strategies are needed to decrease the high mortality with melioidosis septic shock. Preliminary data on granulocyte colony-stimulating factor therapy are very encouraging.
UR - http://www.scopus.com/inward/record.url?scp=0034451685&partnerID=8YFLogxK
U2 - 10.1086/318116
DO - 10.1086/318116
M3 - Article
C2 - 11049780
AN - SCOPUS:0034451685
SN - 1058-4838
VL - 31
SP - 981
EP - 986
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 4
ER -