Endemic melioidosis in tropical northern Australia: A 10-year prospective study and review of the literature

Bart J. Currie, Dale A. Fisher, Diane M. Howard, James N.C. Burrow, David Lo, Sid Selva-Nayagam, Nicholas M. Anstey, Sarah E. Huffam, Paul L. Snelling, Paul J. Marks, Diane P. Stephens, Gary D. Lum, Susan P. Jacups, Vicki L. Krause

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    370 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)981-986
    Number of pages6
    JournalClinical Infectious Diseases
    Volume31
    Issue number4
    DOIs
    Publication statusPublished - 1 Oct 2000

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