Journal Article

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 and Vicki L. Krause

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 31, issue 4, pages 981-986
Published in print October 2000 | ISSN: 1058-4838
Published online October 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/318116
Endemic Melioidosis in Tropical Northern Australia: A 10-Year Prospective Study and Review of the Literature

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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.

Journal Article.  4439 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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