The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study.
BACKGROUND: Over 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum. PRINCIPAL FINDINGS: The principal presentation was pneumonia in 278 (51%), genitourinary infect...
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ftdoajarticles:oai:doaj.org/article:5fe44446479b4a5f84eb02e10c68fcee 2023-05-15T15:14:52+02:00 The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. Bart J Currie Linda Ward Allen C Cheng 2010-01-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0000900 https://doaj.org/article/5fe44446479b4a5f84eb02e10c68fcee EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC2994918?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000900 https://doaj.org/article/5fe44446479b4a5f84eb02e10c68fcee PLoS Neglected Tropical Diseases, Vol 4, Iss 11, p e900 (2010) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2010 ftdoajarticles https://doi.org/10.1371/journal.pntd.0000900 2022-12-31T06:19:21Z BACKGROUND: Over 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum. PRINCIPAL FINDINGS: The principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3-39) and age ≥ 50 years (OR 2.0; 95% CI 1.2-2.3). CONCLUSIONS: Melioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLoS Neglected Tropical Diseases 4 11 e900 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Bart J Currie Linda Ward Allen C Cheng The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
BACKGROUND: Over 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum. PRINCIPAL FINDINGS: The principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3-39) and age ≥ 50 years (OR 2.0; 95% CI 1.2-2.3). CONCLUSIONS: Melioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care. |
format |
Article in Journal/Newspaper |
author |
Bart J Currie Linda Ward Allen C Cheng |
author_facet |
Bart J Currie Linda Ward Allen C Cheng |
author_sort |
Bart J Currie |
title |
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. |
title_short |
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. |
title_full |
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. |
title_fullStr |
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. |
title_full_unstemmed |
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. |
title_sort |
epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year darwin prospective study. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2010 |
url |
https://doi.org/10.1371/journal.pntd.0000900 https://doaj.org/article/5fe44446479b4a5f84eb02e10c68fcee |
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Arctic |
geographic_facet |
Arctic |
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Arctic |
genre_facet |
Arctic |
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PLoS Neglected Tropical Diseases, Vol 4, Iss 11, p e900 (2010) |
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http://europepmc.org/articles/PMC2994918?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000900 https://doaj.org/article/5fe44446479b4a5f84eb02e10c68fcee |
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https://doi.org/10.1371/journal.pntd.0000900 |
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PLoS Neglected Tropical Diseases |
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e900 |
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