The Darwin Prospective Melioidosis Study

• Main Author: Currie BJ
• Format: Thesis
• Language: English
• Published: 2022
• Subjects: Burkholderia pseudomallei; Genome; Bacterial; Incidence; Melioidosis; Middle Aged; Multilocus Sequence Typing; Northern Territory - epidemiology; Prospective Studies; Risk Factors; Whole Genome Sequencing; Melioidosis - epidemiology; Melioidosis - mortality; Menzies; First Nations
• Online Access: https://hdl.handle.net/10137/12313; https://researchers.cdu.edu.au/en/studentTheses/the-darwin-prospective-melioidosis-study %7C Click here for thesis

The Darwin Prospective Melioidosis Study (DPMS) commenced on October 1st, 1989. Over 30 years to September 30th, 2019, there were 1148 individuals with Burkholderia pseudomallei culture-positive melioidosis, of whom 133 (12%) died. Median age was 50 years (IQR 38–60), 48 (4%) study participants were children younger than 15 years of age, 721 (63%) were male individuals, and 600 (52%) First Nations Australians. All but 186 (16%) had clinical risk factors, 513 (45%) had diabetes, and 455 (40%) hazardous alcohol use. Only three (2%) of 133 fatalities had no identified clinical risk factor. Of 1148 primary melioidosis presentations, 1013 (88%) were acute (with an incubation period of 1–21 days, median 4 days, IQR 3–7 days), 106 (9%) were chronic (defined as symptoms for ≥ 2months), and 29 (3%) were considered to be infection activations from latency. 60 (5%) individuals had one or more recurrences of melioidosis, of whom 44 individuals had a relapse and 20 individuals had a new infection, making a total of 1212 episodes of melioidosis over the 30 years. Pneumonia was the most common presentation occurring in 595 (52%) patients. Bacteraemia occurred in 633 (56%) of 1135 patients, septic shock in 240 (21%) patients, and 180 (16%) patients required mechanical ventilation. Cases correlated with rainfall, with 80% of infections occurring during the wet season (November to April). Median annual incidence was 20·5 cases per 100,000 people; the highest annual incidence in First Nations Australians was 103·6 per 100,000 in 2011–12. Over the 30 years, annual incidences increased, as did the proportion of patients with diabetes, although mortality decreased to 17 (6%) of 278 patients over the last 5 years. Genotyping of B. pseudomallei at Menzies School of Health Research evolved from ribotyping in the early days, to pulsed–field gel electrophoresis and BOX–PCR. With the advent of direct genome sequencing, Menzies embraced multilocus sequence typing (MLST) and more recently analysis of whole genome sequencing of B. ...