Endemic Melioidosis in Tropical Northern Australia: A 10‐Year Prospective Study and Review of the Literature

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.

Health effects of kava use in an eastern Arnhem Land Aboriginal community

“…Other health risks for kava users include acute neurological effects 8 and the infectious disease melioidosis, which may be greater among heavy users. 9,10 The aim of the present study was to further investigate health effects of kava consumption in an Arnhem Land community in tropical northern Australia. 148 (13) 143 (15) 138 (15) 0.02…”

Fatal Co-Infection–Melioidosis and Leptospirosis

“…3 It commonly occurs during the rainy season. 1,3,4 Outbreak of melioidosis is uncommon and a few clusters or outbreaks were reported in the literature. The outbreak in Taiwan was following a typhoon and in Western Australia, it was caused by contaminated water supply.…”

“…Melioidosis caused by the gram-negative bacillus, Burkholderia pseudomallei, is a common infection in the tropical and subtropical regions, especially in tropical Australia 1 and in Southeast Asian countries, particularly Malaysia, 2,3 Thailand, 4 and Singapore. 5 Leptospirosis is another common tropical infectious disease.…”

Further Evaluation of a Rapid Diagnostic Test for Melioidosis in an Area of Endemicity

“…To ascertain the specificity and predictive values of the assays, we prospectively tested all patients who had sera sent for melioidosis serology at Royal Darwin Hospital over a 6-week period in early 2003, during the monsoonal wet season when most cases of melioidosis occur in our region (3). Sera from patients with past melioidosis were excluded from analysis, leaving 160 patients.…”