Melioidosis: An Australian Perspective

Smith, Simon; Hanson, Josh; Currie, Bart J.

doi:10.3390/tropicalmed3010027

Cited by 44 publications

(63 citation statements)

References 87 publications

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“…Perhaps melioidosis should even be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and appropriate clinical management is available and given. 18,38 The most important risk factors are diabetes, renal failure, alcoholic liver disease, and thalassemia. 6,7 Interestingly, human immunodeficiency virus does not appear to be a risk factor for melioidosis despite murine studies showing a role for the adaptive immune system in controlling the infection.…”

Section: Host Immune Response and Risk Factorsmentioning

confidence: 99%

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia

Virk

Mukhopadhyay

Wiersinga

2020

Semin Respir Crit Care Med

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AbstractMelioidosis, caused by the facultative intracellular gram-negative pathogen Burkholderia pseudomallei, is an emerging cause of community-acquired pneumonia across the tropics. The majority of patients present with pneumonia with or without sepsis, but localized and asymptomatic infection is also well recognized. Recent modeling and epidemiological studies have demonstrated the widespread presence of B. pseudomallei in otherwise unrecognized regions with a predicted mortality of 90,000 deaths worldwide. Innovative environmental studies are also uncovering how hydrodynamic, pedology, fauna, and weather events influence geographic distribution and incidence of melioidosis cases. Of concern is the changes associated with global warming, which will be conducive to B. pseudomallei in combination with the global diabetes pandemic. In fact, over 80% of patient developing melioidosis have underlying comorbidities. For this great mimicker, culture remains the mainstay of diagnosis and despite availability of other assays, challenges still remain in reducing time to diagnosis and avoiding misdiagnosis. With institution of timely antimicrobials such as ceftazidime and supportive intensive care, overall mortality can be reduced to 10%, although this can still be as high as 50% in poorly resourced areas. Promise is on the horizon with the first human vaccine trials being planned for 2021. Meanwhile new multiomics techniques are giving us a better understanding of the role of virulence and host–pathogen interactions on patient outcomes.

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Section: Host Immune Response and Risk Factorsmentioning

confidence: 99%

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia

Virk

Mukhopadhyay

Wiersinga

2020

Semin Respir Crit Care Med

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“…Meropenem is recommended for the initial intensive therapy and is usually continued for at least eight weeks. Adjunctive oral trimethoprim/sulfamethoxazole is also recommended in Australia [ 10 ]. Disease recrudescence and relapse is common, necessitating a minimum of six months eradication antibiotic therapy - ideally with trimethoprim/sulfamethoxazole - following the initial intensive phase of therapy [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Adjunctive oral trimethoprim/sulfamethoxazole is also recommended in Australia [ 10 ]. Disease recrudescence and relapse is common, necessitating a minimum of six months eradication antibiotic therapy - ideally with trimethoprim/sulfamethoxazole - following the initial intensive phase of therapy [ 10 ]. Appropriate source control is an essential part of management [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Melioidosis of the central nervous system; A potentially lethal impersonator

Owen

Smith

Kuruvath

et al. 2021

IDCases

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A 57-year-old Australian woman, with a history of hazardous alcohol consumption, presented with a seizure following 2 days of fever and headache. Initial imaging suggested the presence of an isolated brain abscess, however, a thorough physical examination, identified no additional septic focus. Five sets of blood cultures were sterile and serology for Burkholderia pseudomallei was negative. Other investigations including computed tomography of her chest, abdomen and pelvis and a trans-esophageal echocardiogram were normal. Despite the administration of intravenous vancomycin, ceftriaxone, and metronidazole, her condition deteriorated. At emergency craniotomy, the abscess was drained and B. pseudomallei was cultured, confirming a diagnosis of melioidosis. She received 8 weeks of intravenous meropenem, combined with oral trimethoprim/sulfamethoxazole; the trimethoprim/sulfamethoxazole was continued for a total of 12 months. She recovered completely and was able to return to full-time work. Melioidosis, is endemic to Australia and South East Asia and, globally, is estimated to kill 89,000 every year. It can affect almost any organ, but up to 5% have central nervous system (CNS) involvement, where it may present as an encephalomyelitis, brain abscess or meningitis. B. pseudomallei is resistant to many commonly used antibiotics and even in well-resourced settings the case-fatality rate of CNS infection may rise to 50 %. This patient lived in a melioid-endemic region, and, with hazardous alcohol consumption, had a classical risk factor for the disease, but the sterile blood cultures and negative B. pseudomallei serology delayed definitive therapy. Despite the delayed diagnosis, definitive drainage and prolonged anti-bacterial therapy ensured a complete recovery.

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“…These data confirm the status of melioidosis in Australia as a seasonal, opportunistic infection. 3,7 Almost 90% of the patients had a documented traditional risk factor for the disease, while 77% presented during the wet season. The study also highlights the advances made in the local acute care of melioidosis, with an almost 3-fold decline in the in-hospital case fatality rate during the 21-year study period.…”

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confidence: 99%

High Rates of Premature and Potentially Preventable Death among Patients Surviving Melioidosis in Tropical Australia

Hanson

Smith

2019

The American Journal of Tropical Medicine and Hygiene

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Although the in-hospital mortality of Australian patients with melioidosis continues to decline, the ensuing clinical course of survivors is poorly described. Between January 1, 1998, and January 31, 2019, 228 patients in Cairns, tropical Australia, survived their hospitalization with melioidosis; however, 52 (23%) subsequently died. Death occurred at a median of 3.8 years after discharge, with patients dying at a mean age of 59 years. Only 1/27 (4%) without predisposing conditions for melioidosis died during follow-up, versus 51/201 (25%) with these comorbidities (P = 0.01). Death during follow-up was more likely in patients with chronic lung disease (OR [95% CI]: 4.05 (1.84-8.93, P = 0.001) and chronic kidney disease (OR [95% CI]: 2.87 [1.33-6.20], P = 0.007), and was most commonly due to infection and macrovascular disease. A significant proportion of Australians surviving hospitalization with melioidosis will die soon after discharge, usually prematurely and frequently from preventable conditions. A more holistic approach is required to their care. Melioidosis, a disease caused by the environmental Gramnegative bacillus Burkholderia pseudomallei, is estimated to kill almost 90,000 people globally every year. 1 In Southeast Asia, where the disease is endemic, the in-hospital mortality exceeds 40%. 2 Melioidosis is also endemic in tropical Australia, but early recognition and access to high-quality intensive care unit (ICU) support in the country's well-resourced health system have reduced the disease's case fatality rate to approximately 10%. 3,4 Melioidosis is an opportunistic infection, with disease developing after only one of every 4,600 exposures. 5 Indeed, in tropical Australia, melioidosis is uncommon in the absence of its classically associated risk factors, which include diabetes mellitus, hazardous alcohol use, chronic kidney disease (CKD), chronic lung disease, and immunosuppression. 3 As more Australians survive their acute infection, there is the opportunity to address these comorbidities more aggressively, with the goal of improving long-term outcomes. This study examined the post-discharge course of patients who survived their hospitalization with melioidosis and aimed to determine whether advances in the acute management of the disease were matched by the patients' long-term outcomes. It was performed at Cairns Hospital, a 531-bed, tertiary referral center located in Far North Queensland, tropical Australia. The hospital serves a population of 280,000, almost 12% of whom identify as Indigenous Australians. Its laboratory is the region's primary public microbiology provider. All patients with a positive culture for B. pseudomallei between January 1, 1998, and January 31, 2019, were eligible for the study. Hospital records were reviewed to determine the patients' demographics, their clinical presentation, their comorbidities, and their clinical course. Comorbidities and complications were defined as described previously. 6 If the presence of a comorbidity or complication was not documented, it wa...

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Melioidosis: An Australian Perspective

Cited by 44 publications

References 87 publications

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia

Melioidosis of the central nervous system; A potentially lethal impersonator

High Rates of Premature and Potentially Preventable Death among Patients Surviving Melioidosis in Tropical Australia

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