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The Epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study

Currie, Bart J., Ward, Linda M. and Cheng, Allen C. (2010). The Epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Neglected Tropical Diseases,4(11):e900.

Document type: Journal Article
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Title The Epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study
Author Currie, Bart J.
Ward, Linda M.
Cheng, Allen C.
Journal Name PLoS Neglected Tropical Diseases
Publication Date 2010
Volume Number 4
Issue Number 11
ISSN 1935-2727   (check CDU catalogue open catalogue search in new window)
Start Page e900
Total Pages 11
Place of Publication United States
Publisher Public Library of Science
HERDC Category C1 - Journal Article (DEST)
Abstract 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).

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.
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