Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature

Clin Infect Dis. 2000 Oct;31(4):981-6. doi: 10.1086/318116. Epub 2000 Oct 25.

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.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Female
  • Granulocyte Colony-Stimulating Factor / therapeutic use
  • Humans
  • Infant
  • Male
  • Melioidosis / drug therapy
  • Melioidosis / epidemiology*
  • Melioidosis / mortality
  • Middle Aged
  • Northern Territory / epidemiology
  • Prospective Studies
  • Risk Factors
  • Shock, Septic / drug therapy
  • Shock, Septic / epidemiology
  • Shock, Septic / mortality
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use
  • Tropical Climate

Substances

  • Granulocyte Colony-Stimulating Factor
  • Trimethoprim, Sulfamethoxazole Drug Combination