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Title: Endemic melioidosis in tropical northern Australia: a 10-year prospective study and review of the literature.
Authors: Currie, B J
Fisher, D A
Howard, D M
Burrow, J N
Lo, D
Selva-Nayagam, S
Anstey, N M
Huffam, S E
Snelling, P L
Marks, P J
Stephens, D P
Lum, G D
Jacups, S P
Krause, V L
Affiliation: Division of Medicine and Pathology Department, Royal Darwin Hospital, Northern Territory Clinical School, Flinders University, Casaurina, Northern Territory, Australia.
Issue Date: Oct-2000
Citation: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2000-10; 31(4): 981-6
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.
DOI: 10.1086/318116
ISSN: 1058-4838
Type: Journal Article
Research Support, Non-U.S. Gov't
Subjects: Adolescent
Aged, 80 and over
Child, Preschool
Granulocyte Colony-Stimulating Factor
Middle Aged
Northern Territory
Prospective Studies
Risk Factors
Shock, Septic
Trimethoprim, Sulfamethoxazole Drug Combination
Tropical Climate
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