Please use this identifier to cite or link to this item: http://docs.prosentient.com.au/prosentientjspui/handle/1/10841
Title: The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management.
Authors: Stewart, James D
Smith, Simon
Binotto, Enzo
McBride, William J
Currie, Bart J
Hanson, Josh
Affiliation: Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia..
Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.. James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia..
Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia..
James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia..
Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia..
Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.. Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.. The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia..
Issue Date: Mar-2017
Citation: PLoS neglected tropical diseases 2017-03; 11(3): e0005411
Abstract: The epidemiology, clinical presentation and management of melioidosis vary around the world. It is essential to define the disease's local features to optimise its management. Between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in Far North Queensland; 154 (78%) presented in the December-April wet season. 145 (74%) patients were bacteraemic, 58 (29%) were admitted to the Intensive Care Unit and 27 (14%) died; nine (33%) of these deaths occurred within 48 hours of presentation. Pneumonia was the most frequent clinical finding, present in 101 (61%) of the 166 with available imaging. A recognised risk factor for melioidosis (diabetes, hazardous alcohol use, chronic renal disease, chronic lung disease, immunosuppression or malignancy) was present in 148 (91%) of 162 patients with complete comorbidity data. Despite representing only 9% of the region's population, Aboriginal and Torres Strait Island (ATSI) people comprised 59% of the cases. ATSI patients were younger than non-ATSI patients (median (interquartile range): 46 (38-56) years versus 59 (43-69) years (p<0.001) and had a higher case-fatality rate (22/117 (19%) versus 5/80 (6.3%) (p = 0.01)). In the 155 patients surviving the initial intensive intravenous phase of treatment, eleven (7.1%) had disease recurrence, despite the fact that nine (82%) of these patients had received prolonged intravenous therapy. Recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. The case fatality rate declined from 12/44 (27%) in the first five years of the study to 7/76 (9%) in the last five (p = 0.009), reflecting national improvements in sepsis management. Melioidosis in Far North Queensland is a seasonal, opportunistic infection of patients with specific comorbidities. The ATSI population bear the greatest burden of disease. Although the case-fatality rate is declining, deaths frequently occur early after hospitalisation, reinforcing the importance of prompt, targeted therapy in high-risk patients.
URI: http://docs.prosentient.com.au/prosentientjspui/handle/1/10841
DOI: 10.1371/journal.pntd.0005411
Type: Journal Article
Subjects: Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Child
Child, Preschool
Ethnic Groups
Female
Humans
Infant
Infant, Newborn
Male
Melioidosis
Middle Aged
Mortality
Queensland
Risk Factors
Seasons
Survival Analysis
Treatment Outcome
Young Adult
Disease Management
Appears in Collections:NT Health digital library

Files in This Item:
There are no files associated with this item.


Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.