. The objective of this study was to determine the association between the level of exposure to Burkholderia pseudomallei and the incidence rate of melioidosis and to survey the transmission modes of B. pseudomallei in the Er-Ren River Basin. The serosurveillance of melioidosis gave seropositivity rates of 36.6%, 21.6%, and 10.9%, respectively, for residents in regions A, B, and C within the Er-Ren Basin area. Culture and PCR-based detection of B. pseudomallei from soil demonstrated that the geographical distribution of this bacterium was confined to a particular site in region B. The distribution of seropositive titers was significantly associated with the incidence rate of melioidosis (120, 68, or 36 incidence cases per 100,000 population in region A, B, or C in 2005), whereas it did not correlate with the geographical distribution of B. pseudomallei within the soil. A survey of transmission modes showed that residents with seropositivity were linked to factors such as having confronted flooding and having walked barefoot on soil, which are potential risk factors associated with exposure to B. pseudomallei. Our findings indicated that the Er-Ren River Basin in Taiwan has the potential to become a high-prevalence area for melioidosis. This is the first report that documents a high prevalence of melioidosis in an area north of latitude 20°N.
December 2006 from two regional hospitals were studied.Results: More than half of these cases were females (45/76, 59%). The mean ages of male and female patients were 43 (median: 41, range: 4-78) and 45.8 (median:49, range: 10-82). The mean hospital stay was 6.4 days. Clinical manifestations were fever (62/76, 82%), malaise (37/76, 49%), skin rashes (37/76, 49%), bone pain/arthralgia (35/76, 46%), anorexia (33/76, 43%), pruritus (33/76, 43%), headache (25/76, 33%), nausea (21/76, 28%), diarrhea (21/76, 28%), vomit (20/76, 26%), hemorrhage (17/76, 22%), skin pain (15/76, 20%), abdominal pain (14/76, 18%), retro-orbital pain (12/76, 16%), conjunctivitis (10/76, 13%). Positive results for RT-PCR occurred in 38 of 76 patients (50%). Serotype 3 was the major causative strain. Prolonged partial thromboplastin time was observed in 44 of 76 patients (58%), while elevation of aspartate aminotransferase was observed in 69 of 76 patients (91%). Thrombocytopenia occurred in 65 of 76 patients (86%) and 32 of them (49%) had severe thrombocytopenia (less than 50,000/mm 3 ), while 65 of 76 patients (86%) were leukopenic and 28 of them (43%) had severe leukopenia (white blood cells ranged from 1,000 to 2,000/mm 3 ). The average duration of peak body temperature to normal was 3.1 days. The mean intervals of leukopenia and thrombocytopenia were 2.5 days and 2.6 days respectively. All patients recovered except an old man with previous exposure to dengue virus died of acute fulminant hepatitis.Conclusion: Dengue fever occurred predominantly in females, fever was the major manifestation. Most of the patients contracted hepatitis, leukopenia and thrombocytopenia. Clinical outcome was satisfactory.
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