Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

Smith, Simon; Horne, Peter; Rubenach, Sally; Gair, Richard; Stewart, James D.; Fairhead, Lee; Hanson, Josh

doi:10.3201/eid2712.211302

Cited by 18 publications

(20 citation statements)

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“…In that study this was attributed to Indigenous Australians’ socioeconomic disadvantage, their higher prevalence of comorbidities and their greater exposure to the Eucalyptus trees (an environmental reservoir for Cryptococcus gattii ) in the rural areas where they comprise a greater proportion of the population. The incidence of melioidosis is increasing in FNQ, and although CNS involvement is infrequent, a high index of suspicion is necessary in the appropriate clinical context [ 3 , 10 , 46 , 47 ]. Other tropical pathogens were not encountered as frequently; there were only three cases of leptospiral meningitis and no rickettsial CNS infections in this study, despite FNQ having the highest incidence of leptospirosis in Australia and a rising incidence of rickettsial infections [ 2 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…Urban expansion from recent population growth in the region (with a resulting expansion in medical services leading to more immunocompromised patients) and the area’s reputation as an international travel hub, might also be expected to affect the incidence of disease [ 2 , 3 , 9 , 10 ]. Approximately 17% of the local population identifies as an Aboriginal and/or Torres Strait Islander Australian [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

et al. 2022

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Background The epidemiology of central nervous system (CNS) infections in tropical Australia is incompletely defined. Methods A retrospective study of all individuals in Far North Queensland, tropical Australia, who were diagnosed with a CNS infection between January 1, 2000, and December 31, 2019. The microbiological aetiology of the infection was correlated with patients’ demographic characteristics and their clinical course. Results There were 725 cases of CNS infection during the study period, meningitis (77.4%) was the most common, followed by brain abscess (11.6%), encephalitis (9.9%) and spinal infection (1.1%). Infants (24.3%, p<0.0001) and Aboriginal and Torres Strait Islander Australians (175/666 local residents, 26.3%, p<0.0001) were over-represented in the cohort. A pathogen was identified in 513 cases (70.8%); this was viral in 299 (41.2%), bacterial in 175 (24.1%) and fungal in 35 (4.8%). Cryptococcal meningitis (24 cases) was diagnosed as frequently as pneumococcal meningitis (24 cases). There were only 2 CNS infections with a S. pneumoniae serotype in the 13-valent pneumococcal vaccine after its addition to the National Immunisation schedule in 2011. Tropical pathogens–including Cryptococcus species (9/84, 11%), Mycobacterium tuberculosis (7/84, 8%) and Burkholderia pseudomallei (5/84, 6%)–were among the most common causes of brain abscess. However, arboviral CNS infections were rare, with only one locally acquired case—a dengue infection in 2009—diagnosed in the entire study period. Intensive Care Unit admission was necessary in 14.3%; the overall case fatality rate was 4.4%. Conclusion Tropical pathogens cause CNS infections as commonly as traditional bacterial pathogens in this region of tropical Australia. However, despite being highlighted in the national consensus guidelines, arboviruses were identified very rarely. Prompt access to sophisticated diagnostic and supportive care in Australia’s well-resourced public health system is likely to have contributed to the cohort’s low case-fatality rate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

et al. 2022

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“…Another possibility is that there is heterogeneity in the incidence of RHD and melioidosis across the FNQ region. The recent increase in incidence of melioidosis has occurred predominantly in the urban Cairns region, an area where only 11.6% of the population is Indigenous and where the prevalence of RHD is, accordingly, lower [ 8 ]. However, this would not explain the absence of cases of RHD in patients with melioidosis from remote FNQ (Cape York and the Torres Strait Islands).…”

Section: Discussionmentioning

confidence: 99%

“…This association between melioidosis and RHD and CCF described in the NT has enormous potential significance in Far North Queensland (FNQ), another region in tropical Australia where the incidence of both melioidosis and RHD are increasing [ 6 , 7 ]. The annual incidence of melioidosis more than doubled between 1998 and 2019 to 9.9/100000 population [ 8 ], the annual incidence of RHD has risen to 49/100000 population [ 6 ], while the overall prevalence of CCF in FNQ—estimated at 1.5–2%—is one of the highest in Australia [ 9 ]. This study was performed to identify the prevalence of RHD and/or CCF among patients diagnosed with melioidosis in FNQ.…”

Section: Introductionmentioning

confidence: 99%

Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia

et al. 2022

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Background Patients with rheumatic heart disease (RHD) and congestive cardiac failure (CCF) are believed to have an increased risk of melioidosis and are thought to be more likely to die from the infection. This study was performed to confirm these findings in a region with a high incidence of all three conditions. Principal findings Between January 1998 and December 2021 there were 392 cases of melioidosis in Far North Queensland, tropical Australia; 200/392 (51.0%) identified as an Indigenous Australian, and 337/392 (86.0%) had a confirmed predisposing comorbidity that increased risk for the infection. Overall, 46/392 (11.7%) died before hospital discharge; the case fatality rate declining during the study period (p for trend = 0.001). There were only 3/392 (0.8%) with confirmed RHD, all of whom had at least one other risk factor for melioidosis; all 3 survived to hospital discharge. Among the 200 Indigenous Australians in the cohort, 2 had confirmed RHD; not statistically greater than the prevalence of RHD in the local general Indigenous population (1.0% versus 1.2%, p = 1.0). RHD was present in only 1/193 (0.5%) cases of melioidosis diagnosed after October 2016, a period which coincided with prospective data collection. There were 26/392 (6.6%) with confirmed CCF, but all 26 had another traditional risk factor for melioidosis. Patients with CCF were more likely to also have chronic lung disease (OR (95% CI: 4.46 (1.93–10.31), p<0.001) and chronic kidney disease (odds ratio (OR) (95% confidence interval (CI): 2.98 (1.22–7.29), p = 0.01) than those who did not have CCF. Two patients with melioidosis and CCF died before hospital discharge; both were elderly (aged 81 and 91 years) and had significant comorbidity. Conclusions In this region of tropical Australia RHD and CCF do not appear to be independent risk factors for melioidosis and have limited prognostic utility.

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“…Studies continue in the three tropical cities of northern Australia. A sharp rise in case numbers in Cairns, far north Queensland has been linked to urban development and in particular the construction of a large motorway on the city's southern outskirts during 2011–2017 [46 ▪ ]. The importance of melioidosis as a disease of socioeconomic disadvantage was established in analysis of the Cairns cohort, with socioeconomic disadvantage having a greater independent association with in-hospital death than age, indigenous status, bacteraemia and the classical risk factors for melioidosis, such as diabetes [47 ▪ ].…”

Section: Epidemiologymentioning

confidence: 99%

Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination

Currie

2022

Current Opinion in Infectious Diseases

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Purpose of reviewMelioidosis and its causative bacterium Burkholderia pseudomallei are being found in unexpected locations and bacterial genotyping is providing new insights into global spread and where and how individuals are being infected. This review summarizes recent studies covering the epidemiology, diagnosis, treatment, and prevention of melioidosis. Recent findingsWhole-genome sequencing of B. pseudomallei from patients and environmental sampling is informing the phylogeography of B. pseudomallei at regional, continental, and global levels, while also defining the epidemiology for individual cases. The situation in Africa remains the most unresolved, while the evolving story of B. pseudomallei in the Americas may establish that B. pseudomallei is endemic in parts of southern USA. Guidelines for diagnosis and treatment of melioidosis are well established, and published mortality has decreased from 50% or higher to 10% or lower in some countries but access to laboratory and therapeutic resources are not available or are extremely limited in many melioidosis-endemic regions.

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Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

Cited by 18 publications

References 14 publications

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

The epidemiology and outcomes of central nervous system infections in Far North Queensland, tropical Australia; 2000-2019

Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia

Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination

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