Sporadic and Outbreak Cases of Melioidosis in Southern Taiwan: Clinical Features and Antimicrobial Susceptibility

Shih, Hsin I.; Chuang, Yin-Ching; Cheung, Bruno Man-Hon; Yan, Jing Jou; Chang, Chia–Ming; Chang, Ko; Lee, Nan-Yao; Lee, Hsin‐Chun; Wu, Chi‐Jung; Chen, Po‐Lin; Lee, Ching Chi; Wang, Lirong; Ko, Nai Ying; Ko, Wen–Chien

doi:10.1007/s15010-008-7324-8

Cited by 21 publications

(25 citation statements)

References 24 publications

(34 reference statements)

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“…Mortality during the first 5 years of the study (from October 1989) was 30% and during the last 5 years (until October 2009) was 9% (p<0.001). These rates compare with 49% mortality in the large Thai study from 1986–2004 [24], with mortality now decreasing in that region [18], 65% in bacteremic patients in Malaysia during 1976–1991 [27], 16% in Singapore between 1998–2007 [19], 22% in Taiwan between 2000 and 2005 [26] and 25% in north Queensland between 1996 and 2004 [25].…”

Section: Discussionmentioning

confidence: 62%

“…In the Darwin study 39% of patients were diabetic, with nearly all having adult onset type 2 diabetes. Rates of diabetes from other endemic locations were 57% in the largest series from Thailand [24], 48% in Singapore [19], 60% in Taiwan [26], 38% in bacteremic melioidosis patients in Malaysia [27] and 42% in north Queensland, Australia [25]. When considering the estimated prevalence of diabetes in the whole population, we previously calculated the risk of melioidosis in diabetics in the tropical Top End of the Northern Territory to be 21.2 (95% CI 17.1–26.3) times the risk in non-diabetics [17], which is similar to data from Thailand [14].…”

Section: Discussionmentioning

confidence: 94%

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The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study

2010

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BackgroundOver 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum.Principal FindingsThe principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3–39) and age ≥50 years (OR 2.0; 95% CI 1.2–2.3).ConclusionsMelioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 94%

The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study

2010

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“…This evidence is the first to identify the transmission mode from contaminated soils to aerosols and/or to patients. Approximately 70% of melioidosis patients presented with pulmonary inflammation in an outbreak in Taiwan [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Airborne Transmission of Melioidosis to Humans from Environmental Aerosols Contaminated with B. pseudomallei

Chen

Lin

et al. 2015

PLoS Negl Trop Dis

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Melioidosis results from an infection with the soil-borne pathogen Burkholderia pseudomallei, and cases of melioidosis usually cluster after rains or a typhoon. In an endemic area of Taiwan, B. pseudomallei is primarily geographically distributed in cropped fields in the northwest of this area, whereas melioidosis cases are distributed in a densely populated district in the southeast. We hypothesized that contaminated cropped fields generated aerosols contaminated with B. pseudomallei, which were carried by a northwesterly wind to the densely populated southeastern district. We collected soil and aerosol samples from a 72 km2 area of land, including the melioidosis-clustered area and its surroundings. Aerosols that contained B. pseudomallei-specific TTSS (type III secretion system) ORF2 DNA were well distributed in the endemic area but were rare in the surrounding areas during the rainy season. The concentration of this specific DNA in aerosols was positively correlated with the incidence of melioidosis and the appearance of a northwesterly wind. Moreover, the isolation rate in the superficial layers of the contaminated cropped field in the northwest was correlated with PCR positivity for aerosols collected from the southeast over a 2-year period. According to pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) analyses, PFGE Type Ia (ST58) was the predominant pattern linking the molecular association among soil, aerosol and human isolates. Thus, the airborne transmission of melioidosis moves from the contaminated soil to aerosols and/or to humans in this endemic area.

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“…Of the risk factors, diabetes mellitus is most important. Diabetes has been reported in 38–60% of melioidosis patients 17 , 18 , 19 , 20 , and the calculated risk of melioidosis in diabetics is as high as 21.2 (95% confidence interval 17.1–26.3) times the risk in nondiabetics [16] . The presence of risk factors is associated not only with susceptibility to the disease, but also with its severity and clinical manifestations.…”

Section: Discussionmentioning

confidence: 99%

Imported Melioidosis in South Korea: A Case Series with a Literature Review

Kim

Kwon

Kim

et al. 2015

Osong Public Health and Research Perspectives

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ObjectivesMelioidosis is a potentially fatal infectious disease caused by the environmental anaerobic Gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic to areas of northern Australia and Southeast Asia. With increasing international travel and migration, imported cases of melioidosis are being reported regularly. Here, we summarize the 11 cases of melioidosis reported in South Korea from 2003 to 2014.MethodsTracing epidemiological investigations were performed on every patient reported to the National Surveillance System since 2011. A systematic literature search was performed to identify melioidosis cases that occurred prior to 2011.ResultsThe overall fatality rate was 36.4%. All the patients had visited Southeast Asia where melioidosis is endemic. The stay in the endemic region ranged from 4 days to 20 years. Of the seven patients who developed initial symptoms after returning to South Korea, the time interval between returning to South Korea and symptom onset ranged from 1 day to 3 years. The remaining four patients developed symptoms during their stay in the endemic region and were diagnosed with melioidosis in South Korea. Seven (63.6%) patients possessed at least one risk factor, all of whom were diabetic. Pneumonia was the most frequent clinical manifestation, but the patients showed a wide spectrum of clinical features, including internal organ abscesses, a mycotic aneurysm of the aorta, and coinfection with tuberculosis.ConclusionAn early diagnosis and initiation of the appropriate antibiotics can reduce the mortality of melioidosis. Consequently, increased awareness of the risk factors and clinical features of melioidosis is required.

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Sporadic and Outbreak Cases of Melioidosis in Southern Taiwan: Clinical Features and Antimicrobial Susceptibility

Abstract: Melioidosis can occur sporadically or in a cluster in diabetic patients during rainy seasons in Taiwan.

Cited by 21 publications

References 24 publications

The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study

The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study

Airborne Transmission of Melioidosis to Humans from Environmental Aerosols Contaminated with B. pseudomallei

Imported Melioidosis in South Korea: A Case Series with a Literature Review

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