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The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study

Currie, Bart J ; Ward, Linda ; Cheng, Allen C Diemert, David Joseph

PLoS neglected tropical diseases, 2010-11, Vol.4 (11), p.e900 [Periódico revisado por pares]

United States: Public Library of Science

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Título:
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study
Autor: Currie, Bart J ; Ward, Linda ; Cheng, Allen C
Diemert, David Joseph
Assuntos: Adolescent ; Adult ; Aged ; Aged, 80 and over ; Australia - epidemiology ; Burkholderia pseudomallei ; Burkholderia pseudomallei - isolation & purification ; Burkholderia pseudomallei - physiology ; Child ; Child, Preschool ; Critical Care and Emergency Medicine/Sepsis and Multiple Organ Failure ; Female ; Humans ; Infant ; Infectious Diseases/Bacterial Infections ; Infectious Diseases/Epidemiology and Control of Infectious Diseases ; Infectious Diseases/Neglected Tropical Diseases ; Infectious Diseases/Tropical and Travel-Associated Diseases ; Male ; Melioidosis - diagnosis ; Melioidosis - epidemiology ; Melioidosis - microbiology ; Melioidosis - mortality ; Microbiology/Environmental Microbiology ; Microbiology/Medical Microbiology ; Middle Aged ; Prospective Studies ; Public Health and Epidemiology/Environmental Health ; Public Health and Epidemiology/Infectious Diseases ; Risk Factors ; Young Adult
É parte de: PLoS neglected tropical diseases, 2010-11, Vol.4 (11), p.e900
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
content type line 23
Conceived and designed the experiments: BJC ACC. Performed the experiments: BJC LW ACC. Analyzed the data: BJC LW ACC. Wrote the paper: BJC.
Descrição: Over 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. The 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). Melioidosis 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.
Editor: United States: Public Library of Science
Idioma: Inglês

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The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study

Currie, Bart J ; Ward, Linda ; Cheng, Allen C Diemert, David Joseph

United States: Public Library of Science

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