Hospitalized Bacteremic Melioidosis in Rural Thailand: 2009-2013.

Anchalee Jatapai,Kittisak Tanwisaid,Saithip Bhengsri,Christopher J Gregory,Possawat Jorakate,Ornuma Sangwichian,Somsak Thamthitiwat,Henry C Baggett,John R Macarthur

doi:10.4269/ajtmh.17-0402

Anchalee Jatapai, Kittisak Tanwisaid + Show 7 more

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https://doi.org/10.4269/ajtmh.17-0402

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.Melioidosis incidence and mortality have reportedly been increasing in endemic areas of Thailand, but little population-based data on culture-confirmed Burkholderia pseudomallei infections exist. We provide updated estimates of melioidosis bacteremia incidence and in-hospital mortality rate using integration of two population-based surveillance databases in Nakhon Phanom, Thailand, since automated blood culture became available in 2005. From 2009 to 2013, 564 hospitalized bacteremic melioidosis patients were identified. The annual incidence of bacteremic melioidosis ranged from 14 to 17 per 100,000 persons, and average population mortality rate was 2 per 100,000 persons per year. In-hospital mortality rate declined nonsignificantly from 15% (15/102) to 13% (15/118). Of 313 (56%) bacteremic melioidosis patients who met criteria for acute lower respiratory infection and were included in the hospital-based pneumonia surveillance system, 65% (202/313) had a chest radiograph performed within 48 hours of admission; 46% (92/202) showed radiographic evidence of pneumonia. Annual incidence of bacteremic melioidosis with pneumonia was 2.4 per 100,000 persons (95% confidence intervals; 1.9–2.9). In-hospital death was more likely among bacteremic melioidosis patients with pneumonia (34%; 20/59) compared with non-pneumonia patients (18%; 59/321) (P-value = 0.007). The overall mortality could have been as high as 46% (257/564) if patients with poor clinical condition at the time of discharge had died. The continued high incidence of bacteremic melioidosis, pneumonia, and deaths in an endemic area highlights the need for early diagnosis and treatment and additional interventions for the prevention and control for melioidosis.

Highlights

Melioidosis is a severe infection caused by the highly pathogenic Gram-negative bacillus, Burkholderia pseudomallei, found in soil and water throughout Southeast Asia.[1]
We provide updated estimates of melioidosis bacteremia incidence and in-hospital mortality rate using integration of two population-based surveillance databases in Nakhon Phanom, Thailand, since automated blood culture became available in 2005
Septicemic melioidosis is a major cause of morbidity and the third most frequent cause of death from infectious disease in northeastern Thailand,[10] and its incidence is highest in the northeastern region with recent estimates of 12.7,10 14.9,9 and 24.111 infections per 100,000 persons per year

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Introduction

Melioidosis is a severe infection caused by the highly pathogenic Gram-negative bacillus, Burkholderia pseudomallei, found in soil and water throughout Southeast Asia.[1] This organism is an important cause of community-acquired sepsis and pneumonia in tropical areas with infection resulting from contact with contaminated soil or water via percutaneous inoculation, wound contamination, ingestion, or aerosol inhalation.[1,2] Melioidosis affects people living in and traveling to endemic areas with increasing numbers of patients being reported in northeastern Thailand, northern Australia, Singapore, Malaysia, and parts of Africa.[3,4,5,6,7,8,9].

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