Abstract
In a 12-year prospective study of 318 culture-confirmed cases of melioidosis from the Top End of the Northern Territory of Australia, rainfall data for individual patient locations were correlated with patient risk factors, clinical parameters, and outcomes. Median rainfall in the 14 days before admission was highest for those dying with melioidosis (211 mm), in comparison to 110 mm for those surviving (p = 0.0002). Median 14-day rainfall was also significantly higher for those admitted with pneumonia. On univariate analysis, a prior 14-day rainfall of ≥125 mm was significantly correlated with pneumonia (odds ratio [OR] 1.70 [confidence interval [CI] 1.09 to 2.65]), bacteremia (OR 1.93 [CI 1.24 to 3.02]), septic shock (OR 1.94 [CI 1.14 to 3.29]), and death (OR 2.50 [CI 1.36 to 4.57]). On multivariate analysis, rainfall in the 14 days before admission was an independent risk factor for pneumonia (p = 0.023), bacteremic pneumonia (p = 0.001), septic shock (p = 0.005), and death (p < 0.0001). Heavy monsoonal rains and winds may cause a shift towards inhalation of Burkholderia pseudomallei.
Highlights
In a 12-year prospective study of 318 culture-confirmed cases of melioidosis from the Top End of the Northern Territory of Australia, rainfall data for individual patient locations were correlated with patient risk factors, clinical parameters, and outcomes
The correlation with median 14-day rainfall was significantly higher for patients with pneumonia, those with bacteremia and septic shock, and those who died
Our data confirm our observations that patients admitted with melioidosis 1–2 weeks after heavy monsoonal rainfall are more ill and more likely to die
Summary
In a 12-year prospective study of 318 culture-confirmed cases of melioidosis from the Top End of the Northern Territory of Australia, rainfall data for individual patient locations were correlated with patient risk factors, clinical parameters, and outcomes. While most cases are from recent infection with B. pseudomallei, latency is well recognized, and disease has occurred up to 29 years after a person has left a melioidosis-endemic area [8]. The association between rainfall and melioidosis has long been recognized, with 75% and 85% of cases occurring in the wet season in northeast Thailand [9] and northern Australia [3], respectively. In both regions, the number of seasonal cases correlates with total rainfall. We postulate that heavy rainfall results in a shift towards inhalation as the mode of infection with B. pseudomallei, which leads to more severe illness
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