Pulmonary melioidosis in Cambodia: A prospective study

Blandine Rammaert,Bertrand Guillard,Vantha Te,Laurence Borand,Philippe Buchy,Rob Overtoom,Sophie Goyet,Sirenda Vong,Charles Mayaud,Cécile Angebault,Sopheak Hem,Patrich Lorn Try,Julien Beauté

doi:10.1186/1471-2334-11-126

Abstract

BackgroundMelioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes.MethodsWe characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome.ResultsDuring April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs.ConclusionsThe observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.

Highlights

Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia
Melioidosis is an infectious disease due to non-saprophytic Gram-negative bacillus Burkholderia pseudomallei, which can be found in wet soil and surface water [1]
Fatality rates (~62%) in our cohort were high compared to that of Thailand (40.5% in 2006) [2,16]. These high rates likely were related to multiple factors, including inadequate antibiotic therapy, low awareness of the disease and limited access to health care services rather than a severity of the disease that is peculiar to Cambodia

Summary

Introduction

Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes. The three main routes of contamination are cutaneous inoculation, intensive therapy with ceftazidime followed by 12 to 20 weeks of an oral eradication therapy using a three-drug regimen (i.e. trimethoprim-sulfamethoxazole and doxycycline) [5,10]. Outcome depends on both severity of cases and the level of health services. Septicemia and acute pulmonary forms are the most severe with fatality rates as high as 40%, despite appropriate treatment [1]

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