Abstract
BackgroundOver the last two decades, many epidemiological studies were performed to describe risks and clinical presentations of melioidosis in endemic countries.MethodsWe performed a retrospective analysis of 158 confirmed cases of melioidosis collected from medical records from 2001 to 2015 in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia, in order to update the current status of melioidosis clinical epidemiology in this putatively high risk region of the country.ResultsPrincipal presentations in patients were lung infection in 65 (41.1 %), skin infection in 44 (27.8 %), septic arthritis/osteomyelitis in 20 (12.7 %) and liver infection in 19 (12.0 %). Bacteremic melioidosis was seen in most of patients (n = 121, 76.6 %). Focal melioidosis was seen in 124 (78.5 %) of patients and multi-focal melioidosis was reported in 45 (28.5 %) cases. Melioidosis with no evident focus was in 34 (21.5 %) patients. Fifty-four (34.2 %) patients developed septic shock. Internal organ abscesses and secondary foci in lungs and/or soft tissue were common. A total of 67 (41 %) cases presented during the monsoonal wet season. Death due to melioidosis was reported in 52 (32.9 %) patients, while relapses were occurred in 11 (7.0 %). Twelve fatal melioidosis cases seen in this study were directly attributed to the absence of prompt acute-phase treatment. Predisposing risk factors were reported in most of patients (n = 133, 84.2 %) and included diabetes (74.7 %), immune disturbances (9.5 %), cancer (4.4 %) and chronic kidney disease (11.4 %). On multivariate analysis, the only independent predictors of mortality were the presence of at least one co-morbid factor (OR 3.0; 95 % CI 1.1–8.4), the happening of septic shock (OR 16.5; 95 % CI 6.1–44.9) and age > 40 years (OR 6.47; 95 % CI 1.7–23.8).ConclusionsMelioidosis should be recognized as an opportunistic nonfatal infection for healthy person. Prompt early diagnosis and appropriate antibiotics administration and critical care help in improved management and minimizing risks for death.
Highlights
Over the last two decades, many epidemiological studies were performed to describe risks and clinical presentations of melioidosis in endemic countries
Burkholderia pseudomallei strains differ in their ability to cause disease and the outcome depends on the immune status and response of the infected host
The age grouping was done based on previous studies which noted that usually an individual started to acquire risk factors for melioidosis after the age of 40 [8, 9]
Summary
Over the last two decades, many epidemiological studies were performed to describe risks and clinical presentations of melioidosis in endemic countries. Melioidosis occurs predominantly in Southeast Asia, northern Australia, the Indian subcontinent and China. Thailand and Australia have the highest endemicity of melioidosis, it was not documented in both countries before 1949 [1]. Melioidosis has emerged over the past 20 years as an important cause of morbidity, mortality, and fatal communityacquired bacteremic pneumonia. The clinical spectrum of melioidosis is broad; several clinical classifications were proposed [2]. Burkholderia pseudomallei strains differ in their ability to cause disease and the outcome depends on the immune status and response of the infected host. The incubation period is approximately 21 days which starts from the event of infection and extends until the onset of symptoms appearance. The period has not been accurately estimated [3, 4]
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