Published Date: 2005-03-24 23:50:00
Subject: PRO/EDR> Melioidosis, fatal - Australia (QLD)
Archive Number: 20050324.0851
MELIOIDOSIS, FATAL - AUSTRALIA (QUEENSLAND)
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Date: Thu, 24 Mar 2005
From: A-Lan Banks <A-Lan.Banks@thomson.com>
Source: Daily Telegraph, Australia [edited]
<http://dailytelegraph.news.com.au/story.jsp?sectionid=1274&storyid=2861802>
3 dead as soil disease strikes
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3 people died and 7 others were in hospital after acquiring a
tropical soil-borne disease in north Queensland. Queensland Health's
Tropical Public Health Unit today, Thu, 24 Mar 2005, warned north
Queenslanders -- especially those with poor health or chronic
conditions -- to take precautions against melioidosis following 10
recent cases.
Public health physician Jeffrey Hanna said 4 people from Cape York, 2
from Townsville, 1 from Bowen, 2 from Cairns, and a visitor from
interstate had all been struck down with the disease. A patient from
Cairns, 1 from Cape York and the interstate visitor all died from the
illness, he said. Dr Hanna said all were elderly and had underlying
medical conditions. Deaths were not unexpected in people with
underlying disease, he said.
Melioidosis is an infection caused by a [bacterium] that lives in the
soil, particularly in the tropical north of Australia. The disease is
usually acquired when broken skin comes into contact with
contaminated soil or water. It presents as either severe pneumonia
or septicemia (bacteria in the blood), and can sometimes be fatal
even with treatment. Symptoms can include skin abscesses or ulcers,
abscesses in internal organs and pneumonia.
Dr Hanna said melioidosis was a wet-season disease and there tended
to be an increase in cases following heavy rain and flooding. He
encouraged north Queenslanders to wear gloves and footwear while
gardening or working outdoors, to cover wounds with waterproof
dressings to prevent exposure to contaminated soil or water, and to
wash skin thoroughly after contact with soil.
"These measures are particularly important for people who have
underlying medical conditions, such as those with diabetes, chronic
kidney or lung disease, immune system problems or people who have a
very high alcohol intake," he said.
"Healthy people are at low risk of becoming sick from melioidosis,
but those who have underlying conditions are particularly at risk of
becoming ill."
During 2004, the disease killed 3 people in north Queensland and
struck down a further 14.
--
A-Lan Banks
<A-Lan.Banks@thomson.com>
[_Burkholderia pseudomallei_ exists as an environmental saprophyte
living in soil and surface water in endemic areas (southeast Asia and
northern tropical Australia), particularly in rice paddies. In
endemic countries, the organism exists primarily in focal areas and
is not equally distributed throughout the landscape. Sporadic cases
have been reported to have been acquired in parts of Africa and the
Americas. The organism may exist in a viable, non-cultivable state in
the environment, interacting with other organisms, particularly
protozoa, which might explain its adaptation to an intracellular
niche. 2 outbreaks in Australia have also implicated potable water
supplies rather than surface water as a potential source of the
infection.
Melioidosis is a disease of the rainy season in the endemic areas. It
mainly affects people who have direct contact with soil and water.
Many have an underlying predisposing condition such as diabetes
(commonest risk factor), renal disease, cirrhosis, thalassemia,
alcohol dependence, immunosuppressive therapy, chronic obstructive
lung disease, cystic fibrosis, and excess kava consumption. Kava is
an herbal member of the pepper family that can be associated with
chronic liver disease.
Melioidosis may present at any age, but peaks in the 4th and 5th
decades of life, affecting men more than women. In addition, although
severe fulminating infection can and does occur in healthy
individuals, severe disease and fatalities are much less common in
those without risk factors. In a rodent model, a higher inoculum can
greatly increase mortality rates even in immunologically normal hosts.
The most commonly recognized presentation of melioidosis is
pneumonia, associated with high fever, significant muscle aches,
chest pain and -- although the cough can be nonproductive --
respiratory secretions can be purulent, significant in quantity, and
associated with on-and-off bright red blood. The lung infection can
be rapidly fatal -- with bacteremia and shock -- or somewhat more
indolent.
Acute melioidosis septicemia is the most severe complication of the
infection. It presents as a typical sepsis syndrome with hypotension,
high cardiac output, and low systemic vascular resistance. In many
cases, a primary focus in the soft tissues or lung can be found. The
syndrome, usually in patients with risk factor comorbidities, is
characteristically associated with multiple abscesses involving the
cutaneous tissues, the lung, the liver, and spleen and a very high
mortality rate (80-95 percent). With prompt optimal therapy, the case
fatality rate can be decreased to 40-50 percent.
The melioidosis bacillus is intrinsically insensitive to many
antimicrobials. It should be noted that bioterrorism strains may be
engineered to be even more resistant. _B. pseudomallei_ is usually
inhibited by tetracyclines, chloramphenicol,
trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins,
carbapenems, ceftazidime, and amoxicillin/clavulanate or
ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro
activity but poor efficacy; and cefepime also did not appear to be
equivalent to ceftazidime in a mouse model. The unusual antimicrobial
profile of resistance to colistin and polymyxin B and the
aminoglycosides but sensitivity to amoxicillin/clavulante is a useful
tool to consider in treatment of infection.
The randomized and quasi-randomized trials comparing melioidosis
treatment have been reviewed, and it was found that the formerly
standard combined therapy of chloramphenicol, doxycycline, and SXT
was associated with a higher mortality rate than therapy with
ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or
ampicillin/sulbactam). The betalactam-betalactamase inhibitor
therapy, however, seemed to have a higher failure rate.
It is not clear from the posting if the out-of-state individual who
died was diagnosed in the endemic area. If not, a delay in diagnosis
could have been a contributor to the demise.
Source: Tolaney P, Lutwick LI. Meliodosis. In: Lutwick LI, Lutwick SM
(eds). Bioterror: the weaponization of infectious diseases. Totowa,
NJ: Humana Press, (in press).
- Mod.LL]
See Also
Melioidosis, tsunami-related (04): Finland 20050307.0679Melioidosis - Australia (NT) 20050116.0131
2004
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Melioidosis - Singapore (04) 20040917.2578
Undiagnosed illness - Taiwan (03): meliodosis 20040804.2133
Melioidosis - Singapore 20040409.0968
Melioidosis - Australia (NT) (02) 20040322.0797
Melioidosis - Australia (NT) 20040319.0770
Melioidosis - Australia (North Qld.) 20040308.0654
2003
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Melioidosis - Australia (Northern Territory) 20031217.3084
Melioidosis - Brazil (Ceara) 20030314.0632
2002
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Melioidosis - Australia (Queensland) 20020313.3732
1999
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Melioidosis, human - Singapore 1998 (02) 19990330.0512
Melioidosis, human - Singapore 1998 19990330.0507
1998
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Melioidosis - UK ex Indian subcontinent 19980905.1780
Melioidosis, fatal - Western Australia (02) 19980109.0061
Melioidosis, fatal - Western Australia 19980109.0060
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