Published Date: 2007-03-20 18:00:02
Subject: PRO> Melioidosis - Australia (NT) (03)
Archive Number: 20070320.0981
MELIOIDOSIS - AUSTRALIA (NORTHERN TERRITORY) (03)
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Date: Tue 20 Mar 2007
From: David Dance <david.dance@phnt.swest.nhs.uk>
I should like to make some comments about the recent posting on melioidosis.
1. By far the strongest association with underlying predisposition to
melioidosis is diabetes mellitus, not mentioned in the discussion.
2. The suggestion that the infection might have been caught whilst
mowing the lawn is interesting, but this has never before been
reported as a risk factor for melioidosis. There is a fundamental
difference between this and tularemia in that the primary reservoir
for _Burkholderia pseudomallei_ is the soil itself, whereas with
_Francisella tularensis_ it is animals that may deposit the organism
on the surface. Furthermore, _B. pseudomallei_ is usually only
readily detected in waterlogged soil, conditions that would not be
favourable for lawn mowing. There is increasing evidence, especially
from northern Australia, that infection may be acquired by inhalation
of aerosols during severe weather events, which may be far more
common than previously recognised and might account for cases of
infection that do not have regular contact with soil and surface water.
3. Chloramphenicol really has no place in the management of the
disease these days, except in extremely resource-poor settings where
other drugs cannot be obtained. The mainstay of acute phase treatment
is ceftazidime, imipenem, or meropenem, with co-trimoxazole and
doxycycline used as 1st choice treatment during the 'eradication' phase.
4. Serodiagnosis is fraught with problems in inhabitants of endemic
areas like northern Australia due to high background seropositivity.
--
Dr David Dance
Regional Microbiologist
Health Protection Agency (South West)
Devon, United Kingdom
<david.dance@phnt.swest.nhs.uk>
[Dr. Dance has written extensively regarding melioidosis. ProMED-mail
(and this moderator) thank him for his comments. - Mod.LL]
See Also
Melioidosis - Australia (NT) (02) 20070319.0960Melioidosis - Australia (NT) 20070102.0016
2006
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Melioidosis 2005 - USA (FL) ex Honduras 20060820.2334
2005
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Melioidosis, fatal - Malaysia (Malacca): susp. RFI 20050601.1530
Melioidosis, fatal - Australia (QLD)(02) 20050326.0873
Melioidosis, fatal - Australia (QLD) 20050324.0851
Melioidosis, tsunami-related (04): Finland 20050307.0679
Melioidosis, tsunami-related (03): Australia, Finland 20050205.0399
Melioidosis, tsunami-related (02): Thailand RFI 20050202.0356
Melioidosis, tsunami-related - Thailand 20050127.0296
Melioidosis - 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
..............................ll/mj/mpp
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