Published Date: 2009-01-16 16:00:43
Subject: PRO/EDR> Melioidosis - Australia (NT)
Archive Number: 20090116.0184
MELIOIDOSIS - AUSTRALIA (NORTHERN TERRITORY)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Fri 16 Jan 2009
Source: Northern Territory News [edited]
So far, 2 people have died from melioidosis in the Northern Territory (NT)
this wet season. The victims were a man and a woman who were both
middle-aged. One of the victims was indigenous. The outbreak of the killer
tropical disease has prompted NT health authorities to issue a warning to
tourists and locals. Symptoms include fever, shortness of breath, boils,
and abdominal pain.
NT Centre for Disease Control director Dr Vicki Krause said the bacteria
lived below the soil's surface during the dry season but after heavy
rainfall could be found in surface water and mud and may become airborne.
"Cases tend to follow the rains and an increase in cases has been seen in
past years following cyclones, heavy rains and floods."
Dr Krause said there had been 10 cases of melioidosis already this wet
season, with the 2 deaths. She said it was important newcomers to the Top
End were aware of the disease and locals did not become complacent.
"Healthy people can get the disease if they are working in muddy soil
without good hand and foot protection," said Dr Krause. "Cleaning up after
flooding can lead to more people being exposed to the bacteria through
walking in muddy water and handling water or mud-soaked items."
Some people become extremely ill within a few days of becoming infected,
with fevers, headaches, confusion, or breathing difficulties. Other people
may present symptoms some time after exposure with weight loss, fevers,
skin ulcers, boils, or chest and abdominal pain, Dr Krause said.
High-pressure hoses can cause the bacteria to become airborne, with
authorities warning people to wear waterproof shoes or boots when cleaning
up flood waters. It is also recommended to wear gloves when handling soil
or mud-soaked items.
[byline: Matt Cunningham]
ProMED rapporteur Brent Barrett
[Infection due to _Burkholderia pseudomallei_ (melioidosis) is endemic in
focal areas of South East Asia and northern Australia. In Australia, it is
also known as Nightcliff gardeners' disease (Nightcliff is a northern
suburb of the city of Darwin in the Northern Territory of Australia. The
Nightcliff area was the site of RAAF [Royal Australian Air Force] camps
with spotlights and large guns used to defend Darwin from bombing during
World War II.). _B. pseudomallei_ is deemed to be a category B biowarfare
agent. It is primarily an infection of humans with underlying diseases such
as alcoholism, malnutrition, cirrhosis, and immunosuppression, but can also
affect healthy individuals, as in this report. In animal models, higher
inocula can cause more serious infection in immunocompetent individuals.
The manifestations of illness in these patients are not stated nor whether
the individuals had underlying risk factors. Clinically, infection due to
_B. pseudomallei_ may be subclinical, but rapidly progressive disseminated
disease involving the skin, liver, or spleen can occur. Pneumonia may be
the presenting form, either acute or chronic. The latter may present years
after exposure, when the individual is no longer in an endemic area and may
look very much like pulmonary tuberculosis. The diagnosis can be confirmed
microbiologically and/or serologically.
A map of Australia showing the location of the Northern Territory can be
found at <http://www.staffordmall.com/media/australia-map.gif>. - Mod.LL]