Published Date: 2011-01-27 14:00:05
Subject: PRO> Melioidosis - Australia: (QL)
Archive Number: 20110127.0319

MELIOIDOSIS - AUSTRALIA: (QUEENSLAND)
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Date: Thu 27 Jan 2011
Source: Northern Times [edited]
<http://northern-times.whereilive.com.au/news/story/disease-outbreak-at-caboolture-flood-site/>


A disease outbreak has forced Moreton Bay Regional Council to close
flood clean up sites at Caboolture's Centenary Lakes. 2 council staff
have contracted melioidosis, an infectious disease caused by a
bacterium called _Burkholderia pseudomallei_.

A council spokesman said it was working with relevant agencies to
address and investigate the incident, and was contacting everyone who
may have worked at the site since the recent floods. "They are being
urged to seek medical assistance if they exhibit symptoms such as
fever, headache, loss of appetite, cough, chest pain, and general
muscle soreness," the spokesman said.

In line with the health alert issued by Queensland's Chief Health
Officer, members of the public are urged to stay clear of areas such
as beaches, rivers, creeks, and other waterways that were subject to
increased inflows of debris and run-off due to the recent floods.

The bacteria that cause melioidosis are found in contaminated water
and soil and spread to humans and animals through direct contact with
the contaminated source.

[Byline: Glenn Roberts]

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[Most of the reports of melioidosis from Australia originate in the
Northern Territory, however, the disease is also endemic in
Queensland, which is east of the Northern Territory. The disease
usually occurs during the rainy season and may be accentuated by
extreme flooding from rain and also from tsunamis as occurred in 2005
in Thailand. A few cases were diagnosed after survivors returned to
their home country of Finland.

_Burkholderia pseudomallei_ exists as an environmental saprophyte
living in soil and surface water in endemic areas (South East 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 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.

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 of 80 to 95 per cent. With prompt optimal therapy, the
case fatality rate can be decreased to 40 to 50 per cent.

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 did not appear, as well, 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/clavulanate is a
useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis
treatment have been reviewed, and it was found that the formerly
standard therapy of chloramphenicol, doxycycline, and SXT combination
had 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.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick
SM (eds). Bioterror: the weaponization of infectious diseases. Totowa
NJ: Humana Press, 2008 pp 145-58. - Mod.LL

Caboolture and Centenary Lakes Park can be located via the
HealthMap/ProMED-mail interactive map of Australia at
<http://healthmap.org/r/0ozh>. - Sr.Tech.Ed.MJ]

See Also

2010
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Melioidosis - Australia (03): (NT) 20100506.1467
Melioidosis - Australia (02): (NT) 20100325.0952
Melioidosis - Australia: (NT) 20100113.0153
2009
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Melioidosis - Australia (NT) 20090116.0184
2008
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Melioidosis - Australia: (NT) 20080123.0279
2007
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Melioidosis - Australia (NT) (03) 20070320.0981
Melioidosis - 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 (03): Australia, Finland 20050205.0399
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): melioidosis 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
.................................................sb/ll/mj
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