Published Date: 2012-02-14 10:15:32
Subject: PRO/EDR> Melioidosis - Australia (02): (NT)
Archive Number: 20120214.1041303
MELIOIDOSIS - AUSTRALIA (02): (NORTHERN TERRITORY)
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Date: Tue 14 Feb 2012
Source: Australian Broadcasting Corp [edited]
http://www.abc.net.au/news/2012-02-14/20120214-melioidosis-tropical-disease-warning/3829408?section=nt
People living in the Top End of the Northern Territory are being warned to protect themselves against the deadly tropical disease melioidosis. The Centre for Disease Control (CDC) says 54 people have contracted the soilborne disease this wet season [2012], and 3 of them have died. It is the largest number of cases recorded this early in the year.
CDC director Vicki Krause says the disease is contracted when bacteria enter the body via cuts, sores, or inhalation. The risk of melioidosis will continue for several months, and people need to protect themselves. Dr Krause says people who have underlying conditions like cancer and lung disease should stay indoors during heavy wind or rain. Waterproof footwear and gloves should be worn when handling soil or mud-soaked items.
[byline: Kristy O'Brien]
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[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. Two 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.
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
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1i3t.]
See Also
Melioidosis - Australia: (NT) 20120121.10177312011
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Melioidosis, fatal - Taiwan: (KH, PT) 20110916.2822
Melioidosis - Australia (02): (NT) 20110412.1155
Melioidosis, camelids - Australia: (QL) 20110324.0926
Melioidosis - Australia: (QL) 20110127.0319
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 - Spain ex Gambia (03) 20091024.3662
Melioidosis - Spain ex Gambia 20091024.3662
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
Melioidosis - Brazil (Ceara) 20030314.0632
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