Recurrent melioidosis in patients in northeast Thailand is frequently due to reinfection rather than relapse
Recurrent melioidosis in patients in northeast Thailand is frequently due to reinfection rather than relapse
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DOI：
10.1128/jcm.43.12.6032-6034.2005
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发表时间：
2005-12-01
影响因子：
9.4
通讯作者：
Peacock, SJ
中科院分区：
文献类型：
--
作者：
Maharjan, B;Chantratita, N;Peacock, SJ
人类类鼻疽病与高复发率有关，尽管有足够的抗菌治疗。在这里，我们定义了1986-2005年间在泰国东北部Sappasithiprasong医院接受治疗的116名患者的复发率和再感染率，这些患者有123次复发类鼻炎。对所有的分离物进行脉冲场凝胶电泳法；通过基于多位点序列分型的基于序列的方法对给定患者的原发病和复发性疾病的分离物进行检测。总体而言，92例(75%)的复发疾病是由同一菌株(复发)引起的，31例(25%)是由于感染了一种新的菌株(再次感染)。复发和再感染患者的复发间隔时间不同；复发患者的中位复发时间为228d(15~3,757d；四分位数区间为99.5~608d)，而再感染患者的中位复发时间为823d(范围为17~2,931d；IQR453~1211天)(P=0.0001)。首次感染后12个月内共发生发作(52%)。原发病后1年内复发感染中57例(89%)与复发有关，而1年后59例中有35例(59%)复发(P<；0.0001)。我们的数据表明，在这种地方性的背景下，再感染是导致四分之一的复发病例的原因。这一发现对类鼻疽患者的临床治疗和抗生素治疗研究具有重要意义，这些研究将复发疾病作为治疗失败的标志。
Human melioidosis is associated with a high rate of recurrent disease, despite adequate antimicrobial treatment. Here, we define the rate of relapse versus the rate of reinfection in 116 patients with 123 episodes of recurrent melioidosis who were treated at Sappasithiprasong Hospital in Northeast Thailand between 1986 and 2005. Pulsed-field gel electrophoresis was performed on all isolates; isolates from primary and recurrent disease for a given patient different by one or more bands were examined by a sequence-based approach based on multilocus sequence typing. Overall, 92 episodes (75%) of recurrent disease were caused by the same strain (relapse) and 31 episodes (25%) were due to infection with a new strain (reinfection). The interval to recurrence differed between patients with relapse and reinfection; those with relapses had a median time to relapse of 228 days (range, 15 to 3,757 days; interquartile range [IQR], 99.5 to 608 days), while those with reinfection had a median time to reinfection of 823 days (range, 17 to 2,931 days; IQR, 453 to 1,211 days) (P = 0.0001). A total of 64 episodes (52%) occurred within 12 months of the primary infection. Relapse was responsible for 57 of 64 (89%) episodes of recurrent infection within the first year after primary disease, whereas relapse was responsible for 35 of 59 (59%) episodes after I year (P < 0.0001). Our data indicate that in this setting of endemicity, reinfection is responsible for one-quarter of recurrent cases. This finding has important implications for the clinical management of melioidosis patients and for antibiotic treatment studies that use recurrent disease as a marker for treatment failure.