The epidemiology of melioidosis in Australia and Papua New Guinea
The epidemiology of melioidosis in Australia and Papua New Guinea
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DOI：
10.1016/s0001-706x(99)00060-1
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发表时间：
2000-02-05
期刊：
影响因子：
2.7
通讯作者：
Mayo, MJ
中科院分区：
文献类型：
--
作者：
Currie, BJ;Fisher, DA;Mayo, MJ
1949年，澳大利亚在昆士兰北部（南纬22度）的绵羊中暴发了类鼻疽病。人类类鼻疽病最早于1950年在汤斯维尔（19°S）被发现。类鼻疽病在北领地上端高度流行，与泰国东北部部分地区一样，它是致命的社区获得性败血性肺炎的最常见原因。自1989年以来的9年中，在皇家达尔文医院（12度S）进行的前瞻性NT类鼻疽病研究记录了206例培养确诊的类鼻疽病例，平均年发病率为16.5/10万。类鼻疽病也见于西澳大利亚北部和昆士兰州北部，包括托雷斯海峡群岛，但在邻近的巴布亚新几内亚并不常见。血清学研究表明，感染在莫尔兹比港地区很少见，但西部省出现了类鼻疽的新证据。NT研究记录了52例（25%）病例的接种事件，潜伏期为1-21天（平均9天）；84%的病例为急性疾病，13%为慢性疾病（患病，2个月）。在4%的病例中，有证据表明潜在病灶可能重新激活；153例男性中有28例（18%）有前列腺脓肿。总死亡率为21%（43例），其中败血症病例（95例）死亡率为39%，非败血症病例（103例）死亡率为4%。肺炎是两组中最常见的症状，此外，8例患者（2例死亡）表现为类鼻疽性脑脊髓炎。澳大利亚温带地区的类鼻疽群归因于从北方进口的动物。来自西澳大利亚西南部温带地区的假马尔杆菌分离株的分子分型显示了25年的克隆性。在这次疫情和北领地的研究中，一些土壤分离株在分子上与流行病学上相关的动物和人类分离株相同。分子分型表明，在澳大利亚北部偏远土著社区发生的两起克隆疫情与供水有关。需要进一步的前瞻性合作研究来评估类鼻疽的临床特征是否存在真正的区域差异，并更好地了解假假芽孢杆菌是如何从环境中获得的。(C) 2000 Elsevier Science B.V.版权所有
Melioidosis was first described in Australia in an outbreak in sheep in 1949 in north Queensland (22 degrees S). Human melioidosis was first described from Townsville (19 degrees S) in 1950. Melioidosis is hyperendemic in the Top End of the Northern Territory (NT) and as in parts of northeastern Thailand it is the commonest cause of fatal community-acquired septicemic pneumonia. In the 9 years since 1989 the prospective NT melioidosis study at Royal Darwin Hospital (12 degrees S) has documented 206 culture confirmed cases of melioidosis, with an average annual incidence of 16.5/100 000. Melioidosis is also seen in the north of Western Australia and north Queensland, including the Torres Strait Islands, but is uncommon in adjacent Papua New Guinea. Serological studies suggest that infection is rare in the Port Moresby region, but there is emerging evidence of melioidosis from Western Province. The NT study has documented inoculating events in 52 (25%) of cases, with an incubation period of 1-21 days (mean 9 days); 84% of cases had acute disease from presumed recent acquisition and 13% had chronic disease (sick, >2 months). In 4% there was evidence of possible reactivation from a latent focus; 28 of 153 (18%) males had prostatic abscesses. The overall mortality was 21% (43 cases), with a mortality rate in septicemic cases (95) of 39% and in non-septicemic cases (103) of 4%. Pneumonia was the commonest presentation in both groups and, in addition, eight patients (two deaths) presented with melioidosis encephalomyelitis. Melioidosis clusters in temperate Australia are attributed to animals imported from the north. Molecular typing of Burkholderia pseudomallei isolates from temperate southwest Western Australia showed clonality over 25 years. In this outbreak and in studies from the NT, some soil isolates are molecularly identical to epidemiologically related animal and human isolates. Molecular typing has implicated the water supply in two clonal outbreaks in remote aboriginal communities in northern Australia. Further prospective collaborative studies are required to evaluate whether there are truly regional differences in clinical features of melioidosis and to better understand how B. pseudomallei is acquired from the environment. (C) 2000 Elsevier Science B.V. All rights reserved.