The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study.
The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study.
复制标题
DOI：
10.1371/journal.pntd.0000900
复制
发表时间：
2010-11-30
影响因子：
3.8
通讯作者：
Cheng AC
中科院分区：
文献类型：
--
作者：
Currie BJ;Ward L;Cheng AC
从1989年10月开始的20多年里，达尔文前瞻性类鼻疽研究记录了来自热带澳大利亚的540例病例，为流行病学和临床谱提供了新的见解。主要表现为肺炎278例（51%）、泌尿生殖道感染76例（14%）、皮肤感染68例（13%）、无明显病灶的菌血症59例（11%）、脓毒性关节炎/骨髓炎20例（4%）和神经性类鼻疽14例（3%）。298例（55%）为菌血症，116例（21%）发生败血性休克（58例死亡）。常见内脏器官脓肿和继发于肺和/或关节的病灶。76例（占372例男性的20%）发生前列腺增生。96例（18%）职业性暴露于类鼻疽伯克霍尔德菌。118人（22%）有特定的娱乐或职业事件被认为是可能的感染事件。436例（81%）出现在季风雨季。12月至2月肺炎患者比例较高，支持在恶劣天气事件期间通过吸入感染的假设。29例发生复发性类鼻疽，主要归因于治疗依从性差。死亡率从前5年的30%下降到后5年的9%（p<0.001）。类鼻疽的危险因素包括糖尿病（39%）、危险酒精使用（39%）、慢性肺病（26%）和慢性肾病（12%）。20%的患者没有可识别的风险因素。在77例致死性病例（14%）中，75例至少有一个风险因素;另外2例为老年人。在对危险因素、年龄、地点和季节的多变量分析中，死亡率的唯一独立预测因素是存在至少一个危险因素（OR 9.4; 95%CI 2.3-39）和年龄≥50岁（OR 2.0; 95%CI 1.2-2.3）。类鼻疽病应被视为一种机会性感染，不太可能杀死一个健康的人，只要感染被早期诊断，并有资源提供适当的抗生素和重症监护。类鼻疽是一种职业和娱乐获得性感染，在东南亚和澳大利亚北方很重要。最近，全球各地都报告了病例。负责细菌，类鼻疽伯克霍尔德氏菌，被认为是一种潜在的生物威胁剂。诱发类鼻疽的风险因素是公认的，最明显的是糖尿病。达尔文前瞻性类鼻疽研究在过去20年中确定了540例类鼻疽病例，对流行病学和临床结果的分析为这种疾病提供了重要的新见解。除糖尿病、危险饮酒和慢性肾脏疾病外，确定的风险因素还包括慢性肺病、恶性肿瘤、风湿性心脏病、心力衰竭和年龄≥50岁。半数患者出现肺炎和感染性休克（21%）。死亡率从研究前5年的30%下降到过去5年的9%，这归因于早期诊断和重症监护管理的改善。在77例致死性病例（14%）中，所有病例均具有已知的类鼻疽风险因素。这支持了这项研究最重要的结论，即只要感染得到早期诊断，并且有资源在需要时提供适当的抗生素和重症监护，类鼻疽病不太可能杀死健康人。
Over 20 years, from October 1989, the Darwin prospective melioidosis study has documented 540 cases from tropical Australia, providing new insights into epidemiology and the clinical spectrum. The principal presentation was pneumonia in 278 (51%), genitourinary infection in 76 (14%), skin infection in 68 (13%), bacteremia without evident focus in 59 (11%), septic arthritis/osteomyelitis in 20 (4%) and neurological melioidosis in 14 (3%). 298 (55%) were bacteremic and 116 (21%) developed septic shock (58 fatal). Internal organ abscesses and secondary foci in lungs and/or joints were common. Prostatic abscesses occurred in 76 (20% of 372 males). 96 (18%) had occupational exposure to Burkholderia pseudomallei. 118 (22%) had a specific recreational or occupational incident considered the likely infecting event. 436 (81%) presented during the monsoonal wet season. The higher proportion with pneumonia in December to February supports the hypothesis of infection by inhalation during severe weather events. Recurrent melioidosis occurred in 29, mostly attributed to poor adherence to therapy. Mortality decreased from 30% in the first 5 years to 9% in the last five years (p<0.001). Risk factors for melioidosis included diabetes (39%), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%). There was no identifiable risk factor in 20%. Of the 77 fatal cases (14%), 75 had at least one risk factor; the other 2 were elderly. On multivariate analysis of risk factors, age, location and season, the only independent predictors of mortality were the presence of at least one risk factor (OR 9.4; 95% CI 2.3–39) and age ≥50 years (OR 2.0; 95% CI 1.2–2.3). Melioidosis should be seen as an opportunistic infection that is unlikely to kill a healthy person, provided infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care. Melioidosis is an occupationally and recreationally acquired infection important in Southeast Asia and northern Australia. Recently cases have been reported from more diverse locations globally. The responsible bacterium, Burkholderia pseudomallei, is considered a potential biothreat agent. Risk factors predisposing to melioidosis are well recognised, most notably diabetes. The Darwin prospective melioidosis study has identified 540 cases of melioidosis over 20 years and analysis of the epidemiology and clinical findings provides important new insights into this disease. Risk factors identified in addition to diabetes, hazardous alcohol use and chronic renal disease include chronic lung disease, malignancies, rheumatic heart disease, cardiac failure and age ≥50 years. Half of patients presented with pneumonia and septic shock was common (21%). The decrease in mortality from 30% in the first 5 years of the study to 9% in the last five years is attributed to earlier diagnosis and improvements in intensive care management. Of the 77 fatal cases (14%), all had known risk factors for melioidosis. This supports the most important conclusion of the study, which is that melioidosis is very unlikely to kill a healthy person, provided the infection is diagnosed early and resources are available to provide appropriate antibiotics and critical care where required.
登录
查看更多内容
DOI：
10.4269/ajtmh.2005.73.1165
发表时间：
2005-12-01
影响因子：
3.3
作者：
Chierakul, W;Wuthiekanun, V;Peacock, SJ
通讯作者：
Peacock, SJ
影响因子：
3.1
作者：
Chanchamroen, Sujin;Kewcharoenwong, Chidchamai;Lertmemongkolchai, Ganjana
通讯作者：
Lertmemongkolchai, Ganjana
影响因子：
15.8
作者：
Cheng, Allen C.;West, T. Eoin;Peacock, Sharon J.
通讯作者：
Peacock, Sharon J.
DOI：
10.1016/s0035-9203(08)70010-5
发表时间：
2008-12-01
影响因子：
2.2
作者：
Cheng, Allen C;Wuthiekanun, Vanaporn;Peacock, Sharon J
通讯作者：
Peacock, Sharon J
DOI：
10.1016/j.trstmh.2004.01.011
发表时间：
2004-11-01
影响因子：
2.2
作者：
Chierakul, W;Rajanuwong, A;White, NJ
通讯作者：
White, NJ