The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management

Background: the epidemiology,clinical presentation and management of melioidosis vary around the world. it is essential to define the disease’s local features to optimise its management. principal findings: between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in far north queensland; 154 (78%) presented in the december-april wet season. 145 (74%) patients were bacteraemic,58 (29%) were admitted to the intensive care unit and 27 (14%) died; nine (33%) of these deaths occurred within 48 hours of presentation. pneumonia was the most frequent clinical finding,present in 101 (61%) of the 166 with available imaging. a recognised risk factor for melioidosis (diabetes,hazardous alcohol use,chronic renal disease,chronic lung disease,immunosuppression or malignancy) was present in 148 (91%) of 162 patients with complete comorbidity data. despite representing only 9% of the region’s population,aboriginal and torres strait island (atsi) people comprised 59% of the cases. atsi patients were younger than non-atsi patients (median (interquartile range): 46 (38–56) years versus 59 (43–69) years (p<0.001) and had a higher case-fatality rate (22/117 (19%) versus 5/80 (6.3%) (p = 0.01)). in the 155 patients surviving the initial intensive intravenous phase of treatment,eleven (7.1%) had disease recurrence,despite the fact that nine (82%) of these patients had received prolonged intravenous therapy. recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. the case fatality rate declined from 12/44 (27%) in the first five years of the study to 7/76 (9%) in the last five (p = 0.009),reflecting national improvements in sepsis management. conclusions: melioidosis in far north queensland is a seasonal,opportunistic infection of patients with specific comorbidities. the atsi population bear the greatest burden of disease. although the case-fatality rate is declining,deaths frequently occur early after hospitalisation,reinforcing the importance of prompt,targeted therapy in high-risk patients. © 2017 stewart et al.