Currie B J, Fisher D A, Anstey N M, Jacups S P
Division of Medicine, Royal Darwin Hospital Clinical School, Flinders University, Northern Territory, Australia.
Trans R Soc Trop Med Hyg. 2000 May-Jun;94(3):301-4. doi: 10.1016/s0035-9203(00)90333-x.
In melioidosis-endemic regions the importance of re-activation of Burkholderia pseudomallei from latent foci remains unclear. This topic was assessed in a 10-year prospective study (1989-99) of melioidosis in the tropical north of the Northern Territory of Australia, together with other aspects of the nature of melioidosis. Incubation period from defined inoculating events was previously ascertained as 1-21 (mean 9) days. Of 252 total cases 244 (97%) were considered to be from recent acquisition of B. pseudomallei infection and 8 (3%) were considered to be re-activation from a latent focus. Acute illness occurred in 222 (88%) cases; 30 (12%) cases had chronic illness (symptomatic for > 2 months). Of the 207 patients surviving the initial illness, 27 (13%) had a confirmed relapse (mean time from initial diagnosis of 8 months), with 5 relapsing twice. Of these 32 relapses, 15 (3 fatal) were associated with poor adherence to the eradication therapy antibiotics and 10 (none fatal) were failures of eradication with doxycycline monotherapy. Following initial intensive therapy with ceftazidime or meropenem for at least 14 days, eradication therapy with trimethoprim-sulphamethoxazole monotherapy for at least 3 months had been more successful.
在类鼻疽病流行地区，伯克霍尔德菌属假鼻疽杆菌从潜伏病灶重新激活的重要性仍不明确。在一项针对澳大利亚北领地热带北部地区类鼻疽病的为期10年（1989 - 1999年）的前瞻性研究中，对这一主题以及类鼻疽病的其他本质特征进行了评估。先前已确定从明确的接种事件算起潜伏期为1 - 21天（平均9天）。在总共252例病例中，244例（97%）被认为是近期感染伯克霍尔德菌属假鼻疽杆菌所致，8例（3%）被认为是潜伏病灶重新激活。222例（88%）出现急性疾病；30例（12%）患有慢性疾病（症状持续超过2个月）。在最初疾病中存活的207例患者中，27例（13%）有确诊的复发（从最初诊断算起平均时间为8个月），其中5例复发两次。在这32次复发中，15次（3次致命）与根除治疗抗生素依从性差有关，10次（无致命）是强力霉素单药根除治疗失败。在最初用头孢他啶或美罗培南进行至少14天的强化治疗后，用甲氧苄啶 - 磺胺甲恶唑单药进行至少3个月的根除治疗更为成功。
