Gibney Katherine B, Cheng Allen C, Currie Bart J
Infectious Diseases Unit and Northern Territory Clinical School, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Clin Infect Dis. 2008 Sep 1;47(5):603-9. doi: 10.1086/590931.
Burkholderia pseudomallei is endemic in northern Australia, and melioidosis is a common cause of sepsis in the region.
We summarized the cutaneous manifestations of melioidosis from a prospective cohort of 486 patients with culture-confirmed melioidosis in northern Australia, and we compared those who had primary skin melioidosis with those who had other forms of melioidosis.
Primary skin melioidosis occurred in 58 patients (12%). Secondary skin melioidosis--multiple pustules from hematogenous spread--was present in 10 patients (2%). Patients with primary skin melioidosis were more likely to have chronic presentations (duration, >or=2 months). On multivariate analysis, patients with primary cutaneous melioidosis were more likely to be children aged <or=15 years (adjusted odds ratio, 8.50; 95% confidence interval [CI], 3.24-22.28) and to have a history of occupational exposure to B. pseudomallei (adjusted odds ratio, 3.12; 95% CI, 1.56-6.25) but were less likely to have typical risk factors--including diabetes (adjusted odds ratio, 0.26; 95% CI, 0.12-0.56), excessive alcohol intake (adjusted odds ratio, 0.45; 95% CI, 0.22-0.90), and chronic lung disease (adjusted odds ratio, 0.26; 95% CI, 0.10-0.67). Of those patients with primary skin melioidosis, 1 patient was bacteremic and none had severe sepsis or died from melioidosis. Four (7%) of the 58 patients presenting with primary skin melioidosis had disseminated melioidosis, and 1 (2%) experienced a relapse of melioidosis. Nine patients (16%) were cured with a regimen of oral antibiotics alone, and 1 recovered with no therapy.
In our cohort, patients with primary skin melioidosis were younger, had fewer underlying medical conditions, and had better outcomes than did those with other forms of melioidosis. There may be a role for exclusive oral antibiotic therapy for some cases of primary skin melioidosis.
类鼻疽杆菌在澳大利亚北部为地方病，类鼻疽是该地区脓毒症的常见病因。
我们总结了澳大利亚北部486例经培养确诊的类鼻疽患者前瞻性队列中的类鼻疽皮肤表现，并将原发性皮肤类鼻疽患者与其他形式类鼻疽患者进行了比较。
原发性皮肤类鼻疽发生于58例患者（12%）。继发性皮肤类鼻疽（血行播散所致多个脓疱）见于10例患者（2%）。原发性皮肤类鼻疽患者更易出现慢性表现（病程≥2个月）。多因素分析显示，原发性皮肤类鼻疽患者更可能为15岁及以下儿童（校正比值比，8.50；95%置信区间[CI]，3.24 - 22.28）且有职业性接触类鼻疽杆菌病史（校正比值比，3.12；95%CI，1.56 - 6.25），但不太可能有典型危险因素，包括糖尿病（校正比值比，0.26；95%CI，0.12 - 0.56）、过量饮酒（校正比值比，0.45；95%CI，0.22 - 0.90）和慢性肺病（校正比值比，0.26；95%CI，0.10 - 0.67）。在原发性皮肤类鼻疽患者中，1例发生菌血症，无患者发生严重脓毒症或死于类鼻疽。58例原发性皮肤类鼻疽患者中有4例（7%）发生播散性类鼻疽，1例（2%）出现类鼻疽复发。9例患者（16%）仅接受口服抗生素治疗治愈，1例未治疗而康复。
在我们的队列中，原发性皮肤类鼻疽患者比其他形式类鼻疽患者年龄更小，基础疾病更少，结局更好。对于某些原发性皮肤类鼻疽病例，单纯口服抗生素治疗可能有效。
