Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia.
PLoS Negl Trop Dis. 2010 Nov 30;4(11):e900. doi: 10.1371/journal.pntd.0000900.
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.
自 1989 年 10 月以来的 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%），无明显病灶菌血症 59 例（11%），脓毒性关节炎/骨髓炎 20 例（4%），神经类鼻疽 14 例（3%）。298 例（55%）为菌血症，116 例（21%）发生感染性休克（58 例死亡）。常见内脏脓肿和肺部及/或关节的继发性病灶。前列腺脓肿发生在 76 例（372 例男性中的 20%）。96 例（18%）有职业接触伯克霍尔德氏菌。118 例（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%）在季风性雨季发病。12 月至 2 月肺炎发生率较高，支持严重天气事件时吸入感染的假设。29 例患者反复发作类鼻疽，主要归因于治疗依从性差。死亡率从第 1 至 5 年的 30%降至第 5 至 10 年的 9%（p<0.001）。类鼻疽的危险因素包括糖尿病（39%）、危险饮酒（39%）、慢性肺病（26%）和慢性肾病（12%）。20%的患者没有可识别的危险因素。在 77 例死亡病例（14%）中，75 例至少有一种危险因素；另 2 例为老年人。在多变量分析中，年龄、地点和季节，唯一的独立死亡预测因子是至少有一种危险因素（OR 9.4；95%CI 2.3-39）和年龄≥50 岁（OR 2.0；95%CI 1.2-2.3）。
类鼻疽应被视为一种机会性感染，只要及早诊断并提供适当的抗生素和重症监护资源，就不太可能杀死健康人。
