Stewart James D, Smith Simon, Binotto Enzo, McBride William J, Currie Bart J, Hanson Josh
Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia.
James Cook University Clinical School, Cairns Hospital, Cairns, Queensland, Australia.
PLoS Negl Trop Dis. 2017 Mar 6;11(3):e0005411. doi: 10.1371/journal.pntd.0005411. eCollection 2017 Mar.
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.
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.
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.
类鼻疽病的流行病学、临床表现及治疗在世界各地存在差异。明确该病的局部特征对于优化其治疗至关重要。
1998年至2016年期间，昆士兰远北地区有197例经培养确诊的类鼻疽病病例；154例（78%）出现在12月至次年4月的雨季。145例（74%）患者发生菌血症，58例（29%）入住重症监护病房，27例（14%）死亡；其中9例（33%）在就诊后48小时内死亡。肺炎是最常见的临床症状，166例有影像学资料的患者中101例（61%）出现肺炎。162例有完整合并症数据的患者中，148例（91%）存在类鼻疽病的公认危险因素（糖尿病、有害饮酒、慢性肾病、慢性肺病、免疫抑制或恶性肿瘤）。尽管原住民和托雷斯海峡岛民（ATSI）仅占该地区人口的9%，但却占病例的59%。ATSI患者比非ATSI患者年轻（中位数（四分位间距）：46（38 - 56）岁对59（43 - 69）岁（p<0.001）），且病死率更高（22/117（19%）对5/80（6.3%）（p = 0.01））。在155例度过初始强化静脉治疗阶段的患者中，11例（7.1%）疾病复发，尽管这些患者中有9例（82%）接受了延长的静脉治疗。复发通常是由于源头控制不足或口服根除治疗依从性差。病死率从研究的前五年的12/44（27%）降至最后五年的7/76（9%）（p = 0.009），反映出全国在脓毒症管理方面的改善。
昆士兰远北地区的类鼻疽病是一种季节性的、针对特定合并症患者的机会性感染。ATSI人群承担着最大的疾病负担。尽管病死率在下降，但死亡经常发生在住院后早期，这凸显了对高危患者进行及时、有针对性治疗的重要性。
