The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study
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{"title"=>"The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year darwin prospective study", "type"=>"journal", "authors"=>[{"first_name"=>"Bart J.", "last_name"=>"Currie", "scopus_author_id"=>"14520829200"}, {"first_name"=>"Linda", "last_name"=>"Ward", "scopus_author_id"=>"35761633900"}, {"first_name"=>"Allen C.", "last_name"=>"Cheng", "scopus_author_id"=>"8521487500"}], "year"=>2010, "source"=>"PLoS Neglected Tropical Diseases", "identifiers"=>{"scopus"=>"2-s2.0-78649801897", "pui"=>"360094641", "pmid"=>"21152057", "issn"=>"1935-2735", "isbn"=>"10.1371/journal.pntd.0000900", "doi"=>"10.1371/journal.pntd.0000900", "sgr"=>"78649801897"}, "id"=>"591abf0f-43e8-3147-bbcb-b55cda9242d5", "abstract"=>"BACKGROUND 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. PRINCIPAL FINDINGS 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). CONCLUSIONS 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.", "link"=>"http://www.mendeley.com/research/epidemiology-clinical-spectrum-melioidosis-540-cases-20-year-darwin-prospective-study", "reader_count"=>117, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>4, "Researcher"=>19, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>28, "Student > Postgraduate"=>9, "Student > Master"=>19, "Other"=>8, "Student > Bachelor"=>12, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>5, "Professor"=>3}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>4, "Researcher"=>19, "Student > Doctoral Student"=>5, "Student > Ph. D. Student"=>28, "Student > Postgraduate"=>9, "Student > Master"=>19, "Other"=>8, "Student > Bachelor"=>12, "Lecturer"=>1, "Lecturer > Senior Lecturer"=>5, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>8, "Engineering"=>2, "Environmental Science"=>1, "Biochemistry, Genetics and Molecular Biology"=>6, "Agricultural and Biological Sciences"=>37, "Medicine and Dentistry"=>50, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Physics and Astronomy"=>1, "Social Sciences"=>2, "Immunology and Microbiology"=>8}, "reader_count_by_subdiscipline"=>{"Engineering"=>{"Engineering"=>2}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>50}, "Social Sciences"=>{"Social Sciences"=>2}, "Physics and Astronomy"=>{"Physics and Astronomy"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>8}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>37}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>6}, "Unspecified"=>{"Unspecified"=>8}, "Environmental Science"=>{"Environmental Science"=>1}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}}, "reader_count_by_country"=>{"Belgium"=>1, "United States"=>2, "Japan"=>1, "Denmark"=>2, "Malaysia"=>2, "Australia"=>1, "Thailand"=>2, "Germany"=>2}, "group_count"=>2}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/406573"], "description"=>"<div><h3>Background</h3><p>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.</p><h3>Principal Findings</h3><p>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 <em>Burkholderia pseudomallei</em>. 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).</p><h3>Conclusions</h3><p>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.</p></div>", "links"=>[], "tags"=>["epidemiology", "540", "cases", "20", "darwin", "prospective"], "article_id"=>140318, "categories"=>["Biological Sciences", "Medicine", "Cancer", "Microbiology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900", "stats"=>{"downloads"=>0, "page_views"=>10, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/The_Epidemiology_and_Clinical_Spectrum_of_Melioidosis_540_Cases_from_the_20_Year_Darwin_Prospective_Study/140318", "title"=>"The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 00:05:18"}
  • {"files"=>["https://ndownloader.figshare.com/files/814542"], "description"=>"<p>RHD/CCF; rheumatic heart disease and/or congestive cardiac failure.</p><p>ns; not significant.</p>", "links"=>[], "tags"=>["factors", "278", "patients", "presenting", "melioidosis"], "article_id"=>484908, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t003", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_factors_in_278_patients_presenting_with_melioidosis_pneumonia_/484908", "title"=>"Risk factors in 278 patients presenting with melioidosis pneumonia.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:21:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/814567"], "description"=>"1<p>7 blood cultures not done, 3 blood cultures negative.</p>2<p>Culture +ve for <i>B. pseudomallei</i> only from rectal swab, although fatal septic shock.</p>3<p>blood culture not done.</p>", "links"=>[], "tags"=>["presentations", "outcomes", "540", "cases"], "article_id"=>484937, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t002", "stats"=>{"downloads"=>1, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Clinical_presentations_and_outcomes_of_540_cases_of_melioidosis_/484937", "title"=>"Clinical presentations and outcomes of 540 cases of melioidosis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:22:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/814748"], "description"=>"1<p>Risk factors; as listed in <a href=\"http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0000900#pntd-0000900-t001\" target=\"_blank\">Table 1</a>.</p><p>ns; not significant.</p>", "links"=>[], "tags"=>["critical care and emergency medicine/sepsis and multiple organ failure", "infectious diseases/bacterial infections", "infectious diseases/epidemiology and control of infectious diseases", "infectious diseases/neglected tropical diseases", "infectious diseases/tropical and travel-associated diseases", "microbiology/environmental microbiology", "microbiology/medical microbiology", "public health and epidemiology/environmental health", "public health and epidemiology/infectious diseases"], "article_id"=>485114, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t008", "stats"=>{"downloads"=>1, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Associations_with_mortality_/485114", "title"=>"Associations with mortality.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:25:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/814598"], "description"=>"1<p>more than 1 secondary focus found in some cases.</p>", "links"=>[], "tags"=>["foci", "diagnostic"], "article_id"=>484967, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t005", "stats"=>{"downloads"=>1, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Secondary_clinical_foci_for_major_primary_diagnostic_groups_/484967", "title"=>"Secondary clinical foci for major primary diagnostic groups.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:22:47"}
  • {"files"=>["https://ndownloader.figshare.com/files/814502"], "description"=>"1<p>Mostly patients taking prednisolone therapy. Two with HIV infection and 1 with HTLV-I infection.</p>2<p>Three with hepatitis B-related chronic liver disease, 1 with hemochromatosis and chronic liver disease, 1 with other chronic liver disease and 1 with multiple strokes and prior aspiration pneumonia.</p>3<p>Both elderly; ages 75 and 82 years old but no other apparent risk factors for melioidosis.</p>4<p>Not significant in comparison to those without the risk factor.</p>5<p>Risk ratio = 1.5 (95% CI 1.1–2.4) in comparison to those without chronic lung disease; p = 0.048.</p>6<p>Risk ratio = 0.11 (95%CI 0.03–0.44) in comparison to presence of any risk factor; p<0.001.</p>", "links"=>[], "tags"=>["factors", "540", "patients"], "article_id"=>484871, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t001", "stats"=>{"downloads"=>1, "page_views"=>3, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_factors_for_540_patients_with_melioidosis_/484871", "title"=>"Risk factors for 540 patients with melioidosis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:21:11"}
  • {"files"=>["https://ndownloader.figshare.com/files/814677"], "description"=>"<p>Associations with bacteremia.</p>", "links"=>[], "tags"=>["critical care and emergency medicine/sepsis and multiple organ failure", "infectious diseases/bacterial infections", "infectious diseases/epidemiology and control of infectious diseases", "infectious diseases/neglected tropical diseases", "infectious diseases/tropical and travel-associated diseases", "microbiology/environmental microbiology", "microbiology/medical microbiology", "public health and epidemiology/environmental health", "public health and epidemiology/infectious diseases"], "article_id"=>485035, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t007", "stats"=>{"downloads"=>2, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Associations_with_bacteremia_/485035", "title"=>"Associations with bacteremia.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:23:55"}
  • {"files"=>["https://ndownloader.figshare.com/files/814625"], "description"=>"1<p>calculated for males only.</p>", "links"=>[], "tags"=>["abscesses", "foci", "540", "patients"], "article_id"=>484997, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t004", "stats"=>{"downloads"=>1, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Internal_organ_abscesses_and_other_foci_of_infection_in_540_patients_with_melioidosis_/484997", "title"=>"Internal organ abscesses and other foci of infection in 540 patients with melioidosis.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:23:17"}
  • {"files"=>["https://ndownloader.figshare.com/files/814708"], "description"=>"1<p>Significant trend for lower mortality over time; p<0.001 Chi-squared test of trend for proportion.</p>2<p>Significant trend for lower mortality over time; p = 0.002 Chi-squared test of trend for proportion.</p>", "links"=>[], "tags"=>["outcomes", "20"], "article_id"=>485075, "categories"=>["Computational Biology", "Medicine", "Infectious Diseases", "Microbiology", "Virology"], "users"=>["Bart J. Currie", "Linda Ward", "Allen C. Cheng"], "doi"=>"https://dx.doi.org/10.1371/journal.pntd.0000900.t006", "stats"=>{"downloads"=>2, "page_views"=>2, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Changing_outcomes_over_the_20_years_/485075", "title"=>"Changing outcomes over the 20 years.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2010-11-30 01:24:35"}

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Relative Metric

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