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Pulmonary melioidosis in Cambodia: a prospective study.

Rammaert B, Beauté J, Borand L, Hem S, Buchy P, Goyet S, Overtoom R, Angebault C, Te V, Try PL, Mayaud C, Vong S, Guillard B - BMC Infect. Dis. (2011)

Bottom Line: Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei.Effective drugs that were available did not include ceftazidime.The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut Pasteur - Cambodia, Phnom Penh, Cambodia.

ABSTRACT

Background: Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes.

Methods: We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome.

Results: During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs.

Conclusions: The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.

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Related in: MedlinePlus

Chest radiographs evoking tuberculosis in 5 patients with pulmonary melioidosis. A: 48 year-old male; B: 52 year-old male; C: 52 year-old male who had a positive smear for acid-fast bacilli; D, 36 year-old male; E, 43 year-old male
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Figure 1: Chest radiographs evoking tuberculosis in 5 patients with pulmonary melioidosis. A: 48 year-old male; B: 52 year-old male; C: 52 year-old male who had a positive smear for acid-fast bacilli; D, 36 year-old male; E, 43 year-old male

Mentions: Chest radiographs were only available in 34 (87.2%) cases (Table 4). Of these, 5 patients had no evidence of pneumonia or pleural effusion, 2 only had pleural effusions and 27 (79.4%) had pneumonia associated with abscesses, nodules or pleural effusions; 16 (59.3%) pneumonia consisted of pulmonary lesions in two or more lobes. All severe melioidosis cases for which chest radiographs were available showed evidence of pneumonia with either alveolar consolidation (n = 2), nodules (n = 3) or pleuropneumonia (n = 2). Two patients who had normal chest radiographs tested positive for B. pseudomallei by blood culture. Pulmonary sequelae were found on 3 chest radiographs including emphysema, probable TB sequelae and bronchiectasis related- post-infection. Interestingly the experts panel interpreted chest radiographs of five cases of melioidosis as TB-like (Figure 1); all but one were negative for acid-fast bacilli (AFB) by direct sputum examination (in line with the national TB program, AFB negative pneumonias evocative of TB are not systematically cultured). Three of these five cases had chronic melioidosis.


Pulmonary melioidosis in Cambodia: a prospective study.

Rammaert B, Beauté J, Borand L, Hem S, Buchy P, Goyet S, Overtoom R, Angebault C, Te V, Try PL, Mayaud C, Vong S, Guillard B - BMC Infect. Dis. (2011)

Chest radiographs evoking tuberculosis in 5 patients with pulmonary melioidosis. A: 48 year-old male; B: 52 year-old male; C: 52 year-old male who had a positive smear for acid-fast bacilli; D, 36 year-old male; E, 43 year-old male
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117704&req=5

Figure 1: Chest radiographs evoking tuberculosis in 5 patients with pulmonary melioidosis. A: 48 year-old male; B: 52 year-old male; C: 52 year-old male who had a positive smear for acid-fast bacilli; D, 36 year-old male; E, 43 year-old male
Mentions: Chest radiographs were only available in 34 (87.2%) cases (Table 4). Of these, 5 patients had no evidence of pneumonia or pleural effusion, 2 only had pleural effusions and 27 (79.4%) had pneumonia associated with abscesses, nodules or pleural effusions; 16 (59.3%) pneumonia consisted of pulmonary lesions in two or more lobes. All severe melioidosis cases for which chest radiographs were available showed evidence of pneumonia with either alveolar consolidation (n = 2), nodules (n = 3) or pleuropneumonia (n = 2). Two patients who had normal chest radiographs tested positive for B. pseudomallei by blood culture. Pulmonary sequelae were found on 3 chest radiographs including emphysema, probable TB sequelae and bronchiectasis related- post-infection. Interestingly the experts panel interpreted chest radiographs of five cases of melioidosis as TB-like (Figure 1); all but one were negative for acid-fast bacilli (AFB) by direct sputum examination (in line with the national TB program, AFB negative pneumonias evocative of TB are not systematically cultured). Three of these five cases had chronic melioidosis.

Bottom Line: Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei.Effective drugs that were available did not include ceftazidime.The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut Pasteur - Cambodia, Phnom Penh, Cambodia.

ABSTRACT

Background: Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes.

Methods: We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome.

Results: During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs.

Conclusions: The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.

Show MeSH
Related in: MedlinePlus