The epidemiology of melioidosis in Australia and Papua New Guinea
Introduction
Melioidosis was first described from Australia in an outbreak in sheep in 1949 in Winton, north Queensland (Cottew, 1950). The first human case described was a 32-year-old diabetic from Townsville, north Queensland, who developed fatal septicemic melioidosis (Rimington, 1962). Another case in north Queensland was documented from 1959 and the first reported case in the Northern Territory (NT) was from 1960 (Crotty et al., 1963). Since then melioidosis has been increasingly recognised as an important cause of sepsis in humans and animals in northern Australia. At Royal Darwin Hospital (RDH) in the tropical north of the NT, melioidosis is the commonest cause of fatal community-acquired bacteremic pneumonia (Currie, 1996). In a prospective pneumonia study in adults at RDH, Burkholderia pseudomallei has accounted for 60 out of 255 (24%) cases of adult community-acquired bacteremic pneumonia where the organism was identified (Currie, unpublished data). B. pseudomallei accounted for 30 (36%) of the 84 deaths in this study. Streptococcus pneumoniae was the commonest organism overall, with 100 cases (39%), but accounting for only 17 (20%) of the fatal cases.
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Endemic and introduced disease in Australia
Although the endemic area for melioidosis has generally been stated to be between the latitudes 20°S and 20°N (Leelarasamee and Bovornkitti, 1989, Dance, 1991), the first description from Australia in sheep was actually from 22°S (Cottew, 1950). Between 1981 and 1983, there were 159 cases of melioidosis in piggeries in the region of the Burnett River at 25.5°S (Ketterer et al., 1986). The cases were attributed to a contaminated water supply, possibly associated with preceding heavy rainfall and
Melioidosis in Papua New Guinea
In addition to the above case, another case was attributed to World War II service in Papua New Guinea (PNG), making a latent period of 24 years from exposure to fatal melioidosis (Kingston, 1971). This patient was from Brisbane and therefore it is also possible that there had been exposure to introduced infection. However, since 1964 at least six cases of melioidosis (four fatal) have been documented from Port Moresby (Rowlands and Curtis, 1965, De Buse et al., 1975, Lee and Naraqi, 1980,
Epidemiological findings from the prospective Royal Darwin Hospital melioidosis study
Since 1989 we have been prospectively studying all cases of melioidosis in the tropical north (Top End) of the Northern Territory (Currie et al., 1993, Merianos et al., 1993). The majority of these patients are managed at RDH, but a small number are managed in consultation with us by colleagues in the regional hospitals at Gove to the east in Arnhem Land and Katherine, 300 km south of Darwin. Over a 9-year period there have been 206 culture confirmed cases of melioidosis, with an age range from
Acknowledgements
We would like to acknowledge the expert assistance of Gary Lum, Brian Dwyer and the Microbiology staff at Royal Darwin Hospital and our medical and nursing colleagues throughout the Top End who provide ongoing care for the patients, together with Vicki Krause, Jan Bullen and Angela Merianos and staff from the Centre for Disease Control and its regional Units. Patient management has been facilitated by the enthusiasm of our Infectious Diseases Registrars, Tim Heath, Gabrielle O’Kane, Graeme
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