Clinical features and epidemiology of melioidosis pneumonia

Clinical
features and epidemiology of melioidosis pneumonia: results from a 21-year
study and review of the literature.

Clin
Infect Dis. 2012; 54(3):362-9 (ISSN: 1537-6591)

Meumann EM; Cheng AC; Ward L; Currie BJ

Infectious Diseases Department and Northern Territory Clinical School, Royal
Darwin Hospital, Darwin.

Background. Melioidosis is an important cause of
community-acquired sepsis in Southeast Asia and northern Australia, and
pneumonia is the most common presentation. Clinical manifestations range from
acute fulminant sepsis to chronic infection mimicking tuberculosis. Pneumonia
may be the primary presenting feature, or it can develop secondary to initial
disease at a distant focus. Methods. A prospective database of all melioidosis
patients at Royal Darwin Hospital (Australia) between 1989 and 2010 was reviewed.
Results. Of 624 patients with culture-confirmed melioidosis, 319 (51%)
presented with pneumonia as the primary diagnosis. Acute/subacute
presentations accounted for the majority of primary pneumonia cases (91%);
chronic disease was seen less commonly (9%). Secondary pneumonia developed
in 20% of patients with other primary melioidosis presentations and was
particularly common in those with positive blood cultures. Risk factors
for presentation with primary pneumonia (compared with other primary presentations)
were rheumatic heart disease or congestive cardiac failure, chronic obstructive
pulmonary disease, smoking, and diabetes mellitus, with P < .05 for
these conditions in a multivariate logistic regression model. Patients
presenting with pneumonia more frequently developed septic shock (33% vs 10%; P
< .001) and died (20% vs 8%; P <.001) compared with patients with other
primary presentations. Multilobar disease occurred in 28% of primary
pneumonia patients and was associated with greater mortality (32%) than in
those with single-lobe disease (14%; P < .001). Conclusions. Melioidosis
pneumonia is often a rapidly progressive illness with high mortality,
particularly among those with multilobar disease. Risk factors have been
identified, and early diagnosis and treatment should be priorities.