Sporadic and outbreak cases of melioidosis in Southern Taiwan: Clinical features and antimicrobial susceptibility

Hsin-I Shih, Y. C. Chuang, B. M.H. Cheung, J. J. Yan, Chia-Ming Chang, K. Chang, Nan-Yao Lee, H. C. Lee, C. J. Wu, Po-Lin Chen, C. C. Lee, L. R. Wang, Nai-Ying Ko, Wen-Chien Ko

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Abstract

Background: : Melioidosis has been well known to be endemic in Thailand and Northern Australia, and was reported sporadically in Taiwan before 2005. Methods: : We retrospectively analyzed 58 patients with melioidosis in southern Taiwan from 2000 to 2005, including 40 clustered and 18 sporadic cases, for clinical characteristics and antimicrobial susceptibility. Results: : Fifty-one (88%) cases were found during the rainy season, and there was a significant correlation between the average monthly rainfalls and the case number (r = 0.37; p = 0.001). Diabetes mellitus was the most common underlying disease (35 cases, 60%). The majority (52 cases, 90%) had never traveled abroad before illness, indicating indigenous acquisition of Burkholderia pseudomallei. In comparison, clustered cases were older, less often had underlying diabetes mellitus and had a shorter duration of clinical symptoms before admission than sporadic cases. Acute form of melioidosis predominated, and shock at admission was independently associated with a grave prognosis. Overall, 22% of 58 patients died in hospitals. Ceftazidime, imipenem, meropenem, amoxicillin/clavulanic acid, co-trimoxazole, and doxycycline, as previously recommended, were the potentially therapeutic choices. The role of piperacillin/ tazobactam for melioidosis remains undefined. Conclusions: : Melioidosis can occur sporadically or in a cluster in diabetic patients during rainy seasons in Taiwan.

Original languageEnglish
Pages (from-to)9-15
Number of pages7
JournalInfection
Volume37
Issue number1
DOIs
Publication statusPublished - 2009 Feb 1

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Melioidosis
Taiwan
Disease Outbreaks
meropenem
Diabetes Mellitus
Burkholderia pseudomallei
Amoxicillin-Potassium Clavulanate Combination
Ceftazidime
Imipenem
Doxycycline
Sulfamethoxazole Drug Combination Trimethoprim
Thailand
Shock

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Shih, Hsin-I ; Chuang, Y. C. ; Cheung, B. M.H. ; Yan, J. J. ; Chang, Chia-Ming ; Chang, K. ; Lee, Nan-Yao ; Lee, H. C. ; Wu, C. J. ; Chen, Po-Lin ; Lee, C. C. ; Wang, L. R. ; Ko, Nai-Ying ; Ko, Wen-Chien. / Sporadic and outbreak cases of melioidosis in Southern Taiwan : Clinical features and antimicrobial susceptibility. In: Infection. 2009 ; Vol. 37, No. 1. pp. 9-15.
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Sporadic and outbreak cases of melioidosis in Southern Taiwan : Clinical features and antimicrobial susceptibility. / Shih, Hsin-I; Chuang, Y. C.; Cheung, B. M.H.; Yan, J. J.; Chang, Chia-Ming; Chang, K.; Lee, Nan-Yao; Lee, H. C.; Wu, C. J.; Chen, Po-Lin; Lee, C. C.; Wang, L. R.; Ko, Nai-Ying; Ko, Wen-Chien.

In: Infection, Vol. 37, No. 1, 01.02.2009, p. 9-15.

Research output: Contribution to journalArticle

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T1 - Sporadic and outbreak cases of melioidosis in Southern Taiwan

T2 - Clinical features and antimicrobial susceptibility

AU - Shih, Hsin-I

AU - Chuang, Y. C.

AU - Cheung, B. M.H.

AU - Yan, J. J.

AU - Chang, Chia-Ming

AU - Chang, K.

AU - Lee, Nan-Yao

AU - Lee, H. C.

AU - Wu, C. J.

AU - Chen, Po-Lin

AU - Lee, C. C.

AU - Wang, L. R.

AU - Ko, Nai-Ying

AU - Ko, Wen-Chien

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N2 - Background: : Melioidosis has been well known to be endemic in Thailand and Northern Australia, and was reported sporadically in Taiwan before 2005. Methods: : We retrospectively analyzed 58 patients with melioidosis in southern Taiwan from 2000 to 2005, including 40 clustered and 18 sporadic cases, for clinical characteristics and antimicrobial susceptibility. Results: : Fifty-one (88%) cases were found during the rainy season, and there was a significant correlation between the average monthly rainfalls and the case number (r = 0.37; p = 0.001). Diabetes mellitus was the most common underlying disease (35 cases, 60%). The majority (52 cases, 90%) had never traveled abroad before illness, indicating indigenous acquisition of Burkholderia pseudomallei. In comparison, clustered cases were older, less often had underlying diabetes mellitus and had a shorter duration of clinical symptoms before admission than sporadic cases. Acute form of melioidosis predominated, and shock at admission was independently associated with a grave prognosis. Overall, 22% of 58 patients died in hospitals. Ceftazidime, imipenem, meropenem, amoxicillin/clavulanic acid, co-trimoxazole, and doxycycline, as previously recommended, were the potentially therapeutic choices. The role of piperacillin/ tazobactam for melioidosis remains undefined. Conclusions: : Melioidosis can occur sporadically or in a cluster in diabetic patients during rainy seasons in Taiwan.

AB - Background: : Melioidosis has been well known to be endemic in Thailand and Northern Australia, and was reported sporadically in Taiwan before 2005. Methods: : We retrospectively analyzed 58 patients with melioidosis in southern Taiwan from 2000 to 2005, including 40 clustered and 18 sporadic cases, for clinical characteristics and antimicrobial susceptibility. Results: : Fifty-one (88%) cases were found during the rainy season, and there was a significant correlation between the average monthly rainfalls and the case number (r = 0.37; p = 0.001). Diabetes mellitus was the most common underlying disease (35 cases, 60%). The majority (52 cases, 90%) had never traveled abroad before illness, indicating indigenous acquisition of Burkholderia pseudomallei. In comparison, clustered cases were older, less often had underlying diabetes mellitus and had a shorter duration of clinical symptoms before admission than sporadic cases. Acute form of melioidosis predominated, and shock at admission was independently associated with a grave prognosis. Overall, 22% of 58 patients died in hospitals. Ceftazidime, imipenem, meropenem, amoxicillin/clavulanic acid, co-trimoxazole, and doxycycline, as previously recommended, were the potentially therapeutic choices. The role of piperacillin/ tazobactam for melioidosis remains undefined. Conclusions: : Melioidosis can occur sporadically or in a cluster in diabetic patients during rainy seasons in Taiwan.

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