• 1.

    Limmathurotsakul D et al. 2016. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 1: pii: 15008.

    • Search Google Scholar
    • Export Citation
  • 2.

    Birnie E et al. 2019. Thrombocytopenia impairs host defense against Burkholderia pseudomallei (melioidosis). J Infect Dis 219: 648659.

  • 3.

    Smith S, Hanson J, Currie BJ, 2018. Melioidosis: an Australian perspective. Trop Med Infect Dis 3: pii: E27.

  • 4.

    Stephens DP, Thomas JH, Ward LM, Currie BJ, 2016. Melioidosis causing critical illness: a review of 24 Years of experience from the royal Darwin Hospital ICU. Crit Care Med 44: 15001505.

    • Search Google Scholar
    • Export Citation
  • 5.

    Cheng AC, Wuthiekanun V, Limmathurotsakul D, Chierakul W, Peacock SJ, 2008. Intensity of exposure and incidence of melioidosis in Thai children. Trans R Soc Trop Med Hyg 102 (Suppl 1): S37S39.

    • Search Google Scholar
    • Export Citation
  • 6.

    Stewart JD, Smith S, Binotto E, McBride WJ, Currie BJ, Hanson J, 2017. The epidemiology and clinical features of melioidosis in Far North Queensland: implications for patient management. PLoS Negl Trop Dis 11: e0005411.

    • Search Google Scholar
    • Export Citation
  • 7.

    Hempenstall AJ, Smith S, Stanton D, Hanson J, 2019. Melioidosis in the torres strait islands, Australia: exquisite interplay between pathogen, host, and environment. Am J Trop Med Hyg 100: 517521.

    • Search Google Scholar
    • Export Citation
  • 8.

    AIHW, 2016. Australia’s Health 2016. Australia’s Health Series No. 15. Canberra, Australia: Australian Institute of Health and Welfare.

    • Search Google Scholar
    • Export Citation
  • 9.

    Ambrosino N, Bertella E, 2018. Lifestyle interventions in prevention and comprehensive management of COPD. Breathe (Sheff) 14: 186194.

  • 10.

    Vanfleteren L, Spruit MA, Wouters EFM, Franssen FME, 2016. Management of chronic obstructive pulmonary disease beyond the lungs. Lancet Respir Med 4: 911924.

    • Search Google Scholar
    • Export Citation
  • 11.

    Tonelli M, Wiebe N, Culleton B, House A, Rabbat C, Fok M, McAlister F, Garg AX, 2006. Chronic kidney disease and mortality risk: a systematic review. J Am Soc Nephrol 17: 20342047.

    • Search Google Scholar
    • Export Citation
  • 12.

    Levey AS, Coresh J, 2012. Chronic kidney disease. Lancet 379: 165180.

  • 13.

    Kidney Health Australia, 2015. Chronic Kidney Disease (CKD) Management in General Practice, Guidance and Clinical Tips to Help Identify, Manage and Refer Patients with CKD in Your Practice. Melbourne, Victoria, Australia: Kidney Health Australia.

    • Search Google Scholar
    • Export Citation
  • 14.

    Baena-Diez JM et al. 2016. Risk of cause-specific death in individuals with diabetes: a competing risks analysis. Diabetes Care 39: 19871995.

  • 15.

    GBD 2016 Alcohol Collaborators, 2018. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 392: 10151035.

    • Search Google Scholar
    • Export Citation
  • 16.

    Cheng AC, Currie BJ, 2005. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 18: 383416.

  • 17.

    Dunachie SJ et al. 2017. Infection with Burkholderia pseudomallei–immune correlates of survival in acute melioidosis. Sci Rep 7: 12143.

  • 18.

    Kronsteiner B et al. 2019. Diabetes alters immune response patterns to acute melioidosis in humans. Eur J Immunol 2019 Apr 29. doi:10.1002/eji.201848037 [Epub ahead of print].

    • Search Google Scholar
    • Export Citation
  • 19.

    Koh GC, Schreiber MF, Bautista R, Maude RR, Dunachie S, Limmathurotsakul D, Day NP, Dougan G, Peacock SJ, 2013. Host responses to melioidosis and tuberculosis are both dominated by interferon-mediated signaling. PLoS One 8: e54961.

    • Search Google Scholar
    • Export Citation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

High Rates of Premature and Potentially Preventable Death among Patients Surviving Melioidosis in Tropical Australia

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  • 1 Department of Medicine, Cairns Hospital, Cairns, Australia;
  • | 2 The Kirby Institute, University of New South Wales, Sydney, Australia
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Although the in-hospital mortality of Australian patients with melioidosis continues to decline, the ensuing clinical course of survivors is poorly described. Between January 1, 1998, and January 31, 2019, 228 patients in Cairns, tropical Australia, survived their hospitalization with melioidosis; however, 52 (23%) subsequently died. Death occurred at a median of 3.8 years after discharge, with patients dying at a mean age of 59 years. Only 1/27 (4%) without predisposing conditions for melioidosis died during follow-up, versus 51/201 (25%) with these comorbidities (P = 0.01). Death during follow-up was more likely in patients with chronic lung disease (OR [95% CI]: 4.05 (1.84–8.93, P = 0.001) and chronic kidney disease (OR [95% CI]: 2.87 [1.33–6.20], P = 0.007), and was most commonly due to infection and macrovascular disease. A significant proportion of Australians surviving hospitalization with melioidosis will die soon after discharge, usually prematurely and frequently from preventable conditions. A more holistic approach is required to their care.

Author Notes

Address correspondence to Josh Hanson, The Kirby Institute, Level 6, Wallace Wurth Building, High Street, UNSW, Kensington NSW 2052, Australia. E-mail: jhanson@kirby.unsw.edu.au

Authors’ addresses: Josh Hanson, The Kirby Institute, University of New South Wales, Sydney, Australia, E-mail: jhanson@kirby.unsw.edu.au. Simon Smith, Department of Medicine, Cairns Hospital, Cairns, Australia, E-mail: simon.smith2@health.qld.gov.au.

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