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THE ROLE AND SIGNIFICANCE OF SPUTUM CULTURES IN THE DIAGNOSIS OF MELIOIDOSIS

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  • 1 Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Menzies School of Health Research, Charles Darwin University and Northern Territory Clinical School, Flinders University, Darwin, Australia; Medical Department, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand; Department of Internal Medicine and Infectious Diseases, St. George’s Hospital Medical School, London, United Kingdom; University Medical Centre Nijmegen, The Netherlands; Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom

Pneumonia is a common manifestation of melioidosis, the disease caused by Burkholderia pseudomallei. In this study, we defined the prognostic significance of a positive sputum culture. A total of 712 patients presenting to Sappasithiprasong Hospital, Ubon Ratchathani, Thailand, with melioidosis between January 1992 and December 2002 had a sputum culture performed during admission, which was positive for B. pseudomallei in 444 patients (62%). The median duration of sputum positivity was 9 days (range, 1 to 49 days). Sputum cultures were negative in 32% of patients with radiologic changes suggestive of pulmonary involvement. Overall in-hospital mortality was 48%. A positive sputum culture was associated with mortality (adjusted OR 2.8, 95% CI: 1.9, 4.0; P < 0.001). This was independent of renal disease, a prior history of melioidosis, positive blood cultures, and other potential confounders. The presence of B. pseudomallei in the sputum of patients with melioidosis is associated with a poorer prognosis.

Author Notes

Reprint requests: Sharon J. Peacock, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Phayathai, Bangkok 10400, Thailand, Telephone: +66 2 354 9172, Fax: +66 2 354 9169, E-mail: Sharon@tropmedres.ac.
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