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Australia Thirty-year Menzies melioidosis study finds cases are rising but mortality has tumbled

03:36  23 july  2021
03:36  23 july  2021 Source:   abc.net.au

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New research shows the mortality rate for melioidosis has declined. But the number of cases being diagnosed is steadily increasing. Experts say people with existing conditions such as diabetes and heavy drinkers are at the highest risk. Mr Creek remembers that day — and the weeks leading up to it — well. The researchers found the number of cases diagnosed each year trended upwards, rising from six in the first year of their study to 41 cases in the final one (there was also a spike of 96 cases over the 2011-12 wet season following Cyclone Grant).

Cases of melioidosis , which is also known as Whitmore's disease, are under-reported because its symptoms - including abscesses, fever and sepsis - are quite unspecific. Proper diagnosis also requires laboratory equipment that is scarce in developing countries, where Burkholderia pseudomallei, the When accurately diagnosed and treated properly, melioidosis death rates can be as low as 10 percent, but without the right medication they can rise to as high as 70 percent. When untreated, the disease kills up to 9 patients in 10. The authors of the study say their model predicts that melioidosis killed

On the day Bob Creek was due to retire, he was in Royal Darwin Hospital being treated for a potentially deadly soil-borne disease.

Mr Creek remembers that day — and the weeks leading up to it — well.

On May 4, 2017, he fell down a verandah footing and scraped his leg.

"It was a bit of a muddy hole, and I took some skin off my shin — nothing out of the ordinary," Mr Creek said.

Six weeks later, and with his wound no closer to healing, Mr Creek learned he had acquired a potentially lethal disease when he came into contact with the mud.

Melioidosis is caused by a bacterium living in the soil that comes to the surface during heavy rainfall.

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Melioidosis has a wide range of radiological manifestations making it a mimicker. Diagnosis requires a high index of clinical suspicion in patients with septicemia or a fever of unknown origin living in or with a travel history to endemic areas. We present a pictorial review of the radiological manifestations of melioidosis , which is a useful knowledge for radiologists to help arrive at an early diagnosis. In this pictorial review, we present the radiological manifestations chosen from 139 patients with culture proven melioidosis .

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"My knowledge of melioidosis was that death commonly followed, and I thought at that point I was a candidate," Mr Creek said.

New research, published today in The Lancet Infectious Diseases medical journal, has tracked the disease as it has moved out of medical obscurity.

It shows that although fewer people in Darwin are dying from the disease, the number of cases being diagnosed is steadily increasing.

'Melioidosis was gravely feared'

Researchers followed patients who had been diagnosed with the disease in Darwin over the past 30 years, tracking their age, location and any pre-existing health conditions such as diabetes or chronic lung disease.

Lead author Bart Currie from the Menzies School of Health Research said the mortality rate for people diagnosed with melioidosis plummeted over the lifetime of the study.

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"When we first started the study, melioidosis was gravely feared in the Top End because it was causing such high mortality," he said.

Over the first five years of the study, 31 per cent of people diagnosed with melioidosis in Darwin died from the disease, compared with 6 per cent of people who died from the disease in the last five years of the study.

Professor Currie put this down to four key reasons: early diagnosis, access to new antibiotics for treatment, increased public awareness and the high level of care given to critically ill patients.

"If you can make that diagnosis within 24 to 48 hours of a person's illness or presentation then you have an opportunity to do the things that can to save their lives," he said.

University of Western Australia senior research fellow Mitali Sarkar-Tyson agreed rapid diagnosis played a major role in improving survival rates, as did awareness.

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"There's also been a lot of work done to educate medical professions about the need to routinely test for melioidosis," she said.

"The disease itself has flu-like symptoms so it's quite often misdiagnosed."

The study shows cases of melioidosis in Darwin directly correlate with rainfall, with 80 per cent of infections diagnosed during the wet season.

More cases of the disease

The researchers found the number of cases diagnosed each year trended upwards, rising from six in the first year of their study to 41 cases in the final one (there was also a spike of 96 cases over the 2011-12 wet season following Cyclone Grant).

The number of cases per 100,000 people in Darwin also increased.

Professor Currie said there were several reasons for this increase, including the fact that more people in the Top End had diabetes (a risk factor for the disease) today than in the early 1990s.

He said construction across the Greater Darwin also contributed to higher caseloads, because this work disrupted the soil.

Dr Sarkar-Tyson added that increased awareness likely led to more tests and diagnoses.

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Professor Currie said their research provided some evidence that the bacteria can become airborne during a monsoon.

And he warned future caseloads would increase due to climate change.

"Global warming is likely to increase the risk of melioidosis in the future," he said.

"The bacterium will proliferate more because of a combination of things: the warmer temperatures, the greater humidity in the tropics and more increased rainfall."

A warning to others

Professor Currie said people who had underlying health conditions or who drank heavily were most at risk of severe melioidosis.

But Mr Creek, who was not a heavy drinker and had no existing health issues, is using his story to warn others about the seriousness of the illness.

He spent three weeks in hospital and then three months receiving treatment at home post-diagnosis.

"I was probably in a small percentage of people who present with melioidosis that didn't have any obvious pre-existing conditions," Mr Creek said.

Today, more than four years later, Mr Creek has finally fully recovered from the disease.

But his journey back to health has been rocky.

"Six to nine months after the treatment, I started to get really strong muscle pains and aches to the point where I couldn't bend over, I couldn't lift my arms," Mr Creek.

"The fatigue and muscle soreness, I felt afterwards for some two and a half years."

To avoid melioidosis, people in the Top End should wear covered, waterproof footwear while outdoors near mud or soil, put on gloves for gardening and stay indoors during heavy rain and wind.

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