Pulmonary melioidosis in Cambodia: A prospective study

We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome.During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs.The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.Melioidosis is an infectious disease due to non-saprophytic Gram-negative bacillus Burkholderia pseudomallei, which can be found in wet soil and surface water [1]. Endemic areas encompass Southeast Asia and Northern Australia demonstrating seasonality with more cases detected/reported during the rainy season [2,3]. In addition to contact with an environmental exposure, underlying conditions pre-disposing for the disease include diabetes mellitus, alcohol abuse, chronic lung disease and chronic renal disease [1,4]. The three main routes of contamination are cutaneous inoculation, inhala