Territory Stories

The Northern Territory Disease Control Bulletin

Details:

Title

The Northern Territory Disease Control Bulletin

Creator

Territory Health Services, Centre for Disease Control

Collection

Northern Territory disease control bulletin; E-Journals; PublicationNT; Northern Territory disease control bulletin

Date

2002-03

Location

Casuarina

Notes

Date:2002-03; This publication contains may contain links to external sites. These external sites may no longer be active.; Made available via the Publications (Legal Deposit) Act 2004 (NT).

Language

English

Subject

Communicable diseases; Reporting; Northern Territory; Statistics; Periodicals

Publisher name

Northern Territory Government

Place of publication

Casuarina

Series

Northern Territory disease control bulletin

Volume

v. 9 no. 1

File type

application/pdf

ISSN

1440-883X

Use

Attribution International 4.0 (CC BY 4.0)

Copyright owner

Northern Territory Government

License

https://creativecommons.org/licenses/by/4.0

Parent handle

https://hdl.handle.net/10070/233806

Citation address

https://hdl.handle.net/10070/655675

Page content

The Northern Territory Disease Control Bulletin Vol 9, No.1, March 2002 2 4. The incubation period has been ascertained from the Top End study to be 1-21 days, with a mean incubation period of 9 days. 5. Pneumonia is the commonest presentation of melioidosis. As well as severe septicaemic pneumonia with mortality often over 50%, many patients present with milder forms of pneumonia, which respond well to appropriate antibiotics. Other presentations of melioidosis include skin abscesses or ulcers, abscesses in the internal organs such as the prostate, spleen, kidney and liver, fulminant septicaemia with multiorgan abscesses and unusual neurological illnesses such as brainstem encephalitis and acute flaccid paraplegia. 6. Diabetes is the most important risk factor for melioidosis, with around 40% of cases being diabetic. In addition, excessive alcohol consumption, chronic renal disease, chronic lung disease and excessive kava drinking are risk factors for melioidosis. While the majority of patients with melioidosis have one or more of these risk factors, melioidosis can also occur in children and healthy adults. However severe disease and death are extremely rare in people without identified risk factors. 7. Melioidosis has recently been diagnosed in several people with cystic fibrosis living in or travelling to melioidosis endemic regions. Colonisation of airways with B. pseudomallei may also be occurring, suggesting that the bacteria may behave in a similar way to B. cepacia. 8. Persons without symptoms or a known history of disease can also be found to be positive on serological testing, indicating asymptomatic infection. A small proportion of these people can re-activate from latent infection many years later in life, analogous to tuberculosis. However re-activation represents probably less than 5% of Top End cases, with the vast majority of presentations following infection during the current wet season. 9. The likelihood of diagnosis is increased by using selective culture media (modified Ashdowns broth), frequent sampling (sputum, throat, rectal and ulcer swabs) and collection of blood cultures. Clinicians should liaise with laboratory staff to ensure selective media are available including for remote communities. 10. Early diagnosis and appropriate antibiotic therapy decrease mortality. 11. Follow-up of cases and adherence to eradication therapy (usually at least 3 months of antibiotics after discharge) are critical to prevent relapse, which can be fatal. 12. Each monsoon cases of melioidosis occur in travellers returning from tropical Australia to southern states or overseas countries. 13. Public education remains very important so that wherever possible people avoid contact with wet season soils or muddy water. Wearing footwear and the use of gloves whilst gardening or working outdoors are very important measures to avoid possible exposure. These preventive measures are especially important to emphasise for all diabetics. The NT melioidosis treatment protocol The Top End empirical protocol for adult community-acquired pneumonia is devised to cover melioidosis in patients with risk factors, as well as other important pathogens (see NT Disease Control Bulletin, Vol 7 No 4, December 2000, p 5-6). Once melioidosis is confirmed the usual treatment recommended is: Initial intensive therapy for at least 14 days with: intravenous high dose ceftazidime or meropenem and high dose cotrimoxazole plus folic acid This is followed by: Eradication therapy for at least 3 months of: oral monotherapy and high dose cotrimoxazole plus folic acid Durations of intensive and eradication therapy may need to be prolonged in more extensive pneumonia, deep-seated infections, bone, joint and CNS infections.


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