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Travel Med Infect Dis. 2019 Jul 29:101461. doi: 10.1016/j.tmaid.2019.07.017. [Epub ahead of print]

Melioidosis in travelers: An analysis of Dutch melioidosis registry data 1985-2018.

Author information

1
Center for Experimental and Molecular Medicine and Melioidosis Expertise Center, Amsterdam UMC, Location Academic Medical Center (AMC), Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: e.birnie@amc.uva.nl.
2
Center for Experimental and Molecular Medicine and Melioidosis Expertise Center, Amsterdam UMC, Location Academic Medical Center (AMC), Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands.
3
Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
4
Department of Pathology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
5
Spaarne Gasthuis, Haarlem, the Netherlands.
6
Department of Radiology, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
7
Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands.
8
Center for Experimental and Molecular Medicine and Melioidosis Expertise Center, Amsterdam UMC, Location Academic Medical Center (AMC), Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, the Netherlands; Division of Infectious Diseases, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: w.j.wiersinga@amc.uva.nl.
9
Department of Medical Microbiology, Northwest Clinics, Alkmaar, the Netherlands.
10
Department of Intensive Care, Flevo Hospital, Almere, the Netherlands.
11
Center for Experimental and Molecular Medicine, Center of Tropical Medicine and Travel Medicine, Division of Infectious Diseases, Department of Pathology, Department of Radiology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
12
Department of Medical Microbiology, OLVG General Hospital, Amsterdam, the Netherlands.
13
Department of Medical Microbiology, Amsterdam UMC, Location VUmc, Vrije Universiteit, Amsterdam, the Netherlands.
14
Laboratory for Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, the Netherlands.
15
Department of Surgical Oncology, Red Cross Hospital, Beverwijk, the Netherlands.
16
Microvida Laboratory for Microbiology, Amphia Hospital, Breda, the Netherlands.
17
Department of Medical Microbiology, Reinier de Graaf Group, Delft, the Netherlands.
18
Department of Medical Microbiology, Certe, Groningen, the Netherlands.
19
Department of Internal Medicine and Department of Pathology, Spaarne Gasthuis, Haarlem, the Netherlands.
20
Regional Public Health Laboratory Kennemerland, Haarlem, the Netherlands.
21
Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands.
22
Department of Medical Microbiology, Izore Center for Infectious Diseases Friesland, Leeuwarden, the Netherlands.
23
Department of Otorhinolaryngology-Head and Neck Surgery, Medical Center Leeuwarden (MCL), Leeuwarden, the Netherlands.
24
Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
25
Department of Internal Medicine, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands.
26
Dijklander Hospital, Purmerend, the Netherlands.
27
Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands.
28
Department of Medical Microbiology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands.
29
Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
30
Department of Medical Microbiology and Department of Pathology, Diakonessenhuis, Utrecht, the Netherlands.
31
Department of Medical Microbiology, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, the Netherlands.

Abstract

BACKGROUND:

Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is an opportunistic infection across the tropics. Here, we provide a systematic overview of imported human cases in a non-endemic country over a 25-year period.

METHODS:

All 55 Dutch microbiology laboratories were contacted in order to identify all B. pseudomallei positive cultures from 1990 to 2018. A response rate of 100% was achieved. Additionally, a systematic literature search was performed, medical-charts reviewed, and tissue/autopsy specimens were re-assessed.

RESULTS:

Thirty-three travelers with melioidosis were identified: 70% male with a median-age of 54 years. Risk factors were present in most patients (n = 23, 70%), most notably diabetes (n = 8, 24%) and cystic fibrosis (n = 3, 9%). Countries of acquisition included Thailand, Brazil, Indonesia, Panama, and The Gambia. Disease manifestations included pneumonia, intra-abdominal abscesses, otitis externa, genitourinary, skin-, CNS-, and thyroid gland infections. Twelve (36%) patients developed sepsis and/or septic shock. Repeat episodes of active infection were observed in five (15%) and mortality in four (12%) patients. Post-mortem analysis showed extensive metastatic (micro)abscesses amongst other sites in the adrenal gland and bone marrow.

CONCLUSIONS:

The number of imported melioidosis is likely to increase, given rising numbers of (immunocompromised) travelers, and increased vigilance of the condition. This first systematic retrospective surveillance study in a non-endemic melioidosis country shows that imported cases can serve as sentinels to provide information about disease activity in areas visited and inform pre-travel advice and post-travel clinical management.

KEYWORDS:

Burkholderia pseudomallei; Fever in returned travelers; Melioidosis; Surveillance; Travel medicine

PMID:
31369898
DOI:
10.1016/j.tmaid.2019.07.017
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