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Relapse in melioidosis: incidence and risk factors
W Chaowagul1, Y Suputtamongkol, D A Dance
1Department of Medicine, Sappasitprasong Hospital, Ubon Ratchatani, Thailand.
Abstract:
From 1986 to 1991, 602 patients with melioidosis were seen in Sappasitprasong Hospital, Ubon Ratchatani, Thailand. The in-hospital mortality was 42%. Of 118 adult patients followed long-term, 27 (23%) had culture-proven relapses of melioidosis (3 relapsed twice), a relapse rate of 15% (95% confidence interval [CI], 11-22) per year. The median time from discharge to relapse was 21 weeks (range, 1-290). In 44% of patients, relapses included septicemia, and 27% died. Patients with severe disease (multiple foci of infection or septicemia) relapsed 4.7 times (95% CI, 1.6-14.1) more frequently than patients with localized melioidosis. Underlying disease was not a risk factor, but initial parenteral treatment with ceftazidime reduced the risk of relapse 2-fold (95% CI, 1.1-3.4). Relapses were 3.3 (95% CI, 1.4-9.0) times more frequent following short-course (< or = 8 weeks) oral coamoxiclav than after the oral combination regimen of chloramphenicol, doxycycline, and cotrimoxazole. Longer oral treatment with either reduced relapse 1.6-fold (95% CI, 1.2-1.9). The optimum choice and duration of antibiotic treatment to prevent relapse in melioidosis remain to be determined.
Insights
Melioidosis relapses are common, especially with severe disease. Initial ceftazidime treatment and longer oral antibiotic courses may reduce relapse risk in melioidosis patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Melioidosis, a serious bacterial infection, has high mortality and relapse rates in endemic areas.
- Understanding factors influencing melioidosis relapse is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the incidence and risk factors for melioidosis relapse.
- To evaluate the impact of antibiotic treatment regimens on relapse rates.
Main Methods:
- Retrospective analysis of 602 melioidosis patients treated between 1986-1991.
- Long-term follow-up of 118 adult patients to assess relapse rates and outcomes.
- Comparison of relapse frequencies based on disease severity and antibiotic treatment protocols.
Main Results:
- High in-hospital mortality (42%) and a significant long-term relapse rate (15% per year).
- Severe melioidosis cases (septicemia, multiple foci) had a 4.7-fold higher relapse risk.
- Parenteral ceftazidime reduced relapse risk twofold; longer oral antibiotic courses (chloramphenicol, doxycycline, cotrimoxazole) also decreased relapse rates.
Conclusions:
- Melioidosis relapse is a significant clinical challenge, influenced by disease severity.
- Ceftazidime and extended oral antibiotic therapy show promise in preventing relapse.
- Further research is needed to optimize antibiotic choice and duration for melioidosis relapse prevention.