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      Polymicrobial community-acquired Acinetobacter baumannii and Burkholderia pseudomallei bacteremia: opportunistic infections with similar risk factors in northern Australia

      case-report
      Author(s): * , , ,
      Publication date (Electronic):
      Journal: IDCases
      Publisher: Elsevier
      Keywords: Tropical medicine, melioidosis, Acinetobacter, pneumonia

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          Abstract

          We report the case of a 61-year-old man from northern Australia with concurrent community-onset Acinetobacter baumannii complex and Burkholderia pseudomallei bacteremia presenting as severe tropical pneumonia requiring intensive care unit support. The pneumonia was complicated by L3/4 discitis and vertebral osteomyelitis presumed to be due to melioidosis. His risk factors included chronic lung disease and immunosuppression with etanercept. This case of concurrent infection highlights the similar risk factors, presentation and epidemiology of both infections, emphasises the importance of accurate microbiologic identification and reinforces the current Australian empiric antimicrobial treatment recommendations for severe tropical pneumonia.

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          Most cited references16

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          Community-acquired Acinetobacter baumannii: clinical characteristics, epidemiology and pathogenesis.

          Carina Dexter, Gerald L Murray, Ian T. Paulsen … (2015)
          Community-acquired Acinetobacter baumannii (CA-Ab) is a rare but serious cause of community-acquired pneumonia in tropical regions of the world. CA-Ab infections predominantly affect individuals with risk factors, which include excess alcohol consumption, diabetes mellitus, smoking and chronic lung disease. CA-Ab pneumonia presents as a surprisingly fulminant course and is characterized by a rapid onset of fever, severe respiratory symptoms and multi-organ dysfunction, with a mortality rate reported as high as 64%. It is unclear whether the distinct clinical syndrome caused by CA-Ab is because of host predisposing factors or unique bacterial characteristics, or a combination of both. Deepening our understanding of the drivers of overwhelming CA-Ab infection will provide important insights into preventative and therapeutic strategies.
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            The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management

            James Stewart, Simon Funge-Smith, Enzo Binotto … (2017)
            Background The epidemiology, clinical presentation and management of melioidosis vary around the world. It is essential to define the disease’s local features to optimise its management. Principal findings Between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in Far North Queensland; 154 (78%) presented in the December-April wet season. 145 (74%) patients were bacteraemic, 58 (29%) were admitted to the Intensive Care Unit and 27 (14%) died; nine (33%) of these deaths occurred within 48 hours of presentation. Pneumonia was the most frequent clinical finding, present in 101 (61%) of the 166 with available imaging. A recognised risk factor for melioidosis (diabetes, hazardous alcohol use, chronic renal disease, chronic lung disease, immunosuppression or malignancy) was present in 148 (91%) of 162 patients with complete comorbidity data. Despite representing only 9% of the region’s population, Aboriginal and Torres Strait Island (ATSI) people comprised 59% of the cases. ATSI patients were younger than non-ATSI patients (median (interquartile range): 46 (38–56) years versus 59 (43–69) years (p<0.001) and had a higher case-fatality rate (22/117 (19%) versus 5/80 (6.3%) (p = 0.01)). In the 155 patients surviving the initial intensive intravenous phase of treatment, eleven (7.1%) had disease recurrence, despite the fact that nine (82%) of these patients had received prolonged intravenous therapy. Recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. The case fatality rate declined from 12/44 (27%) in the first five years of the study to 7/76 (9%) in the last five (p = 0.009), reflecting national improvements in sepsis management. Conclusions Melioidosis in Far North Queensland is a seasonal, opportunistic infection of patients with specific comorbidities. The ATSI population bear the greatest burden of disease. Although the case-fatality rate is declining, deaths frequently occur early after hospitalisation, reinforcing the importance of prompt, targeted therapy in high-risk patients.
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              The association of melioidosis with climatic factors in Darwin, Australia: A 23-year time-series analysis.

              Mark Mayo, Bart Currie, Audrey Hill … (2016)
              Melioidosis is an often fatal disease in humans and animals and endemic in Southeast Asia and northern Australia. It is caused by the environmental bacterium Burkholderia pseudomallei. We analysed weather and climate factors preceding new melioidosis cases in Darwin and compared the time between weather event and admission to hospital for severe and average wet season rainfall.
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                Author and article information

                Contributors
                Lee Fairhead
                John Vardanega
                Rakesh Pandey
                Simon Smith
                Journal
                Journal ID (nlm-ta): IDCases
                Journal ID (iso-abbrev): IDCases
                Title: IDCases
                Publisher: Elsevier
                ISSN (Electronic): 2214-2509
                Publication date PMC-release: 23 May 2020
                Publication date Collection: 2020
                Publication date (Electronic): 23 May 2020
                Volume: 21
                Electronic Location Identifier: e00833
                Affiliations
                [0005]Department of Medicine, Cairns Hospital, Cairns, QLD 4870, PO Box 902, Australia
                Author notes
                [* ]Corresponding author. lee.fairhead@ 123456health.qld.gov.au
                Article
                Publisher ID: S2214-2509(20)30141-4 Publisher ID: e00833
                DOI: 10.1016/j.idcr.2020.e00833
                PMC ID: 7264049
                SO-VID: a9f161d8-fedd-4694-a7b2-0bd4e37c9b9d
                Copyright © © 2020 The Author(s)
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 19 May 2020
                Date revision received : 19 May 2020
                Date accepted : 19 May 2020
                Categories
                Subject: Article

                Keywords: tropical medicine,melioidosis,acinetobacter,pneumonia
                Data availability:
                Keywords: tropical medicine, melioidosis, acinetobacter, pneumonia

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