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.

中文翻译：

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旅行者中的类鼻疽：1985-2018 年荷兰类鼻疽登记数据分析

背景

类鼻疽由革兰氏阴性菌类鼻疽伯克霍尔德氏菌引起，是一种横跨热带地区的机会性感染。在这里，我们系统地概述了 25 年来非流行国家的输入性人类病例。

方法

联系了所有 55 个荷兰微生物学实验室，以确定 1990 年至 2018 年的所有B. pseudomallei阳性培养物。实现了 100% 的响应率。此外，还进行了系统的文献检索，审查了病历，并对组织/尸检标本进行了重新评估。

结果

确定了 33 名患有类鼻疽的旅行者：70% 为男性，中位年龄为 54 岁。大多数患者 (n = 23, 70%) 存在风险因素，最显着的是糖尿病 (n = 8, 24%) 和囊性纤维化 (n = 3, 9%)。收购国家包括泰国、巴西、印度尼西亚、巴拿马和冈比亚。疾病表现包括肺炎、腹腔内脓肿、外耳炎、泌尿生殖系统、皮肤、中枢神经系统和甲状腺感染。十二名 (36%) 患者出现败血症和/或败血性休克。在五名 (15%) 患者中观察到活动性感染的重复发作，在四名 (12%) 患者中观察到死亡。验尸分析显示肾上腺和骨髓中其他部位存在广泛的转移性（微）脓肿。

结论

考虑到（免疫功能低下的）旅行者人数增加以及对该病的警惕性提高，输入性类鼻疽的数量可能会增加。这项在非类鼻疽流行国家开展的首次系统性回顾性监测研究表明，输入病例可以充当哨兵，提供有关所访问地区疾病活动的信息，并为旅行前建议和旅行后临床管理提供信息。