Please use this identifier to cite or link to this item: http://dora.health.qld.gov.au/qldresearchjspui/handle/1/1767
Title: Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia
Authors: Davies, Phoebe 
Smith, Simon 
Wilcox, Rob 
Stewart, James 
Davis, Tania 
McKenna, Kylie 
Hanson, Josh 
Issue Date: 2022
Source: Davies P, Smith S, Wilcox R, Stewart JD, Davis TJ, McKenna K, Hanson J. Examination of the independent contribution of rheumatic heart disease and congestive cardiac failure to the development and outcome of melioidosis in Far North Queensland, tropical Australia. PLoS Negl Trop Dis. 2022 Jul 18;16(7):e0010604. doi: 10.1371/journal.pntd.0010604. PMID: 35849581; PMCID: PMC9292120.
Journal: PLoS neglected tropical diseases
Abstract: Patients with rheumatic heart disease (RHD) and congestive cardiac failure (CCF) are believed to have an increased risk of melioidosis and are thought to be more likely to die from the infection. This study was performed to confirm these findings in a region with a high incidence of all three conditions. Between January 1998 and December 2021 there were 392 cases of melioidosis in Far North Queensland, tropical Australia; 200/392 (51.0%) identified as an Indigenous Australian, and 337/392 (86.0%) had a confirmed predisposing comorbidity that increased risk for the infection. Overall, 46/392 (11.7%) died before hospital discharge; the case fatality rate declining during the study period (p for trend = 0.001). There were only 3/392 (0.8%) with confirmed RHD, all of whom had at least one other risk factor for melioidosis; all 3 survived to hospital discharge. Among the 200 Indigenous Australians in the cohort, 2 had confirmed RHD; not statistically greater than the prevalence of RHD in the local general Indigenous population (1.0% versus 1.2%, p = 1.0). RHD was present in only 1/193 (0.5%) cases of melioidosis diagnosed after October 2016, a period which coincided with prospective data collection. There were 26/392 (6.6%) with confirmed CCF, but all 26 had another traditional risk factor for melioidosis. Patients with CCF were more likely to also have chronic lung disease (OR (95% CI: 4.46 (1.93-10.31), p<0.001) and chronic kidney disease (odds ratio (OR) (95% confidence interval (CI): 2.98 (1.22-7.29), p = 0.01) than those who did not have CCF. Two patients with melioidosis and CCF died before hospital discharge; both were elderly (aged 81 and 91 years) and had significant comorbidity. In this region of tropical Australia RHD and CCF do not appear to be independent risk factors for melioidosis and have limited prognostic utility.
Description: Cairns & Hinterland Hospital and Health Service (CHHHS) affiliated authors: Phoebe Davies, Simon Smith, Rob Wilcox, James D Stewart, Tania J Davis, Kylie McKenna, Josh Hanson
DOI: 10.1371/journal.pntd.0010604
Type: Article
Appears in Sites:Cairns & Hinterland HHS Publications

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