Contact investigation of melioidosis cases reveals regional endemicity in Puerto Rico.

Autor:	Doker TJ; Epidemic Intelligence Service Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Sharp TM; Dengue Branch, Centers for Disease Control and Prevention., Rivera-Garcia B; Puerto Rico Department of Health, San Juan., Perez-Padilla J; Dengue Branch, Centers for Disease Control and Prevention., Benoit TJ; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Ellis EM; Epidemic Intelligence Service Dengue Branch, Centers for Disease Control and Prevention., Elrod MG; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Gee JE; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Shieh WJ; Infectious Diseases Pathology Branch., Beesley CA; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Ryff KR; Puerto Rico Department of Health, San Juan., Traxler RM; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Galloway RL; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Haberling DL; Prion and Public Health Office, Centers for Disease Control and Prevention., Waller LA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia., Shadomy SV; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Bower WA; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Hoffmaster AR; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Walke HT; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia., Blaney DD; Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2015 Jan 15; Vol. 60 (2), pp. 243-50. Date of Electronic Publication: 2014 Sep 30.
DOI:	10.1093/cid/ciu764
Abstrakt:	Background: Melioidosis results from infection with Burkholderia pseudomallei and is associated with case-fatality rates up to 40%. Early diagnosis and treatment with appropriate antimicrobials can improve survival rates. Fatal and nonfatal melioidosis cases were identified in Puerto Rico in 2010 and 2012, respectively, which prompted contact investigations to identify risk factors for infection and evaluate endemicity. Methods: Questionnaires were administered and serum specimens were collected from coworkers, neighborhood contacts within 250 m of both patients' residences, and injection drug user (IDU) contacts of the 2012 patient. Serum specimens were tested for evidence of prior exposure to B. pseudomallei by indirect hemagglutination assay. Neighborhood seropositivity results guided soil sampling to isolate B. pseudomallei. Results: Serum specimens were collected from contacts of the 2010 (n = 51) and 2012 (n = 60) patients, respectively. No coworkers had detectable anti-B. pseudomallei antibody, whereas seropositive results among neighborhood contacts was 5% (n = 2) for the 2010 patient and 23% (n = 12) for the 2012 patient, as well as 2 of 3 IDU contacts for the 2012 case. Factors significantly associated with seropositivity were having skin wounds, sores, or ulcers (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.2-17.8) and IDU (OR, 18.0; 95% CI, 1.6-194.0). Burkholderia pseudomallei was isolated from soil collected in the neighborhood of the 2012 patient. Conclusions: Taken together, isolation of B. pseudomallei from a soil sample and high seropositivity among patient contacts suggest at least regional endemicity of melioidosis in Puerto Rico. Increased awareness of melioidosis is needed to enable early case identification and early initiation of appropriate antimicrobial therapy. (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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