Melioidosis in Pahang: A Review from Registry Data 2011-2015

Background A review of melioidosis cases was conducted throughout the state of Pahang, Malaysia, from 2000 to 2004, found that there were high annual incidences and mortality rates among melioidosis patients. A series of programs on medical education has since been introduced throughout Pahang, and a registry has been created to track the effects.   

Methods A comprehensive review of the confirmed melioidosis cases from 1st January 2011 to 31st December 2015 was performed to trace back the cultures from all microbiology laboratories in Pahang. Comparisons were made between these cases and previous records retrieved from the registry. Information was verified from the patient's case note when necessary. Completed data were analysed.    

Results A total of 239 patients had positive cultures for Burkholderia pseudomallei  from the total cases of 249 melioidosis cases. The calculated melioidosis incidence in Pahang, was 2.89 per 100, 000 population every year (4.18 per 100,000 adult population annually and 0.8 per 100,000 pediatric population annually). There were predominantly males (78.7%), Malays (82.7%), and had a median age of 52 years (range 1 -84 years). The most common predisposing factor and clinical presentation were diabetes (n=171, 69%) and pneumonia (n=112, 45.0%) respectively. With the known outcomes, 106(48.4%) of them did not survive, and while the other 113(51.6%) were fully discharged and received appropriate antibiotics for both intensive and eradication therapies. Twenty-two patients (8.9%) had culture-confirmed relapses.   

Conclusion Despite improvements in patient management, especially in treatment involving antibiotics, mortality rates remained high. A concerted effort must be made to formulate a better strategy to reduce the mortality rate of melioidosis.

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