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Melioidosis in Papua New Guinea: is it less common than in tropical Australia?
417
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE (1993) 87, 417
1Short Report1 Melioidosis in Papua New Guinea: it less common than in tropical Australia?
is
Bart Currie Menzies School of Health Research and Royal Darwin Hospital, P.O. Box 41096, Casuarina, NT 081 I, Australia
The importance of melioidosis as a cause of community-acquired sepsisin endemic areasis being increasingly recognized (CHAOWAGULet al., 1989), and it is the commonest cause of fatal bacteraemic community-acquired pneumonia in the tropical Northern Territory of Austraha (ANSTEYet al., 1992). Together with south-east Asia and northern Australia, Papua New Guinea is included as an endemic area, and indeed many other tropical regions are now recognized to have melioidosis (DANCE. 1991). It is therefore of interest that few cases of melioidosis ‘have been diagnosed in Papua New Guinea. Case Report
A 28 years old highland male, with a history of heavy alcohol intake, living in Port Moresby, Papua New Guinea, presented to Port Moresby General Hospital with fuhninant left unner lobe nneumonia after 4 d of diarrhoea followed by fever, pieuritic chest pain and dyspnoea. On admission his blood pressure was 110/70, temperature 39.4”C and resgiratory.rate 60/min. The white cell count was 8.7~ 10 /L, sodnm 129 mmol/L, creaoYL, urea 15.0 mmol/L, bilirubin 49 tinine 250 urnol/L, anr aspartate aminotransferase 46 units/L. The patient was given parenteral penicillin and gentamicin, but he deteriorated and died the dav after admission. A Gram-negative bacillus was cultured from his blood; it was sensitive by disc diffusion to sulphamethoxazole/trimethonrim. chloramnhenicol and tetracvcline, but resistant td gen&nicin and penicillin. The organism was not characterized in Paoua New Guinea but was identified bv Patricia Short of the New Zealand Communicable DiseaseCentre asPseudonwnaspseudomallei . Discussion
Two fatal cases of chronic/reactivated melioidosis in Australia have been attributed to World War II service in Papua New Guinea over 20 years earlier (NEWLAND, 1971). Since 1964at least 5 other cases 1969: KINGSTON. of melioidosis (3 fatal) have been documented from Port Moresby (ROWLANDS8~ CURTIS, 1965; DE BUSE et al., 1975; LEE & NARAQI, 1980). The first isolation of P. pseudomallei from a marsupial was from a tree climbing kangaroo in Port Moresby (EGERTON, 1963).
However, it does appear that, despite the same difficulties with laboratory facilities and clinical awareness recognized in other tropical regions (DANCE, 1991), melioidosis may be less common in Papua New Guinea than in neighbouring tropical Australia. Two limited serological studies in Papua New Guinea have failed to detect antibodies to P. pseudomallzi (ROWLANDS& CURTIS, 1965; BARNESet al., 1991), in contrast to 5.7% seroprevalence in north Queensland, Australia (ASHDOWN& GUARD,1984). P. pseudomallei inhabits soil and water, with skin inoculation considered the most common portal of entry (CHAOWAGUL et al.., 1989). There are many climatic and environmental sirmlarities between tropical Australia and coastal Papua, and melioidosis is well recognized on the intervening Torres Strait islands (JOHNSON, 1967), with 7.8% seroprevalence (ASHDOWN & GUARD, 1984). It is therefore evident that both the distribution of environmental P. pseudomallei and the epidemiology of melioidosis in Australasia need further elucidation, including the possibility that P. pseudomallei colonized the region from south-east Asia and subsequently spread locally. References
Anstey, N. M., Currie, B. J. & Withnall, K. M. (1992).Community-acquiredAcinetobacter pneumoniain the Northern Territorv of Australia.Clinical InfectiousDiseases.14.83-91. Ashdown, L. R. 81 Guard, R. W.<(1984). The prevalence of human melioidosis in northern Queensland. American Journal of Tropical Medicine and Hygiene, 33,474-$78. Barnes, D. J., Gottlieb, T., Naraqi, S. & Benn, R. (1991). The role of viruses and atypical organisms in the pathogenesis of adult pneumonia in Papua New Guinea. Papua New Guinea Medi~alJournal, 34, lc16. Chaowagul, W.,, White, N. J., Dance, D. A. B., Wattanagoon, Y., Naigowtt, P., Davis, T. M. E., Looareesuwan, S. & Pitakwatchara, N. (1989). Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand. Journal of Znfectious Diseases? 159,890-899. Dance,,D. A. B. (1991).Mehoidosis:the tip of the iceberg? Clrnical Mk-robiology Reviews, 4,52-60. De Buse, P. J., Henderson, A. & White, M. (1975). Melioidosis in a child in Paoua New Guinea. Medical ‘fournal of AustraIia, ii, 47&478.* Eeerton. 1. R. (1963). Melioidosis in a tree climbimr kanearoo. ” Au&&an
V&r&yJoumal,
39,243-244.
-
-
Johnson, D. W. (1967). Melioidosrs: report of four casesfrom Torres Strait. MedicalJoumal ofAustralia, ii, 587-588. Kingston, C. W. (1971). Chronic or latent melioidosis. Medical 3oumalofAusnalia,ii,618-621. Lee? L. & Naraqi, S. (1980). Primary gram negative pneumonia m adults in Papua New Guinea. Papua New Guinea Medical 3ournal,23,174-178. Newland, R. C. (1969). Chronic melioidosis: a case in Sydney. Patholoev. 1.149-152. Rowlands,r’B: & Curtis, P. G. (1%5). A caseof melioidosis in Papua and New Guinea. Medical Journal of Australia, ii, 494-496. Received 27 October 1992; accepted November I992
for publication 24
TRANSACTIONS OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE (1993) 87, 417
1Short Report1 Melioidosis in Papua New Guinea: it less common than in tropical Australia?
is
Bart Currie Menzies School of Health Research and Royal Darwin Hospital, P.O. Box 41096, Casuarina, NT 081 I, Australia
The importance of melioidosis as a cause of community-acquired sepsisin endemic areasis being increasingly recognized (CHAOWAGULet al., 1989), and it is the commonest cause of fatal bacteraemic community-acquired pneumonia in the tropical Northern Territory of Austraha (ANSTEYet al., 1992). Together with south-east Asia and northern Australia, Papua New Guinea is included as an endemic area, and indeed many other tropical regions are now recognized to have melioidosis (DANCE. 1991). It is therefore of interest that few cases of melioidosis ‘have been diagnosed in Papua New Guinea. Case Report
A 28 years old highland male, with a history of heavy alcohol intake, living in Port Moresby, Papua New Guinea, presented to Port Moresby General Hospital with fuhninant left unner lobe nneumonia after 4 d of diarrhoea followed by fever, pieuritic chest pain and dyspnoea. On admission his blood pressure was 110/70, temperature 39.4”C and resgiratory.rate 60/min. The white cell count was 8.7~ 10 /L, sodnm 129 mmol/L, creaoYL, urea 15.0 mmol/L, bilirubin 49 tinine 250 urnol/L, anr aspartate aminotransferase 46 units/L. The patient was given parenteral penicillin and gentamicin, but he deteriorated and died the dav after admission. A Gram-negative bacillus was cultured from his blood; it was sensitive by disc diffusion to sulphamethoxazole/trimethonrim. chloramnhenicol and tetracvcline, but resistant td gen&nicin and penicillin. The organism was not characterized in Paoua New Guinea but was identified bv Patricia Short of the New Zealand Communicable DiseaseCentre asPseudonwnaspseudomallei . Discussion
Two fatal cases of chronic/reactivated melioidosis in Australia have been attributed to World War II service in Papua New Guinea over 20 years earlier (NEWLAND, 1971). Since 1964at least 5 other cases 1969: KINGSTON. of melioidosis (3 fatal) have been documented from Port Moresby (ROWLANDS8~ CURTIS, 1965; DE BUSE et al., 1975; LEE & NARAQI, 1980). The first isolation of P. pseudomallei from a marsupial was from a tree climbing kangaroo in Port Moresby (EGERTON, 1963).
However, it does appear that, despite the same difficulties with laboratory facilities and clinical awareness recognized in other tropical regions (DANCE, 1991), melioidosis may be less common in Papua New Guinea than in neighbouring tropical Australia. Two limited serological studies in Papua New Guinea have failed to detect antibodies to P. pseudomallzi (ROWLANDS& CURTIS, 1965; BARNESet al., 1991), in contrast to 5.7% seroprevalence in north Queensland, Australia (ASHDOWN& GUARD,1984). P. pseudomallei inhabits soil and water, with skin inoculation considered the most common portal of entry (CHAOWAGUL et al.., 1989). There are many climatic and environmental sirmlarities between tropical Australia and coastal Papua, and melioidosis is well recognized on the intervening Torres Strait islands (JOHNSON, 1967), with 7.8% seroprevalence (ASHDOWN & GUARD, 1984). It is therefore evident that both the distribution of environmental P. pseudomallei and the epidemiology of melioidosis in Australasia need further elucidation, including the possibility that P. pseudomallei colonized the region from south-east Asia and subsequently spread locally. References
Anstey, N. M., Currie, B. J. & Withnall, K. M. (1992).Community-acquiredAcinetobacter pneumoniain the Northern Territorv of Australia.Clinical InfectiousDiseases.14.83-91. Ashdown, L. R. 81 Guard, R. W.<(1984). The prevalence of human melioidosis in northern Queensland. American Journal of Tropical Medicine and Hygiene, 33,474-$78. Barnes, D. J., Gottlieb, T., Naraqi, S. & Benn, R. (1991). The role of viruses and atypical organisms in the pathogenesis of adult pneumonia in Papua New Guinea. Papua New Guinea Medi~alJournal, 34, lc16. Chaowagul, W.,, White, N. J., Dance, D. A. B., Wattanagoon, Y., Naigowtt, P., Davis, T. M. E., Looareesuwan, S. & Pitakwatchara, N. (1989). Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand. Journal of Znfectious Diseases? 159,890-899. Dance,,D. A. B. (1991).Mehoidosis:the tip of the iceberg? Clrnical Mk-robiology Reviews, 4,52-60. De Buse, P. J., Henderson, A. & White, M. (1975). Melioidosis in a child in Paoua New Guinea. Medical ‘fournal of AustraIia, ii, 47&478.* Eeerton. 1. R. (1963). Melioidosis in a tree climbimr kanearoo. ” Au&&an
V&r&yJoumal,
39,243-244.
-
-
Johnson, D. W. (1967). Melioidosrs: report of four casesfrom Torres Strait. MedicalJoumal ofAustralia, ii, 587-588. Kingston, C. W. (1971). Chronic or latent melioidosis. Medical 3oumalofAusnalia,ii,618-621. Lee? L. & Naraqi, S. (1980). Primary gram negative pneumonia m adults in Papua New Guinea. Papua New Guinea Medical 3ournal,23,174-178. Newland, R. C. (1969). Chronic melioidosis: a case in Sydney. Patholoev. 1.149-152. Rowlands,r’B: & Curtis, P. G. (1%5). A caseof melioidosis in Papua and New Guinea. Medical Journal of Australia, ii, 494-496. Received 27 October 1992; accepted November I992
for publication 24