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      Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

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          Abstract

          During January 1998–December 2019, the annual incidence of melioidosis in Far North Queensland, Queensland, Australia, more than doubled. Because climate and prevalence of predisposing medical conditions remained stable during that time, we hypothesize that the increased incidence was caused by urban expansion and increased construction, resulting in greater exposure to Burkholderia pseudomallei.

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          A Wilcoxon-type test for trend.

          J Cuzick (1985)
          An extension of the Wilcoxon rank-sum test is developed to handle the situation in which a variable is measured for individuals in three or more (ordered) groups and a non-parametric test for trend across these groups is desired. The uses of the test are illustrated by two examples from cancer research.
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            Increasing Incidence of Human Melioidosis in Northeast Thailand

            Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative environmental bacterium Burkholderia pseudomallei. A prospective cohort study identified 2,243 patients admitted to Sappasithiprasong Hospital in northeast Thailand with culture-confirmed melioidosis between 1997 and 2006. These data were used to calculate an average incidence rate for the province of 12.7 cases of melioidosis per 100,000 people per year. Incidence increased incrementally from 8.0 (95% confidence interval [CI] = 7.2–10.0) in 2000 to 21.3 (95% CI = 19.2–23.6) in 2006 (P < 0.001; χ2 test for trend). Male sex, age ≥ 45 years, and either known or undiagnosed diabetes were independent risk factors for melioidosis. The average mortality rate from melioidosis over the study period was 42.6%. The minimum estimated population mortality rate from melioidosis in 2006 was 8.63 per 100,000 people (95% CI = 7.33–10.11), the third most common cause of death from infectious diseases in northeast Thailand after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis.
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              Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis.

              Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia(1,2). Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods(3). The bacterium is intrinsically resistant to a wide range of antimicrobials, and treatment with ineffective antimicrobials may result in case fatality rates (CFRs) exceeding 70%(4,5). The importation of infected animals has, in the past, spread melioidosis to non-endemic areas(6,7). The global distribution of B. pseudomallei and the burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases and the presence of environmental B. pseudomallei and combine this in a formal modelling framework(8-10) to estimate the global burden of melioidosis. We estimate there to be 165,000 (95% credible interval 68,000-412,000) human melioidosis cases per year worldwide, from which 89,000 (36,000-227,000) people die. Our estimates suggest that melioidosis is severely underreported in the 45 countries in which it is known to be endemic and that melioidosis is probably endemic in a further 34 countries that have never reported the disease. The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers.
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                Author and article information

                Journal
                Emerg Infect Dis
                Emerg Infect Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                December 2021
                : 27
                : 12
                : 3119-3123
                Affiliations
                [1]Cairns Hospital, Cairns, Queensland, Australia (S. Smith, J. Stewart, L. Fairhead, J. Hanson);
                [2]Tropical Public Health Services, Cairns (P. Horne, S. Rubenach, R. Gair);
                [3]University of New South Wales, Sydney, New South Wales, Australia (J. Hanson)
                Author notes
                Address for correspondence: Simon Smith, Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia; email: simon.smith2@ 123456health.qld.gov.au
                Article
                21-1302
                10.3201/eid2712.211302
                8632158
                34808088
                73ab9320-3ab4-4424-b969-c14cb820a3fa
                Copyright @ 2021

                Emerging Infectious Diseases is a publication of the U.S. Government. This publication is in the public domain and is therefore without copyright. All text from this work may be reprinted freely. Use of these materials should be properly cited.

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                Dispatch
                Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998–2019

                Infectious disease & Microbiology
                melioidosis,tropical medicine,weather,climate,bacteria,burkholderia pseudomallei,far north queensland,australia

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