| 2005 |
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| Recurrent melioidosis in patients in northeast Thailand is frequently due to reinfection
rather than relapse. |
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| Maharjan, B., Chantratita, N., Vesaratchavest, M., Cheng, A., Wuthiekanun, V., Chierakul, W.,
Chaowagul, W., Day, N. P., and Peacock, S. J. |
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| Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400,
Thailand |
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| Abstract: Human melioidosis is associated with a high rate of recurrent disease, despite adequate
antimicrobial treatment. Here, we define the rate of relapse versus the rate of reinfection in 116 patients with 123 episodes of recurrent melioidosis who
were treated at Sappasithiprasong Hospital in Northeast Thailand between 1986 and 2005. Pulsed-field gel electrophoresis was performed on all isolates;
isolates from primary and recurrent disease for a given patient different by one or more bands were examined by a sequence-based approach based on
multilocus sequence typing. Overall, 92 episodes (75%) of recurrent disease were caused by the same strain (relapse) and 31 episodes (25%) were due
to infection with a new strain (reinfection). The interval to recurrence differed between patients with relapse and reinfection; those with relapses had a
median time to relapse of 228 days (range, 15 to 3,757 days; interquartile range [IQR], 99.5 to 608 days), while those with reinfection had a median time to
reinfection of 823 days (range, 17 to 2,931 days; IQR, 453 to 1,211 days) (P = 0.0001). A total of 64 episodes (52%) occurred within 12 months of the
primary infection. Relapse was responsible for 57 of 64 (89%) episodes of recurrent infection within the first year after primary disease, whereas relapse
was responsible for 35 of 59 (59%) episodes after 1 year (P < 0.0001). Our data indicate that in this setting of endemicity, reinfection is responsible for
one-quarter of recurrent cases. This finding has important implications for the clinical management of melioidosis patients and for antibiotic treatment
studies that use recurrent disease as a marker for treatment failure |
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| Published in:J.Clin.Microbiol. 43[12], 6032-6034. 2005. |
