Fulminant septic melioidosis after a vacation in Thailand.

Severe infection with Burkholderia pseudomallei (formerly Pseudomonas pseudomallei), the bacterium causing melioidosis, is a common cause of acquired septicaemia in south-east Asia and northern Australia. A few cases of infected travellers returning to European countries have been reported. Melioidosis is a tropical disease, the clinical presentation ranging from asymptomatic infection to fulminant sepsis. Predisposing conditions such as impaired cellular immunity, preexisting renal failure or diabetes mellitus seem to enhance the severity of the disease. For a definite diagnosis the bacterium has to be isolated. The antimicrobial treatment of choice is ceftazidime in combination with co-trimoxazole or doxycycline. Even with correct antibiotic treatment the mortality rate is high in cases of fulminant sepsis. We report a 29-year old man with Type I diabetes who acquired melioidosis during a vacation in Thailand. After returning to Austria he was admitted to the intensive care unit with multiple organ failure. Despite intensive care treatment the patient's infection proved lethal. Burkholderia pseudomallei was isolated from the blood and bronchoalveolar lavage.

Long-term outcome after open treatment of severe intra-abdominal infection and pancreatic necrosis.

BACKGROUND: Outcome assessment after surgical treatment of intra-abdominal infections and pancreatic necrosis has concentrated on postoperative complications and survival, while long-term results have received little attention. OBJECTIVES: To evaluate hospital costs and long-term outcome for patients undergoing open treatment of intra-abdominal infection or pancreatic necrosis and to determine whether results justify costs. DESIGN: Cohort study and cost-effectiveness analysis. SETTING: Referral center. PATIENTS: From January 1, 1988, through June 30, 1996, we used open treatment for 147 patients with pancreatic necrosis (n=75; group 1), severe intra-abdominal infections due to benign diseases (n=50; group 2), and infections due to malignant neoplasm (n=22; group 3). All surviving patients (n=92) were followed up. Fifty-seven patients in group 1, 25 patients in group 2, and 10 patients in group 3 survived. INTERVENTIONS: The effective costs of treatment per surviving patient (including restorative surgery) were calculated. The patients were interviewed, and the residence location, medical treatment, degree of recovery, functional state, and employment status were assessed. We assessed the quality of life by using the short general health survey (SF-36). MAIN OUTCOME MEASURES: Costs, survival, and long-term outcome. RESULTS: The effective costs per survivor studied were $175000 (group 1) and $232400 (groups 2 and 3). Most patients experienced good long-term results, ie, employment status was unchanged for 69 (75%) of the patients, and the functional state was unchanged for 81 (88%) of the patients. Readmission to a hospital was necessary for 14 (15%) of the patients, and 5 (6%) required care in nursing homes. Of the patients studied, 75% described their quality of life as good. Patients in group 3 had significantly worse results for survival, functional status, and quality of life (P<.01, log-rank test). CONCLUSIONS: Our study demonstrated that open treatment of severe intra-abdominal infection and pancreatic necrosis is a cost-effective treatment with good long-term results for most patients. However, patients with malignant neoplasms did not benefit from this therapy and, therefore, should not be treated by laparostomy.

[The occurrence of Babesia divergens in the Freiburg i. Br. district and piroplasmosis prevention trials in cattle]. / Zum Vorkommen von Babesia divergens im Bezirk Freiburg i. Br. und Versuche zur Piroplasmoseprophylaxe beim Rind.

The occurrence of Babesia divergens in the Freiburg i. Br. district is reported. By interviewing farmers and by serological investigations, three valleys where located in which bovine piroplasmosis occurs since many years. Main objective of this study was to strategically control the vector ticks, Ixodes ricinus with the synthetic pyrethroid flumethrin, in order to prevent clinical piroplasmosis after turnout to pastures in spring, without interfering with protective immunity against Babesia divergens. A total of 200 cattle were used for trials in the period 1990-92. Three pour-on treatments of fortnightly intervals provided best results. Only 4.3% of 163 treated cattle contracted piroplasmosis, in contrast to 19% of 37 untreated cattle. All cattle were sero-negative at the time of turnout. At the end of pasture periods 1990 and 1991 82.4 and 79.6% respectively of treated cattle were sero-positive.