Pulmonary melioidosis in Cambodia: a prospective study

BMC Infect Dis. 2011 May 14;11:126. doi: 10.1186/1471-2334-11-126.


Background: Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes.

Methods: We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome.

Results: During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs.

Conclusions: The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / economics
  • Anti-Bacterial Agents / therapeutic use
  • Burkholderia pseudomallei
  • Cambodia / epidemiology
  • Child
  • Child, Preschool
  • Cost of Illness
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Melioidosis / drug therapy
  • Melioidosis / economics
  • Melioidosis / epidemiology*
  • Melioidosis / microbiology
  • Middle Aged
  • Pneumonia, Bacterial / drug therapy
  • Pneumonia, Bacterial / economics
  • Pneumonia, Bacterial / epidemiology*
  • Pneumonia, Bacterial / microbiology
  • Prospective Studies
  • Young Adult


  • Anti-Bacterial Agents