Sporadic and outbreak cases of melioidosis in southern Taiwan

Melioidosis has been well known to be endemic in Thailand and northern Australia and reported sporadically in Taiwan before 2005. We retrospectively analyzed 58 patients with melioidosis in southern Taiwan from 2000 to 2005, including 40 clustering and 18 sporadic cases, for clinical characteristics and antimicrobial susceptibility. Fifty-one (88%) cases were found in the rainy season, and there was a significant correlation between the average monthly rainfalls and the case number ( r = 0.37; P = .001). Diabetes mellitus was the most common underlying disease (35 cases, 60%). The majority of patients (51 cases, 88%) had never traveled abroad before their illness, indicating indigenous acquisition of Burkholderia pseudomallei . In comparison, clustering cases were older, less often had underlying diabetes mellitus, and had a shorter duration of clinical symptoms before admission than sporadic cases ( P < .005). Shock at admission was independently associated with a grave prognosis. Ceftazidime, imipenem, meropenem, amoxicillin/clavulanic acid, co-trimoxazole, and doxycycline were potential choices.