Cutaneous melioidosis in the tropical top end of Australia: a prospective study and review of the literature.

BACKGROUND: Burkholderia pseudomallei is endemic in northern Australia, and melioidosis is a common cause of sepsis in the region.
METHODS: We summarized the cutaneous manifestations of melioidosis from a prospective cohort of 486 patients with culture-confirmed melioidosis in northern Australia, and we compared those who had primary skin melioidosis with those who had other forms of melioidosis.
RESULTS: Primary skin melioidosis occurred in 58 patients (12%). Secondary skin melioidosis--multiple pustules from hematogenous spread--was present in 10 patients (2%). Patients with primary skin melioidosis were more likely to have chronic presentations (duration, >or=2 months). On multivariate analysis, patients with primary cutaneous melioidosis were more likely to be children aged <or=15 years (adjusted odds ratio, 8.50; 95% confidence interval [CI], 3.24-22.28) and to have a history of occupational exposure to B. pseudomallei (adjusted odds ratio, 3.12; 95% CI, 1.56-6.25) but were less likely to have typical risk factors--including diabetes (adjusted odds ratio, 0.26; 95% CI, 0.12-0.56), excessive alcohol intake (adjusted odds ratio, 0.45; 95% CI, 0.22-0.90), and chronic lung disease (adjusted odds ratio, 0.26; 95% CI, 0.10-0.67). Of those patients with primary skin melioidosis, 1 patient was bacteremic and none had severe sepsis or died from melioidosis. Four (7%) of the 58 patients presenting with primary skin melioidosis had disseminated melioidosis, and 1 (2%) experienced a relapse of melioidosis. Nine patients (16%) were cured with a regimen of oral antibiotics alone, and 1 recovered with no therapy.
CONCLUSION: In our cohort, patients with primary skin melioidosis were younger, had fewer underlying medical conditions, and had better outcomes than did those with other forms of melioidosis. There may be a role for exclusive oral antibiotic therapy for some cases of primary skin melioidosis.