ABSTRACT
Melioidosis is caused by the environmental bacterium Burkholderia pseudomallei and can present with severe sepsis. Predisposing risk factors are present in 80% of cases. Monoclonal antibodies are increasingly prescribed for varied medical conditions. This report describes the first known case of melioidosis in a patient whose only risk factor for disease is treatment with a monoclonal antibody. Prescribers of monoclonal antibodies and other immunosuppressants should ensure that their patients are aware of the potential risk of melioidosis prior to travel and the precautions that should be taken.
Subject(s)
Amoxicillin-Potassium Clavulanate Combination/administration & dosage , Anti-Infective Agents/administration & dosage , Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/adverse effects , Arthritis, Psoriatic/drug therapy , Melioidosis/drug therapy , Adalimumab , Antibodies, Monoclonal, Humanized/immunology , Antirheumatic Agents/immunology , Arthritis, Psoriatic/immunology , Burkholderia pseudomallei/isolation & purification , Humans , Male , Melioidosis/immunology , Melioidosis/microbiology , Middle Aged , Risk Factors , Treatment Outcome , Trimethoprim, Sulfamethoxazole Drug Combination/adverse effectsABSTRACT
A retrospective observational study of human T-lymphotropic virus-1 (HTLV-1) serology requests made to the Northern Territory Government Pathology Service (NTGPS) between 2008 and 2011, was undertaken to review aspects of HTLV-1 sero-epidemiology and performance of the assays. A total of 5686 HTLV-1 serology requests, representing 3555 individual patients, were received during the study period; 368 HTLV-1 confirmed positive serology results were identified from the 3555 individual patients included in the sample. There was a distinct difference in the performance of the two antibody assays in use during this period, with the Serodia particle agglutination having a 5.7% indeterminate positivity rate compared to 18.1% indeterminate positivity rate of the Abbott HTLV 1/2 assay. We believe this is partially a serological anomaly related to current Australian western blot positive interpretative criteria, rather than false positive screening assay results.The majority (99.7%) of positive results occurred in Indigenous patients. The HTLV-1 positive rate varied geographically from a regional high of 51.7%, and falling inversely with distance from Central Australia. Patients with positive serology had a mean age of 49.9 (±13.9) years, with positivity occurring equally in males and females.
