{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T23:55:51Z","timestamp":1783641351569,"version":"3.55.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australian National Health and Medical Research Council Investigator","award":["2041264"],"award-info":[{"award-number":["2041264"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Melioidosis is caused by infection with Burkholderia pseudomallei. Most cases present acutely however a minority have chronic symptoms. We aimed to define the clinical epidemiology of chronic melioidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Cases of melioidosis with symptoms for \u22652 months in the Australian Northern Territory from 1989 to 2023 were described and compared to cases with symptoms for &amp;lt;2 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among the 126 (9.4%) chronic melioidosis cases, the most common presentations were pneumonia (38.9%) and skin and soft tissue infections (32.5%). In those with primary pneumonia, neoplasia was a differential diagnosis in 25.5% and tuberculosis in 32.4% of chest radiography reports. Patients with chronic compared to acute melioidosis were significantly more likely to have cutaneous disease (32.5% vs 10.4%, P &amp;lt; .001) and less likely to have pneumonia (38.9% vs 53.6%, P = .002), have positive blood cultures (14.3% vs 59.1%, P &amp;lt; .001), have more than one infective focus (13.5% vs 22.5%, P = .019), or die from their initial melioidosis episode (2.4% vs 11.1%, P = .003). Those with chronic presentations were less likely to be diagnosed in the wet season (55.6% vs 83.9%, P &amp;lt; .001), be First Nations Australians (35.7% vs 54.8%, P &amp;lt; .001), or have clinical risk factors for melioidosis including diabetes mellitus (32.5% vs 48.0%, P &amp;lt; .001), chronic kidney disease (6.4% vs 12.4%, P = .046), and hazardous alcohol use (27.0% vs 40.3%, P = .003). Serology by indirect hemagglutination assay was positive at diagnosis in 87.0% of chronic presentations compared to 48.5% of acute cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients with chronic melioidosis have fewer risk factors for melioidosis, lower disease severity, higher serology titers, and lower mortality than patients with acute melioidosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag294","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:45:22Z","timestamp":1778845522000},"source":"Crossref","is-referenced-by-count":1,"title":["Epidemiology, Clinical Features, and Outcomes of Chronic Melioidosis in the Top End of Australia's Northern Territory, 1989\u20132023"],"prefix":"10.1093","volume":"13","author":[{"given":"Harsimran","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital , Darwin, Northern Territory ,","place":["Australia"]},{"name":"College of Medicine and Dentistry, James Cook University , Townsville, Queensland ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8878-8837","authenticated-orcid":false,"given":"Bart J","family":"Currie","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital , Darwin, Northern Territory ,","place":["Australia"]},{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celeste","family":"Woerle","sequence":"additional","affiliation":[{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7993-820X","authenticated-orcid":false,"given":"Ella M","family":"Meumann","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital , Darwin, Northern Territory ,","place":["Australia"]},{"name":"Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University , Darwin, Northern Territory ,","place":["Australia"]},{"name":"Microbiology Department, Territory Pathology , Darwin, Northern Territory ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026060514523491800_ofag294-B1","first-page":"27","article-title":"Melioidosis: an Australian perspective","volume":"3","author":"Smith","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"2026060514523491800_ofag294-B2","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1038\/s41579-023-00972-5","article-title":"Burkholderia pseudomallei and melioidosis","volume":"22","author":"Meumann","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"2026060514523491800_ofag294-B3","doi-asserted-by":"crossref","first-page":"e2072","DOI":"10.1371\/journal.pntd.0002072","article-title":"Activities of daily living associated with acquisition of melioidosis in northeast Thailand: a matched case-control study","volume":"7","author":"Limmathurotsakul","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"2026060514523491800_ofag294-B4","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.3201\/eid0912.020750","article-title":"Intensity of rainfall and severity of melioidosis, Australia","volume":"9","author":"Currie","year":"2003","journal-title":"Emerg Infect Dis"},{"key":"2026060514523491800_ofag294-B5","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3201\/eid2101.140042","article-title":"Association of melioidosis incidence with rainfall and humidity, Singapore, 2003\u20132012","volume":"21","author":"Liu","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"2026060514523491800_ofag294-B6","doi-asserted-by":"crossref","first-page":"e900","DOI":"10.1371\/journal.pntd.0000900","article-title":"The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study","volume":"4","author":"Currie","year":"2010","journal-title":"PLoS Negl Trop Dis"},{"key":"2026060514523491800_ofag294-B7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000431","article-title":"Estimation of seroprevalence of melioidosis among adult high risk groups in Southeastern India by indirect hemagglutination assay","volume":"2","author":"Raj","year":"2022","journal-title":"PLOS Glob Public Health"},{"key":"2026060514523491800_ofag294-B8","doi-asserted-by":"crossref","first-page":"156","DOI":"10.4269\/ajtmh.24-0007","article-title":"Melioidosis and activation from latency: the \u2018time bomb\u2019 has not occurred","volume":"111","author":"Howes","year":"2024","journal-title":"Am J Trop Med Hyg"},{"key":"2026060514523491800_ofag294-B9","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/S1473-3099(21)00022-0","article-title":"The darwin prospective melioidosis study: a 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2026060514523491800_ofag294-B10","doi-asserted-by":"crossref","first-page":"2316","DOI":"10.1128\/JCM.00231-06","article-title":"Role of selective and nonselective Media for isolation of Burkholderia pseudomallei from throat swabs of patients with melioidosis","volume":"44","author":"Cheng","year":"2006","journal-title":"J Clin Microbiol"},{"key":"2026060514523491800_ofag294-B11","author":"Currie"},{"key":"2026060514523491800_ofag294-B12","author":"Department of Health and Families, NT Government"},{"key":"2026060514523491800_ofag294-B13","author":"Australian Bureau of Statistics"},{"key":"2026060514523491800_ofag294-B14","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1128\/CVI.00021-13","article-title":"Surprisingly low seroprevalence of Burkholderia pseudomallei in exposed healthy adults in the darwin region of tropical Australia where melioidosis is highly endemic","volume":"20","author":"James","year":"2013","journal-title":"Clin Vaccine Immunol"},{"key":"2026060514523491800_ofag294-B15","first-page":"25","article-title":"Melioidosis in Malaysia: incidence, clinical challenges, and advances in understanding pathogenesis","volume":"3","author":"Nathan","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"2026060514523491800_ofag294-B16","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/S1473-3099(19)30157-4","article-title":"Global burden of melioidosis, 2015: a systematic review and data synthesis","volume":"19","author":"Birnie","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"2026060514523491800_ofag294-B17","doi-asserted-by":"crossref","first-page":"3119","DOI":"10.3201\/eid2712.211302","article-title":"Increased incidence of melioidosis in far North Queensland, Queensland, Australia, 1998\u20132019","volume":"27","author":"Smith","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"2026060514523491800_ofag294-B18","volume-title":"Prevalence of chronic diseases in the Northern Territory, 2019","author":"Health Statistics and Informatics","year":"2019"},{"key":"2026060514523491800_ofag294-B19","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/S0035-9203(03)80035-4","article-title":"A proposed scoring system for predicting mortality in melioidosis","volume":"97","author":"Cheng","year":"2003","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2026060514523491800_ofag294-B20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0013222","article-title":"Exploring patient characteristics and respiratory impacts of pulmonary melioidosis: a 5-year experience from endemic region of Thailand","volume":"19","author":"Ngeyvijit","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"2026060514523491800_ofag294-B21","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.crad.2009.08.008","article-title":"Radiological manifestations of melioidosis","volume":"65","author":"Lim","year":"2010","journal-title":"Clin Radiol"},{"key":"2026060514523491800_ofag294-B22","article-title":"Tuberculosis in Australia's tropical north: a population-based genomic epidemiological study","volume":"15","author":"Meumann","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"2026060514523491800_ofag294-B23","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1016\/S0140-6736(21)00200-2","article-title":"Mediastinal melioidosis masquerading as malignancy of the lung","volume":"397","author":"Kho","year":"2021","journal-title":"The Lancet"},{"key":"2026060514523491800_ofag294-B24","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s43055-023-00994-2","article-title":"Imaging case series of melioidosis: the great masquerader","volume":"54","author":"Amin","year":"2023","journal-title":"Egypt J Radiol Nucl Med"},{"key":"2026060514523491800_ofag294-B25","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.4269\/ajtmh.2006.74.1074","article-title":"Development of antibodies to Burkholderia pseudomallei during childhood in melioidosis-endemic northeast Thailand","volume":"74","author":"Wuthiekanun","year":"2006","journal-title":"Am J Trop Med Hyg"},{"key":"2026060514523491800_ofag294-B26","first-page":"100360","article-title":"Seroprevalence of melioidosis and its associated risk factors -A population-based study in Odisha, eastern India","volume":"8","author":"Behera","year":"2025","journal-title":"Curr Res Microb Sci"},{"key":"2026060514523491800_ofag294-B27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003834","article-title":"Airborne transmission of melioidosis to humans from environmental aerosols contaminated with B. pseudomallei","volume":"9","author":"Chen","year":"2015","journal-title":"PLoS Negl Trop Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/6\/ofag294\/68454584\/ofag294.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/6\/ofag294\/68454584\/ofag294.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:52:40Z","timestamp":1780685560000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag294\/8700045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":27,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag294","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,6]]},"article-number":"ofag294"}}