A Case of <i>Burkholderia pseudomallei</i> Mycotic Aneurysm Linked to Exposure in the Caribbean via Whole-Genome Sequencing

Speiser, Lisa J.; Kasule, Sabirah N; Hall, Carina M.; Sahl, Jason W.; Wagner, David M.; Saling, Chris; Kole, Amy; Meltzer, Andrew J.; Davila, Victor J.; Orenstein, Robert; Grys, Thomas E.; Graf, Erin H.

doi:10.1093/ofid/ofac136

Open Forum Infectious Diseases

2022

DOI: 10.1093/ofid/ofac136

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A Case of Burkholderia pseudomallei Mycotic Aneurysm Linked to Exposure in the Caribbean via Whole-Genome Sequencing

Lisa J. Speiser

Sabirah N Kasule

Carina M. Hall

et al.

Abstract: Melioidosis, an infection caused by Burkholderia pseudomallei, has a very high risk of mortality when treated, with an even higher risk of fatality if undiagnosed or not treated appropriately. It is endemic to Asia, Australia, South America, and the Caribbean; however, the number of melioidosis cases reported in the United States has been increasing. Therefore, physicians should be aware of this clinical entity and its possible presentations. Mycotic aneurysms due to B. pseudomallei are extremely rare, account… Show more

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Cited by 3 publications

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Travel-associated melioidosis: a narrative review

Norman

Chen

2023

Journal of Travel Medicine

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Background: Melioidosis, caused by Burkholderia pseudomallei, may be considered a neglected tropical disease which remains underdiagnosed in many geographical areas. Travelers can act as sentinels of disease activity and data from imported cases may help complete the global map of melioidosis. Methods: A literature search for imported melioidosis for the period 2016-2022 was performed in PubMed and Google Scholar. Results: In total, 137 reports of melioidosis associated with travel were identified. The majority were males (71%) and associated with exposure in Asia (77%) (mainly Thailand, 41%, and India, 9%). A minority acquired the infection in the Americas-Caribbean area (6%), Africa (5%) and Oceania (2%). The most frequent comorbidity was diabetes mellitus (25%) followed by underlying pulmonary, liver or renal disease (8%, 5% and 3%, respectively). Alcohol/tobacco use were noted for 7 and 6 patients, respectively (5%). Five patients (4%) had associated non-HIV related immunosuppression and 3 patients (2%) had HIV infection. One patient (0.8%) had concomitant COVID-19. A proportion (27%) had no underlying diseases. The most frequent clinical presentations included pneumonia (35%), sepsis (30%), and skin/soft tissue infections (14%). Most developed symptoms <1 week after return (55%) and 29% developed symptoms >12 weeks after. Ceftazidime and meropenem were the main treatments used during the intensive intravenous phase (52% and 41% of patients, respectively) and the majority (82%) received co-trimoxazole alone/combination, for the eradication phase. Most patients had a favorable outcome/survived (87%). The search also retrieved cases in imported animals or cases secondary to imported commercial products. Conclusions: As post-pandemic travel soars, health professionals should be aware of the possibility of imported melioidosis with its diverse presentations. Currently no licensed vaccine is available so prevention in travelers should focus on protective measures (avoiding contact with soil/stagnant water in endemic areas). Biological samples from suspected cases require processing in biosafety level 3 facilities.

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Travel-associated melioidosis: a narrative review

Norman

Chen

2023

Journal of Travel Medicine

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Low risk of acquiring melioidosis from the environment in the continental United States

et al. 2022

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Melioidosis is an underreported human disease of tropical and sub-tropical regions caused by the saprophyte Burkholderia pseudomallei. Although most global melioidosis cases are reported from tropical regions in Southeast Asia and northern Australia, there are multiple occurrences from sub-tropical regions, including the United States (U.S.). Most melioidosis cases reported from the continental U.S. are the result of acquiring the disease during travel to endemic regions or from contaminated imported materials. Only two human melioidosis cases from the continental U.S. have likely acquired B. pseudomallei directly from local environments and these cases lived only ~7 km from each other in rural Texas. In this study, we assessed the risk of acquiring melioidosis from the environment within the continental U.S. by surveying for B. pseudomallei in the environment in Texas where these two human melioidosis cases likely acquired their infections. We sampled the environment near the homes of the two cases and at additional sampling locations in surrounding counties in Texas that were selected based on ecological niche modeling. B. pseudomallei was not detected at the residences of these two cases or in the surrounding region. These negative data are important to demonstrate that B. pseudomallei is rare in the environment in the U.S. even at locations where locally acquired human cases likely have occurred, documenting the low risk of acquiring B. pseudomallei infection from the environment in the continental U.S.

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Burkholderia pseudomallei Laboratory Exposure, Arizona, USA

Speiser¹,

Graf²,

Seville³

et al. 2023

Emerg. Infect. Dis.

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A Case of Burkholderia pseudomallei Mycotic Aneurysm Linked to Exposure in the Caribbean via Whole-Genome Sequencing

Cited by 3 publications

References 46 publications

Travel-associated melioidosis: a narrative review

Travel-associated melioidosis: a narrative review

Low risk of acquiring melioidosis from the environment in the continental United States

Burkholderia pseudomallei Laboratory Exposure, Arizona, USA

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