Case report: recovery from persistent septicemic melioidosis.

Inglis, Timothy J. J.; Golledge, C.L.; Clair, Adele; Harvey, Jennet

doi:10.4269/ajtmh.2001.65.76

Cited by 23 publications

(16 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…pseudomallei is susceptible to kanamycin, although this antibiotic is no longer used in the treatment of clinical melioidosis. Transposon mutation analysis has revealed that the (214). Although successful in this case, this applicability of this remains uncertain, and it is unlikely to gain widespread acceptance.…”

Section: Antibiotic Resistancementioning

confidence: 99%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

View full text Add to dashboard Cite

Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease

show abstract

Section: Antibiotic Resistancementioning

confidence: 99%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

View full text Add to dashboard Cite

show abstract

“…5 Another case of persistent septicemic melioidosis was confirmed in a patient who had visited the affected community during the outbreak, and the link with the original case cluster was made by genotyping with DNA macrorestriction analysis. 6 A second late-onset case of melioidosis was linked with the original cluster by the same method, bringing the total number of septicemic cases to seven, with three deaths and two delayed onset cases after 6 and 18 months, respectively. There were no more cases of melioidosis in the affected community and no culture-positive cases caused by the pulsotype of B. pseudomallei associated with the outbreak ( Figure 2 ).…”

Section: Introductionmentioning

confidence: 99%

The Aftermath of the Western Australian Melioidosis Outbreak

Inglis¹,

O'Reilly²,

Merritt³

et al. 2011

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Melioidosis became a notifiable disease in Western Australia (WA) 2 years after the West Kimberley melioidosis outbreak. Two cases of melioidosis caused by the outbreak genotype of Burkholderia pseudomallei (National Collection of Type Cultures [NCTC] 13177) occurred in 1998 and 1999 in persons who visited the outbreak location at the time. No other infections caused by the outbreak strain have been recorded in WA since that time, despite an average of four culture-positive cases per year. Sporadic cases of melioidosis often follow tropical storms and cyclones during summer, and they have been detected outside the endemic area when cyclones travel far inland. In 2007, environmental isolates resembling NCTC 13177 were found 500 km east of the outbreak location after unusually severe weather. Recent whole-genome analysis places NCTC 13177 genetically close to other Australian isolates. Additional biogeographic and ecological studies are needed to establish the relative importance of environmental cofactors in disease pathogenesis.

show abstract

“…pseudomallei strains for intracellular antibacterial susceptibility (7). Results from initial in vitro coculture studies indicated that the opacification of the growth media was due to a combination of intracellular and extracellular growth resulting from bacterium-ameba interactions (6).…”

Section: Discussionmentioning

confidence: 99%

“…At present, clinical trial data do not conclusively demonstrate an improved outcome when carbapenems are compared with ceftazidime (12), despite the theoretical benefit expected from improved intracellular penetration. In a recent case study, a previously published amebic cellular model of B. pseudomallei infection was used to demonstrate the superior intracellular activity of meropenem over ceftazidime and sulfamethoxazole (7). Although it was found that improved in vitro activity corresponded to the clinical improvement in a single persistent septicemic case, this outcome had alternative explanations based on other aspects of patient care.…”

mentioning

confidence: 99%

Comparison of the Susceptibilities of Burkholderia pseudomallei to Meropenem and Ceftazidime by Conventional and Intracellular Methods

Inglis¹,

Rodrigues²,

Rigby

et al. 2004

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The effect of the two antibiotics ceftazidime and meropenem on a collection of 46 Burkholderia pseudomallei isolates representing clinical and environmental sources across northern Australia was investigated by using a series of in vitro test methods. The susceptibility testing methods used included Kirby-Bauer disk diffusion, Etest MIC, broth microdilution MIC, and a modification of the microdilution method in which Acanthamoeba cells were added to simulate the effect of a professional phagocytic cell on test outcome. In a semiquantitative validation coculture series, the majority of bacteria were intracellular up to a multiplicity of infection of 10 bacteria to one ameba. The optical density and bacterial count (log 10 CFU/ml) correlated across the range tested (r 2 ‫؍‬ 0.77; P < 0.0001). Susceptibility test results were compared against clinical outcomes. The MICs of ceftazidime were consistently higher than those of meropenem by all three methods. The MICs of both agents were significantly higher when Acanthamoeba trophozoites were added to the broth microdilution method. Conventional and intracellular MIC results were consistent for clinical isolates from the Western Australian outbreak cluster despite the wide variety of clinical outcomes. Further development of the intracellular MIC method is expected to help assess the efficacy of antimicrobial agents on this bacterial species in an intracellular setting.Burkholderia pseudomallei, the bacterial species responsible for the potentially fatal infection known as melioidosis, is a facultative intracellular pathogen. The ability of B. pseudomallei to survive in macrophages has been known for some time (10) and is used to explain unusual aspects of melioidosis including late onset and recurrent disease. Treatment of the acute, septicemic form of melioidosis often relies on ceftazidime. In a study with a septicemic relapse rate of around 23%, relapse was more common in the patient group not treated with ceftazidime (1). The combined mortality of septicemic and nonsepticemic melioidosis in Australia has been put at 21% (2). There has been growing interest in the use of carbapenems as an alternative antibiotic option for acute B. pseudomallei infection (12, 13). At present, clinical trial data do not conclusively demonstrate an improved outcome when carbapenems are compared with ceftazidime (12), despite the theoretical benefit expected from improved intracellular penetration. In a recent case study, a previously published amebic cellular model of B. pseudomallei infection was used to demonstrate the superior intracellular activity of meropenem over ceftazidime and sulfamethoxazole (7). Although it was found that improved in vitro activity corresponded to the clinical improvement in a single persistent septicemic case, this outcome had alternative explanations based on other aspects of patient care. In the present study we used an amebic intracellular susceptibility method to compare the activity of a carbapenem and ceftazidime on a range of B. pseudomallei isolat...

show abstract

Case report: recovery from persistent septicemic melioidosis.

Cited by 23 publications

References 23 publications

Melioidosis: Epidemiology, Pathophysiology, and Management

Melioidosis: Epidemiology, Pathophysiology, and Management

The Aftermath of the Western Australian Melioidosis Outbreak

Comparison of the Susceptibilities of Burkholderia pseudomallei to Meropenem and Ceftazidime by Conventional and Intracellular Methods

Contact Info

Product

Resources

About