Identification and Characterization of Burkholderia pseudomallei from Localized Pyogenic Infections in Eastern India: A Clinico-Microbiological Study

Abstract

Melioidosis, caused by Burkholderia pseudomallei, is increasingly recognized in several regions of the globe. The present study was performed to identify and determine the frequency of B. pseudomallei infection in localized pyogenic lesions in eastern India and describe their clinico-microbiological profile. Pus samples were subjected to standard microbiological techniques for isolation and identification of various bacteria, including B. pseudomallei, which were confirmed by PCR. The clinical and demographic details of patients with melioidosis and antimicrobial susceptibility pattern of B. pseudomallei isolates were analyzed. Of 245 samples, 126 (51.4%) were culture positive, yielding 137 isolates. Staphylococcus aureus was the predominant pathogen accounting for 54 (39.4%) isolates, followed by B. pseudomallei accounting for 34 (24.8%) isolates. The mean age of the patients with melioidosis was 39.1 years, with males (24/34; 70.6%) being affected more than females (10/34; 29.4%). A majority of the patients were laborers (12/34; 35.3), followed by homemakers (8/34; 23.5%). Head and neck abscesses (35.3%) were the most common presentation followed by pyogenic lesions of the musculoskeletal system (32.3%) and deep organ abscesses (23.5%). Clinical resolution of infection was observed in 31 (91.2%) patients, relapse in two (5.9%) patients, and death in one (2.9%) patient, respectively. Susceptibility testing revealed all B. pseudomallei isolates to be completely susceptible to the following antimicrobials: ceftazidime, trimethoprim–sulfamethoxazole, imipenem, and doxycycline, with one (2.9%) resistant to amoxicillin–clavulanic acid. Burkholderia pseudomallei is an emerging etiological agent of localized pyogenic infections in eastern India, affecting a mainly adult male population. An increased vigilance along with appropriate diagnostic techniques helps in accurate diagnosis facilitating appropriate therapy.

Coinfection of Melioidosis and Tuberculosis Causing Infective Lumbar Spondylodiscitis

“…However, he was a resident of a TB endemic zone and a farmer by occupation, which made him prone to melioidosis, which is common in irrigated areas such as rice paddies 6 . There are few cases of melioidosis reported from our state earlier 9,18,21,22 .…”

“…Simple tests that can aid in the identification of B. psedudomallei include the typical colony characteristics on MacConkey agar (nonlactose fermenting, small, smooth colonies after overnight incubation turning pink with a metallic sheen after 48 hours and dry wrinkled after 96 hours), “safety-pin” appearance due to typical bipolar staining on Gram stain, and inherent resistance to polymyxins and gentamicin (tested by colistin 10 μg, polymyxin B 300U, and gentamicin 10 μg disks). Newer tests that can help include the commercially available identification systems (Phoenix, Microscan walkway 96, Vitek-2) and matrix-assisted laser desorption ionization mass spectrometry 18 .…”

Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination

“…Informative case series have been published from Tamil Nadu [18], Kerala [19] and Karnataka [20] in southern India and Odissa in eastern India [21]. An extensive soil sampling study from southwest India showed the wide environmental distribution of B. pseudomallei but with considerable differences in abundance between sites and within single sites, the highest abundance during the rainy season and the presence of B. pseudomallei linked to nutrient-depleted habitats [22 ▪ ].…”

Characteristic of pancreatic involvement in melioidosis: Case report and literature review

“…In China, meliodosis is prevalent in regions such as Hainan, Guangdong, Guangxi, Fujian, Hong Kong, and Taiwan, with Hainan being the epicenter of the epidemic [ 3 ]. While melioidosis affects multiple organs, with the lungs and bloodstream being the most commonly infected [ [4] , [5] , [6] ], cases involving the pancreas are exceptionally rare. Our literature search identified 11 reported cases of melioidosis with pancreatic involvement, all of which were distributed in Asia [ [7] , [8] , [9] , [10] , [11] , [12] ], including five from India [ 8 , 10 , 12 ], four from Brunei [ 7 ] and two from China [ 9 , 11 ] ( Table 1 ).…”