Imipenem for the treatment of melioidosis

Minassian, M.A.; Gage, Andrew A.; Price, Erin P.; Sefton, Armine

doi:10.1016/s0924-8579(99)00071-0

Cited by 12 publications

(7 citation statements)

References 9 publications

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“…Although few cases in Sri Lanka have been described (452), a report described a case that was believed to have been acquired in that country (326). Sporadic cases of melioidosis in travelers returning from Bangladesh have also been reported (122,239,300), including a series of three patients presenting with septic arthritis following travel to Syhet (201). One case from within the country has been described (414).…”

Section: Vietnam Melioidosis Was First Noted In What Is Now Southernmentioning

confidence: 99%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

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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

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Section: Vietnam Melioidosis Was First Noted In What Is Now Southernmentioning

confidence: 99%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

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“…10 The use of imipenem in the treatment of acute melioidosis was recently reported by another group. 11 Unfortunately, serious neurological adverse effects have been reported during imipenem use in critically ill patients. 12 Meropenem has therefore replaced imipenem as the carbapenem of choice in a critical care setting.…”

Section: Discussionmentioning

confidence: 99%

Case report: recovery from persistent septicemic melioidosis.

Inglis

Golledge²,

Clair³

et al. 2001

The American Journal of Tropical Medicine and Hygiene

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Abstract. Septicemic melioidosis is often fatal despite treatment with antibiotics such as ceftazidime to which Burkholderia pseudomallei, the causal pathogen, is sensitive in vitro. We report a near-fatal case of septicemic melioidosis with persistent B. pseudomallei bacteremia despite intravenous ceftazidime in which combination therapy with meropenem and ciprofloxacin, splenectomy and correction of metabolic acidosis allowed for hospital discharge. The choice of antibiotic agents was supported by intracellular minimum inhibitory concentration analysis using B. pseudomallei co-culture in Acanthamoeba trophozoites. The patient's B. pseudomallei isolates were indistinguishable by pulsed-field gel electrophoresis from clinical and environmental isolates previously analyzed during investigation of a Western Australian melioidosis outbreak. A combination of antibiotics known to possess intracellular activity against B. pseudomallei, surgery and supportive critical care may provide a means of improving the probability of survival in persistent septicemic melioidosis.

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“…A few cases have also been identified in Sri Lanka [80]. Intermittent cases of melioidosis in travelers from Bangladesh have also been reported [7,81–82], together with 3 patients presenting septic arthritis after travel to Syhet [83]. Transmission was also documented in a 24-year-old Malaysian female patient who developed acute, nonfatal septicemic melioidosis after inhaling infective dust during a blast injury [84].…”

Section: Geographical Distribution Disease Incidence and Ecologymentioning

confidence: 99%

Melioidosis: Clinical impact and public health threat in the tropics

et al. 2017

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This review briefly summarizes the geographical distribution and clinical impact of melioidosis, especially in the tropics. Burkholderia pseudomallei (a gram-negative bacterium) is the major causative agent for melioidosis, which is prevalent in Singapore, Malaysia, Thailand, Vietnam, and Northern Australia. Melioidosis patients are increasingly being recognized in other parts of the world. The bacteria are intrinsically resistant to many antimicrobial agents, but prolonged treatment, especially with combinations of antibiotics, may be effective. Despite therapy, the overall case fatality rate of septicemia in melioidosis remains significantly high. Intracellular survival of the bacteria within macrophages may progress to chronic infections, and about 10% of patients suffer relapses. In the coming decades, melioidosis will increasingly afflict travelers throughout many global regions. Clinicians managing travelers returning from the subtropics or tropics with severe pneumonia or septicemia should consider acute melioidosis as a differential diagnosis. Patients with open skin wounds, diabetes, or chronic renal disease are at higher risk for melioidosis and should avoid direct contact with soil and standing water in endemic regions. Furthermore, there are fears that B. pseudomallei may be used as a biological weapon. Technological advancements in molecular diagnostics and antibiotic therapy are improving the disease outcomes in endemic areas throughout Asia. Research and development efforts on vaccine candidates against melioidosis are ongoing.

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Imipenem for the treatment of melioidosis

Cited by 12 publications

References 9 publications

Melioidosis: Epidemiology, Pathophysiology, and Management

Melioidosis: Epidemiology, Pathophysiology, and Management

Case report: recovery from persistent septicemic melioidosis.

Melioidosis: Clinical impact and public health threat in the tropics

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