Melioidosis: a clinical overview

Limmathurotsakul, Direk; Peacock, Sharon J.

doi:10.1093/bmb/ldr007

Cited by 233 publications

(273 citation statements)

References 46 publications

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“…Monitoring of treatment compliance is crucial as it has been proposed that adherence may be the most important factor in determining recurrence, which is the most serious complication of melioidosis (2). Recurrent melioidosis occurs in 5% to 25% of cases and has a high mortality rate of 25% (2).…”

Section: Therapeutic Approaches Antimicrobial Resistance and Prevenmentioning

confidence: 99%

“…Over the past 3 decades, the disease has emerged as an important cause of mortality in Southeast Asia and northern Australia (2), and has been reported in the Indian subcontinent and Central and South Americas (3)(4)(5). Recognition of melioidosis based on clinical presentation can be challenging, and a delay in diagnosis can result in fatality (6).…”

Section: Introductionmentioning

confidence: 99%

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Burkholderia pseudomallei: Challenges for the Clinical Microbiology Laboratory

et al. 2016

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bMelioidosis is a potentially fatal infection caused by the bacterium Burkholderia pseudomallei. Clinical diagnosis of melioidosis can be challenging since there is no pathognomonic clinical syndrome, and the organism is often misidentified by methods used routinely in clinical laboratories. Although the disease is more prevalent in Thailand and northern Australia, sporadic cases may be encountered in areas where it is not endemic, including the United States. Since the organism is considered a tier 1 select agent according to the Centers for Disease Control and Prevention and the U.S. Department of Agriculture Animal and Plant Health Inspection Service, clinical laboratories must be proficient at rapidly recognizing isolates suspicious for B. pseudomallei, be able to safely perform necessary rule-out tests, and to refer suspect isolates to Laboratory Response Network reference laboratories. In this minireview, we report a case of melioidosis encountered at our institution and discuss the laboratory challenges encountered when dealing with clinical isolates suspicious for B. pseudomallei or clinical specimens from suspected melioidosis cases. CASEA 67-year-old Filipino woman with a previous history of treated tuberculosis, hypertension, type 2 diabetes, coronary artery disease, and complete heart block requiring a pacemaker and drug-eluting stent that was placed 4 months earlier presented to an outside hospital with 2 weeks of progressive left lower quadrant abdominal pain, chills, and subjective fever. She was evaluated in different emergency departments for similar complaints on two occasions in the preceding week, but was discharged home. She was admitted to an outside hospital on this visit and computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed an 8 by 8 by 8 mm suprarenal saccular aneurysm arising from the posterior aortic wall with surrounding inflammation. Blood cultures drawn in the emergency department grew a Gram-negative rod, which was identified by the Vitek 2 (bioMérieux, Durham NC) as Burkholderia pseudomallei. This identification was confirmed several weeks later by the Centers for Disease Control and Prevention (CDC). Transthoracic echocardiography showed no vegetation. The patient was treated with meropenem 1 g intravenously (i.v.) every 8 hours (q8h). Follow-up CT scans performed 9 days after presentation showed that the mycotic aneurysm had enlarged to 13 by 24 by 20 mm and revealed a second aneurysm of the lateral wall of the aorta measuring 4 by 4 mm.The patient was transferred to our institution for surgical evaluation. On arrival, two sets of blood cultures (BD Bactec FX system; Becton, Dickinson and Company, NJ) were collected. Within 48 h of transfer, the patient underwent surgical excision of the mycotic aneurysm and reconstruction of her aorta using bioprosthetic homografts. During the procedure, the aneurysm was found to have ruptured, with the resulting pseudoaneurysm encased in inflammatory material and purulent fluid. Intraoperative samples from t...

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Section: Therapeutic Approaches Antimicrobial Resistance and Prevenmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Burkholderia pseudomallei: Challenges for the Clinical Microbiology Laboratory

et al. 2016

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“…1 When acquired by humans and animals, B. pseudomallei can cause melioidosis, a life-threatening disease that, to this day, still presents a danger to most parts of the tropics. 2 Decades of research on B. pseudomallei has only revealed how versatile this pathogen is, for example, it can (1) infect a multitude of organisms and invade a wide range of cell types, 3,4 (2) result in a broad spectrum of clinical manifestations, 5 (3) resist many clinical antimicrobials 6 and (4) survive extremely harsh environmental conditions. 7 Yet, the molecular mechanisms by which B. pseudomallei evades or modulates host immune responses remain elusive.…”

Section: Introductionmentioning

confidence: 99%

Burkholderia pseudomalleikillsCaenorhabditis elegansthrough virulence mechanisms distinct from intestinal lumen colonization

et al. 2012

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The nematode Caenorhabditis elegans is hypersusceptible to Burkholderia pseudomallei infection. However, the virulence mechanisms underlying rapid lethality of C. elegans upon B. pseudomallei infection remain poorly defined. To probe the host-pathogen interaction, we constructed GFP-tagged B. pseudomallei and followed bacterial accumulation within the C. elegans intestinal lumen. Contrary to slow-killing by most bacterial pathogens, B. pseudomallei caused fairly limited intestinal lumen colonization throughout the period of observation. Using grinder-defective mutant worms that allow the entry of intact bacteria also did not result in full intestinal lumen colonization. In addition, we observed a significant decline in C. elegans defecation and pharyngeal pumping rates upon B. pseudomallei infection. The decline in defecation rates ruled out the contribution of defecation to the limited B. pseudomallei colonization. We also demonstrated that the limited intestinal lumen colonization was not attributed to slowed host feeding as bacterial loads did not change significantly when feeding was stimulated by exogenous serotonin. Both these observations confirm that B. pseudomallei is a poor colonizer of the C. elegans intestine. To explore the possibility of toxin-mediated killing, we examined the transcription of the C. elegans ABC transporter gene, pgp-5, upon B. pseudomallei infection of the ppgp-5::gfp reporter strain. Expression of pgp-5 was highly induced, notably in the pharynx and intestine, compared with Escherichia coli-fed worms, suggesting that the host actively thwarted the pathogenic assaults during infection. Collectively, our findings propose that B. pseudomallei specifically and continuously secretes toxins to overcome C. elegans immune responses.

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“…MD is preventable (Limmathurotsakul and Peacock, 2011). The susceptible population includes farmers, fishermen, and workers, whose education levels and incomes are relatively low.…”

Section: Discussionmentioning

confidence: 99%