Melioidosis presenting as septic arthritis in Bengali men in East London

Hoque, Selina; Minassian, M.A.; Clipstone, S.; Lloyd-Owen, Simon; Sheridan, Elizabeth; Lessing, M.P.A.

doi:10.1093/rheumatology/38.10.1029a

Cited by 15 publications

(10 citation statements)

References 11 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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“…Later on several cases of melioidosis were reported up to 2014 [ 9 ]. From 1991 to 1999, five cases were detected in United Kingdom (UK) among Bangladeshi people who immigrated to UK from the Sylhet region (a northeastern district) of Bangladesh [ 10 – 12 ]. In 2001, we reported the second culture confirmed suppurative melioidosis case in a 48 years old diabetic patient who came from Sherpur district of Bangladesh [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Burkholderia pseudomallei: Its Detection in Soil and Seroprevalence in Bangladesh

Jilani¹,

Robayet²,

Mohiuddin³

et al. 2016

PLoS Negl Trop Dis

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BackgroundMelioidosis, caused by Burkholderia pseudomallei, is an endemic disease in Bangladesh. No systematic study has yet been done to detect the environmental source of the organism and its true extent in Bangladesh. The present study attempted to isolate B. pseudomallei in soil samples and to determine its seroprevalence in several districts in Bangladesh.Methodology and ResultsSoil samples were collected from rural areas of four districts of Bangladesh from where culture confirmed melioidosis cases were detected earlier. Multiple soil samples, collected from 5–7 sampling points of 3–5 sites of each district, were cultured in Ashdown selective media. Suspected colonies of B. pseudomallei were identified by biochemical and serological test, and by polymerase chain reaction (PCR) using 16s rRNA specific primers. Blood samples were collected from 940 healthy individuals of four districts to determine anti- B. pseudomallei IgG antibody levels by indirect enzyme linked immunosorbent assay (ELISA) using sonicated crude antigen. Out of 179 soil samples, B. pseudomallei was isolated from two samples of Gazipur district which is located 58 km north of capital Dhaka city. Both the isolates were phenotypically identical, arabinose negative and showed specific 550bp band in PCR. Out of 940 blood samples, anti- B. pseudomallei IgG antibody, higher than the cut-off value (>0.8), was detected in 21.5% individuals. Seropositivity rate was 22.6%-30.8% in three districts from where melioidosis cases were detected earlier, compared to 9.8% in a district where no melioidosis case was either detected or reported (p<0.01). Seropositivity increased with the advancement of age from 5.3% to 30.4% among individuals aged 1–10 years and > 50 years respectively. The seropositivity rates were 26.0% and 20.6% in male and female respectively, while it was 20–27% among different occupational groups. No significant association was observed with gender (χ2 = 3.441, p = 0.064) or any occupational group (χ2 = 3.835, p = 0.280).ConclusionThis is the first study demonstrating the presence of B. pseudomallei in the environmental (soil) samples of Bangladesh. It also suggested that a large proportion of people, residing in these districts, were exposed to the organism.

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“…One reason might be that our hospital primarily deals with diabetic patients, diabetes is a risk factor for melioidosis, and our hospital receives many referral cases from this region of Bangladesh. It is further noted that cases have been described from Feni 8 and among travellers through Sylhet 16 and Rangpur 18 districts of Bangladesh. Initially he was put on split-mixed regimen of insulin, paracetamol and flucloxacilin.…”

Section: Discussionmentioning

confidence: 94%

“…13 Since the description of an 8-month old girl, who had pneumonia and septic shock due to melioidosis in 1988, 14 a few cases of melioidosis have been reported in Bangladeshi population, or among travellers through Bangladesh in some international as well as few local journals. [7][8][9][15][16][17][18][19][20] Most of them were diabetic. Their presentations included fever, arthritis, cough, cavitating lung lesion, abscesses in liver, spleen and prostate etc.…”

Section: Discussionmentioning

confidence: 99%

Melioidosis: Truly Uncommon or Uncommonly Diagnosed in Bangladesh? A CaseReport

et al. 2016

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Melioidosis is a rarely reported infectious disease in Bangladesh. Patients may present with fever, soft tissue infection, deep seated abscess, arthritis and septicaemia, specially if immunocompromised. It often mimics tuberculosis. Here we describe a case of melioidosis in a middle aged Bangladeshi diabetic farmer who presented with fever, soft tissue infection and septic arthritis involving right hip joint. Culture of pus from soft tissue infection and synovial fluid revealed growth of Burkholderia pseudomallei. He was treated with prolonged courses of antibiotics including ceftazidime in initial phase followed by co-trimoxazole and was cured completely.

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Melioidosis presenting as septic arthritis in Bengali men in East London

Cited by 15 publications

References 11 publications

Melioidosis: Epidemiology, Pathophysiology, and Management

Melioidosis: Epidemiology, Pathophysiology, and Management

Burkholderia pseudomallei: Its Detection in Soil and Seroprevalence in Bangladesh

Melioidosis: Truly Uncommon or Uncommonly Diagnosed in Bangladesh? A CaseReport

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