Severe Sepsis with Multiorgan Failure due to Melioidosis: A Lesson to Learn

Warapitiya, Dinuka S.; Subasinghe, Shyama; Silva, R. F. De; Piyarisi, Dadallage Lalitha; Jayatilleke, Kushlani

doi:10.1155/2021/5563214

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Moreover, IL-18 may also promote the secretion of other pro-inflammatory cytokines such as TNF-α, IL-1β, IL-8, and GM-CSF, which leads to an increase in the expansion, migration, and activation of neutrophils during infections [ 38 ]. Therefore, the elevation of IL-1β and IL-18 secretion by infected monocytes may be the keys cytokines participating in sepsis by affecting other immune cells to orchestrate the secretion of other pro-inflammatory cytokine production, resulting in the cytokine storm as observed in acute melioidosis patients [ 39 ]. In addition, high levels of IL-1β production have also been reported to exert a harmful effect on the host during pulmonary infection of B .…”

Section: Discussionmentioning

confidence: 99%

Differentiation in pyroptosis induction by Burkholderia pseudomallei and Burkholderia thailandensis in primary human monocytes, a possible cause of sepsis in acute melioidosis patients

Khongpraphan,

Ekchariyawat,

Sanongkiet

et al. 2024

PLoS Negl Trop Dis

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Melioidosis caused by Burkholderia pseudomallei is an infectious disease with a high mortality rate. In acute melioidosis, sepsis is a major cause of death among patients. Once the bacterium enters the bloodstream, immune system dysregulation ensues, leading to cytokine storms. In contrast to B. pseudomallei, a closely related but non-virulent strain B. thailandensis has rarely been reported to cause cytokine storms or death in patients. However, the mechanisms in which the virulent B. pseudomallei causes sepsis are not fully elucidated. It is well-documented that monocytes play an essential role in cytokine production in the bloodstream. The present study, therefore, determined whether there is a difference in the innate immune response to B. pseudomallei and B. thailandensis during infection of primary human monocytes and THP-1 monocytic cells by investigating pyroptosis, an inflammatory death pathway known to play a pivotal role in sepsis. Our results showed that although both bacterial species exhibited a similar ability to invade human monocytes, only B. pseudomallei can significantly increase the release of cytosolic enzyme lactate dehydrogenase (LDH) as well as the increases in caspase-1 and gasdermin D activations in both cell types. The results were consistent with the significant increase in IL-1β and IL-18 production, key cytokines involved in pyroptosis. Interestingly, there was no significant difference in other cytokine secretion, such as IL-1RA, IL-10, IL-12p70, IL-15, IL-8, and IL-23 in cells infected by both bacterial species. Furthermore, we also demonstrated that ROS production played a crucial role in controlling pyroptosis activation during B. pseudomallei infection in primary human monocytes. These findings suggested that pyroptosis induced by B. pseudomallei in the human monocytes may contribute to the pathogenesis of sepsis in acute melioidosis patients.

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Section: Discussionmentioning

confidence: 99%

Differentiation in pyroptosis induction by Burkholderia pseudomallei and Burkholderia thailandensis in primary human monocytes, a possible cause of sepsis in acute melioidosis patients

Khongpraphan,

Ekchariyawat,

Sanongkiet

et al. 2024

PLoS Negl Trop Dis

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“…Melioidosis infection can manifest in various ways, ranging from asymptomatic to potentially fatal sepsis. It also has a chronic and recurrent nature and the ability to stay dormant for long periods of time 8. Despite melioidosis being endemic in the Indian subcontinent, there are no national guidelines for treating the disease in India or other South Asian countries.…”

Section: Discussionmentioning

confidence: 99%

Melioidosis: an unusual diagnosis for deep temporal and masticatory space infection following trauma

2022

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We report a patient in his early 70s, with an alleged history of trauma to the right temporal region, following which a swelling developed. A week later, erythematous changes, throbbing pain and occasional fever spikes were noted. A month after the initial trauma, he presented to our institution with necrosed skin over the right temporal region and swelling extending up to the vertex of the skull. The patient was an uncontrolled diabetic and had systemic conditions like chronic obstructive pulmonary disease and chronic kidney disease. A CT scan revealed a collection along the infratemporal space extending into the masticatory space. Routine investigations, blood culture sensitivity, were sent, which revealed the presence of Burkholderia pseudomallei sensitive to ceftazidime and imipenem. Under antibiotic coverage, the treatment was initiated, incision and drainage were done to reduce the bacterial load. However, the patient was lost to underlying systemic conditions and septic shock.

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Meropenem

2021

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Lack of drug effect: case reportA 54-year-old man exhibited a lack of drug effect during treatment with meropenem for melioidosis. The man presented with fever, chills, right leg wound swelling and leg pain after a cut injury for 10 days. He was also experiencing a loss of appetite and malaise. Initially, it was suspected that he had febrile wound sepsis and started receiving treatment with cefotaxime and flucloxacillin. Also, he underwent incision and drainage of the wound. However, his condition worsened and required hospitalisation. His wound culture showed the presence of Burkholderia pseudomallei. Initially, he received treatment with ceftriaxone. His wound was cleaned and dressed with povidone-iodine. Following 5 days of treatment, his condition worsened. Therefore, he was shifted to the ICU. He developed type-1 respiratory failure and vasodilatory shock. Following ICU admission, he started receiving IV meropenem 1g every 12h for suspected melioidosis, along with teicoplanin, metronidazole and doxycycline. The dose of meropenem 1g every 12h was due to acute kidney injury (AKI). Following this treatment, his CRP decreased, but WBC remained elevated. Thereafter, his ALT, AST and ALP increased. Also, his prothrombin time, activated partial thromboplastin time and INR were increased. His AKI was complicated with hyperkalaemia. Chest X-ray revealed heterogenous opacifications. On day 1 of ICU, Burkholderia pseudomallei was isolated from his blood culture. Thereafter, he was diagnosed with melioidosis with evidence of severe sepsis and multiorgan failure. As it was sensitive to meropenem and cotrimoxazole [trimethoprim/sulfamethoxazole], his treatment with meropenem was continued. However, he developed atrial fibrillation, progressively worsening AKI, acute liver failure, melaena and septic shock. He received amiodarone for atrial fibrillation and underwent hemodialysis due to AKI. However, he did not improve. Despite these aggressive measures, his condition worsened. Eventually, he developed refractory septic shock and multiorgan failure. On day 7 of the ICU admission, he died due to melioidosis septicaemia with multiorgan failure.

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Severe Sepsis with Multiorgan Failure due to Melioidosis: A Lesson to Learn

Cited by 5 publications

References 16 publications

Differentiation in pyroptosis induction by Burkholderia pseudomallei and Burkholderia thailandensis in primary human monocytes, a possible cause of sepsis in acute melioidosis patients

Differentiation in pyroptosis induction by Burkholderia pseudomallei and Burkholderia thailandensis in primary human monocytes, a possible cause of sepsis in acute melioidosis patients

Melioidosis: an unusual diagnosis for deep temporal and masticatory space infection following trauma

Meropenem

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