Cases Of Melioidosis Research Articles

Melioidosis an Imported Infection in Qatar: Case Series and Literature Review

Introduction: Melioidosis is a tropical infectious disease caused by Gramnegative bacteria Burkholderia pseudomallei (B. pseudomallei). This soil-borne disease is endemic in Southeast Asia and Northern Australia. In our country it was reported once before in 2000 in a patient who presented with subdural empyema. Case Series Report: We are reporting six cases of Melioidosis presented to our hospital in very close time with different clinical presentations. All patients were from Indian subcontinent. In 3 cases we treated with Meropenem plus Trimethoprim-Sulfamethoxazole (TMP-SMX) followed by oral TMP-SMX and Doxycycline for around 6 months with good clinical and radiological response, while the fourth case was treated with oral TMP-SMX and Doxycycline for 1 month but he lost to follow up, the Fifth cases were treated with IV Ceftazidime followed by TMP-SMX and Doxycycline for 9 weeks, the Sixth cases were treated with IV Ceftazidime followed by TMP-SMX and Amoxicillin/Clavulanic acid for 20 days, there was no mortality reported in our case series for both types Bactraemic and Abactraemic Melioidosis. Conclusions: This case series highlights the importance of early identification of B. pseudomallei which requires a high index of clinical suspicion as well as good understanding of demographical and travel history. Microbiological identification of B. pseudomallei is essential and requires notification of the microbiologist for suspicion of that infection. Prolonged antimicrobial therapy is required for a better clinical outcome.

Successful Isolation of Burkholderia pseudomallei from Soil by Extended Incubation of Ashdown’s Agar: A Cross-sectional Study

Introduction: Melioidosis is an infectious disease of humans and animals caused by an environmental saprophyte Burkholderia pseudomallei. Although the organism is associated with soil and water, environmental isolation is rarely successful which could be due to the existence of viable but non-culturable forms. Aim: To isolate B. pseudomallei from the soil to detect the environmental presence of this organism in and around Puducherry, India. Materials and Methods: A descriptive cross-sectional study was carried out from July 2018 to January 2021 at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. A total of 473 soil samples were collected from areas surrounding the residence and workplaces of seven culture-proven melioidosis cases, from Puducherry and three districts of Tamil Nadu (Cuddalore, Nagapattinam and Villupuram) during the dry and wet seasons. Soil samples were enriched in Ashdown’s broth and cultured on Ashdown’s agar. The plates were incubated at 37°C and examined daily for seven days with a further extended period of incubation till the tenth day for samples that did not show growth. Suspected isolates were subjected to Vitek 2 system for biochemical identification. Confirmation of the isolates was carried out by antigen detection and Polymerase Chain Reaction (PCR). Results: From 473 soil samples processed, bacteria with colony morphology similar to B. pseudomallei were isolated in 56 (11.83%) samples. Only one isolate, which was detected on the tenth day of incubation was confirmed as B. pseudomallei using antigen detection and PCR. This sample was collected during the wet season (December 2020) from Endur, in the Villupuram district of Tamil Nadu, India. Conclusion: The study findings highlight the importance of extended incubation of culture plates at 37°C for up to ten days to improve the chances of isolation from the soil.

Human Melioidosis Caused by Novel Transmission of Burkholderia pseudomallei from Freshwater Home Aquarium, United States1.

Nearly all cases of melioidosis in the continental United States are related to international travel to areas to which Burkholderia pseudomallei, the bacterium that causes melioidosis, is endemic. We report the diagnosis and clinical course of melioidosis in a patient from the United States who had no international travel history and the public health investigation to determine the source of exposure. We tested environmental samples collected from the patient’s home for B. pseudomallei by PCR and culture. Whole-genome sequencing was conducted on PCR-positive environmental samples, and results were compared with sequences from the patient’s clinical specimen. Three PCR-positive environmental samples, all collected from a freshwater home aquarium that had contained imported tropical fish, were a genetic match to the clinical isolate from the patient. This finding suggests a novel route of exposure and a potential for importation of B. pseudomallei, a select agent, into the United States from disease-endemic areas.

Disseminated Melioidosis presenting as pneumonia, femoral and sacral osteomyelitis, splenic abscess and high rectal fistula: A case report and review of literature.

IntroductionMelioidosis is a rare infectious tropical disease caused by Burkholderia pseudomallei (B. pseudomallei), an environmental saprophyte usually habitating on soils of Southeast Asian fields. Most of the reported cases present with pneumonia and intra-abdominal abscess. Diagnosis is established by culture studies from the blood, sputum or abscess drainage. Management relies on culture-guided antibiotic treatment, with good prognosis. Surgical intervention is required in cases not responsive to medical management.Presentation of caseWe are presenting a case of Melioidosis in a 72 year old Filipino who presented with Pneumonia, Femoral and Sacral Osteomyelitis, Splenic Abscess and High Rectal Fistula. He was successfully managed with systemic antibiotic treatment and surgery. The splenic abscess was managed by splenectomy and a transverse loop colostomy was used for fecal diversion to address the rectal fistula.DiscussionMelioidosis varies in its presentation and thus management should be individualized, depending on the organs involved. Our patient presented with multiple foci of infection which rendered the treatment more complicated as compared to those reported previously in published literature. The pneumonia and the osteomyelitis were managed with aggressive systemic antibiotics but the other sites of infection required drainage and surgery.ConclusionMelioidosis is a rare infection caused by an environmental saprophyte Burkholderia pseudomallei. An accurate diagnosis using culture studies is essential to institute appropriate treatment. Antibiotic treatment complemented by surgery for specific organ involvement is essential for cure.

Long segment myelitis secondary to neuro melioidosis

Neuro melioidosis, comprising approximately 4% of all cases of melioidosis carries a high mortality and morbidity. Long segment myelitis due to melioidosis is very rarely reported. We describe a Sri Lankan male who presented with long segment myelitis secondary to melioidosis.

Epidemiology of Neuromelioidosis in Asia-Pacific: A Systematic Review

Introduction: Neuromelioidosis is a rare complication of melioidosis caused by Burkholderia pseudomallei, a Gram-negative bacterium commonly found in soil and surface water. Although cerebral involvement of melioidosis comprises only 4% of total complications, it significantly impacts mortality and morbidity. This study aims to perform a systematic review on various neurological complications of melioidosis in the Asia-Pacific region within the previous 5 years.
 Method: Systematic search was performed in PubMed, Web of Science databases and Google Scholar on neuromelioidosis complications published from 2015-2019.
 Results: Central nervous system (CNS) complications comprise 5% of all cases of melioidosis. 16 selected articles were analysed based on its risk factors like diabetes mellitus, chronic renal and lung disease, alcohol abuse, and immunosuppression. Neuromelioidosis is detected 6-14 days after the first presentation and confirmed by detailed investigations. Radioimaging helps to differentiate neuromelioidosis from other diagnoses such as meningitis or brain abscess. The majority of literature recommended 2-week intensive Ceftazidime or Meropenem therapy, followed by 3–6 months Trimethoprim and Sulfamethoxazole oral eradication therapy.
 Conclusion: Neuromelioidosis is rare, with relatively nonspecific CNS clinical features. Patients or travelers from endemic areas with risk factors should be treated cautiously. Radioimaging modalities aid early microbiological sampling and appropriate antibiotic therapy.

Epidemiological and Clinical Characteristics of Melioidosis Caused by Gentamicin-Susceptible Burkholderia pseudomallei in Sarawak, Malaysia.

Background Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to a broad range of antibiotics, including aminoglycosides. In Sarawak, Malaysia, a high proportion of melioidosis cases are caused by gentamicin-susceptible isolates. There are limited epidemiological and clinical data on these infections.MethodsWe conducted a retrospective study of culture-confirmed melioidosis among adults admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2016.ResultsOne hundred forty-eight adults with culture-confirmed melioidosis were identified. Of 129 (87%) tested, 84 (65%) had gentamicin-susceptible B pseudomallei. The average annual incidence of melioidosis was 12.3 per 100 000 population, with marked variation between districts ranging from 5.8 to 29.3 per 100 000 population. Rural districts had higher incidences of melioidosis and overwhelmingly larger proportions of gentamicin-susceptible B pseudomallei infection. Significantly more patients with gentamicin-susceptible infection had no identified risk factors, with diabetes less frequently present in this group. Ninety-eight percent had acute presentations. Pneumonia, reported in 71%, was the most common presentation. Splenic abscesses were found in 54% of those imaged. Bacteremia was present in 88%; septic shock occurred in 47%. Forty-five (35%) patients died. No differences in clinical, laboratory, or outcome characteristics were noted between gentamicin-susceptible and gentamicin-resistant infections.ConclusionsGentamicin-susceptible B pseudomallei infections are common in Sarawak and dominate in the high-incidence rural interior regions. Clinical manifestations and outcomes are the same as for gentamicin-resistant B pseudomallei infections. Further studies are required to determine if all gentamicin-susceptible B pseudomallei infections in Sarawak are clonal and to ascertain their environmental drivers and niches.

Clinico-microbiological profile of melioidosis cases at a tertiary care hospital

Clinico-microbiological profile of melioidosis cases at a tertiary care hospital

Clinico-microbiological analysis of hospitalized melioidosis cases with sepsis and/or pneumonia: A single -center, Pro- spective study from Eastern India

Clinico-microbiological analysis of hospitalized melioidosis cases with sepsis and/or pneumonia: A single -center, Pro- spective study from Eastern India

Evidence of expanding geographic distribution of melioidosis in Bangladesh: reports of three cases

Melioidosis is an emerging infectious disease in Bangladesh. Reported cases are mostly diagnosed among inhabitants of central and north-east zone of the country. We report three cases of melioidosis occurring among patients with diabetes mellitus and chronic kidney disease from not well-known endemic areas within the country. Patients presented with fever, anorexia and weight loss. Laboratory reports confirmed growth of Burkholderia pseudomallei from blood and urine. These cases are reported to increase awareness among physicians regarding melioidosis occurring beyond the so-called hot spots in Bangladesh. BIRDEM Med J 2021; 11(3): 239-242

The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation

The global distribution of melioidosis is under considerable scrutiny, with both unmasking of endemic disease in African and Pacific nations and evidence of more recent dispersal in the Americas. Because of the high incidence of disease in tropical northern Australia, The Darwin Prospective Melioidosis Study commenced in October, 1989. We present epidemiology, clinical features, outcomes, and bacterial genomics from this 30-year study, highlighting changes in the past decade. The present study was a prospective analysis of epidemiological, clinical, and laboratory data for all culture-confirmed melioidosis cases from the tropical Northern Territory of Australia from Oct 1, 1989, until Sept 30, 2019. Cases were identified on the basis of culture-confirmed melioidosis, a laboratory-notifiable disease in the Northern Territory of Australia. Patients who were culture-positive were included in the study. Multivariable analysis determined predictors of clinical presentations and outcome. Incidence, survival, and cluster analyses were facilitated by population and rainfall data and genotyping of Burkholderia pseudomallei, including multilocus sequence typing and whole-genome sequencing. There were 1148 individuals with culture-confirmed melioidosis, of whom 133 (12%) died. Median age was 50 years (IQR 38-60), 48 (4%) study participants were children younger than 15 years of age, 721 (63%) were male individuals, and 600 (52%) Indigenous Australians. All but 186 (16%) had clinical risk factors, 513 (45%) had diabetes, and 455 (40%) hazardous alcohol use. Only three (2%) of 133 fatalities had no identified risk. Pneumonia was the most common presentation occurring in 595 (52%) patients. Bacteraemia occurred in 633 (56%) of 1135 patients, septic shock in 240 (21%) patients, and 180 (16%) patients required mechanical ventilation. Cases correlated with rainfall, with 80% of infections occurring during the wet season (November to April). Median annual incidence was 20·5 cases per 100 000 people; the highest annual incidence in Indigenous Australians was 103·6 per 100 000 in 2011-12. Over the 30 years, annual incidences increased, as did the proportion of patients with diabetes, although mortality decreased to 17 (6%) of 278 patients over the past 5 years. Genotyping of B pseudomallei confirmed case clusters linked to environmental sources and defined evolving and new sequence types. Melioidosis is an opportunistic infection with a diverse spectrum of clinical presentations and severity. With early diagnosis, specific antimicrobial therapy, and state-of-the-art intensive care, mortality can be reduced to less than 10%. However, mortality remains much higher in the many endemic regions where health resources remain scarce. Genotyping of B pseudomallei informs evolving local and global epidemiology. The Australian National Health and Medical Research Council.

Melioidosis complicated with pericardial effusion - An emerging disease with a rare presentation

Melioidosis, caused by a non-fermenting gram negative bacilli, can mimic a variety of diseases due to its diverse clinical presentation. The incidence of cardiac involvement in melioidosis is less than 1%. We report a rare case of melioidosis in a 65 year old male with chronic kidney disease who presented with fever and pericardial effusion which was misdiagnosed and treated as tuberculous pericardial effusion. Later, on isolation of from paired blood culture samples, pericardial fluid and also from pleural fluid confirmed the diagnosis of disseminated melioidosis. The patient was treated with intravenous ceftazidime after which clinical improvement was observed. Cardiac melioidosis should always be considered in the differential diagnosis of tuberculous pericardial effusion and it should be ruled out before the start of anti-tubercular treatment. This will prevent unnecessary exposure to anti-tubercular drugs and also aids to start early treatment for melioidosis thereby reducing the mortality.

Melioidosis by aminoglycoside susceptible Burkholderia pseudomallei: First case in Bangladesh

Burkholderia pseudomallei is the etiological agent of melioidosis. It is a gram-negative bacillus present in environment and intrinsically resistant to many antibiotics including aminoglycosides. However, recently aminoglycoside susceptible B. pseudomallei has been isolated from melioidosis cases and reported from some countries of the world. But, such aminoglycoside susceptible B. pseudomallei has never been detected in Bangladesh either from melioidosis cases or from environment. All the B. pseudomallei isolated so far in Bangladesh were resistant to gentamicin and other aminoglycosides. Here, we describe a disseminated case of melioidosis caused by aminoglycoside susceptible B. pseudomallei in a 55 years old Bengali male patient. This is the first case of melioidosis due to aminoglycoside susceptible B. pseudomallei in Bangladesh.
 Ibrahim Med. Coll. J. 2020; 14(2): 55-59

Footprints of human melioidosis in the north western Indian states, expanding endemicity in India

Melioidosis is endemic in India and well described from western and eastern coastal states. Sporadic cases of melioidosis have been diagnosed from Gujarat prior to current case series in patient with travel history to endemic areas. We noticed a rise in melioidosis cases from Gujarat and Rajasthan in the last two years. With this case series, we are reporting eleven melioidosis cases who have no travel history to endemic areas and acquired melioidosis locally. This case series alerts practicing clinicians in Gujarat and Rajasthan to look for and keep melioidosis as one of the differential diagnosis in appropriate clinical syndrome.

Multiple hepatic and splenic abscesses due to Burkholderia pseudomallei

We report a case of melioidosis in an alcoholic and diabetic male patient presenting with multiple hepatic and splenic abscesses. Melioidosis is caused by an environmental bacterium Burkholderia pseudomallei. The clinical manifestations vary from asymptomatic infection to fulminant septic shock with abscesses in multiple internal organs. The treatment is prolonged with parenteral antibiotics in intensive phase followed by oral antibiotics in eradication phase till disease resolution. Due to varied clinical presentations, high index of suspicion coupled with adequate laboratory support is essential for rapid diagnosis and prompt initiation of optimal antibiotic therapy.

Melioidosis in a Tertiary Care Center from South India: A 5-year Experience.

The present study was done with the objective to know the clinical presentation, microbiological features, and treatment outcome of melioidosis patients in our hospital, which is an emerging infection in India, and to know the differences in clinical course and outcome between bacteremic and nonbacteremic patients. This retrospective observational study was carried out over a period of 5 years from January 2015 to December 2019. Thirty-five cases of culture-confirmed melioidosis were identified with age range between 5 and 74 years. A large number of patients (n = 31) presented with uncontrolled diabetes mellitus. Six patients died of septic shock, and the outcome of eight patients was unknown as they were discharged against medical advice. There were no relapses observed. Melioidosis growing as a neglected tropical disease in India warrants awareness among all clinicians across the country.How to cite this article: Ganesan V, Murugan M, Sundaramurthy R, Soundaram GVG. Melioidosis in a Tertiary Care Center from South India: A 5-year Experience. Indian J Crit Care Med 2021;25(3):327–330.

The Trend of Direct Medical Cost of Meliodiosis Patients in Kedah: A Retrospective Study from 2014 to 2017.

PurposeThis study was conducted to determine the direct medical cost of treating melioidosis patients. The calculation was made according to the variables extracted from medical records.Materials and MethodsData collection was performed retrospectively on a total of 293 cases from Hospital Sultanah Bahiyah, Kedah, Malaysia. The data consisted of personal information, treatment history, and investigation findings, including blood results, USG abdomen results, and CT scan results. The site of culture and sensitivity were also obtained. The total direct medical cost was based on the antibiotics/treatments received by the patients, diagnostic test and investigations performed. The trend analysis used to see the pattern of costs from 2014 to 2017. All the costs were compared based on patients’ status and duration of stay at the hospital using the independent t-test.ResultsThe overall mean of direct medical cost for melioidosis amounted to US $233.61 (RM931.33). Overall, the finding confirms a huge reduction (44.7%) of direct medical cost from 2014 to 2017 (P = 0.001). From 2015 to 2016, there was a 19.1% reduction of direct medical cost (P>0.95), followed by a 38.8% reduction in costs from 2016 to 2017 (P = 0.019). In the case of the duration of stay, the mean of total direct medical cost among patients with ≥14 duration of stay was higher compared to those with <14 duration of stay (p < 0.001). There was no significant mean difference of direct medical cost between patients who were cured and died.ConclusionDespite the higher mortality of melioidosis cases compared to other infectious diseases, there is a limitation in the amount of published data on the management cost of melioidosis. The importance of cost in managing this disease should be underlined to perform a fully prepared management toward the disease.

Description of two fatal cases of melioidosis in Mexican children with acute pneumonia: case report

BackgroundMelioidosis is an infectious disease caused by Burkholderia pseudomallei. In Mexico, the disease is rarely diagnosed in humans and there is no evidence of simultaneous environmental isolation of the pathogen. Here, we describe clinical profiles of fatal cases of melioidosis in two children, in a region without history of that disease.Case presentationAbout 48 h before onset of symptoms, patients swam in a natural body of water, and thereafter they rapidly developed fatal septicemic illness. Upon necropsy, samples from liver, spleen, lung, cerebrospinal fluid, and bronchial aspirate tissues contained Burkholderia pseudomallei. Environmental samples collected from the locations where the children swam also contained B. pseudomallei. All the clinical and environmental strains showed the same BOX-PCR pattern, suggesting that infection originated from the area where the patients were swimming.ConclusionsThe identification of B. pseudomallei confirmed that melioidosis disease exists in Sonora, Mexico. The presence of B. pseudomallei in the environment may suggest endemicity of the pathogen in the region. This study highlights the importance of strengthening laboratory capacity to prevent and control future melioidosis cases.

Overview of the distribution of Burkholderia pseudomallei sequence types and the Emergence of sequence type 1342 in Malaysia.

Burkholderia pseudomallei, a Gram-negative bacterial pathogen that causes melioidosis, is of public health importance in endemic areas including Malaysia. An investigation of the molecular epidemiology links of B.pseudomallei would contribute to better understanding of the clonal relationships, transmission dynamics and evolutionary change. Multilocus sequence typing (MLST) of 45 clinical B.pseudomallei isolates collected from sporadic melioidosis cases in Malaysia was performed. In addition, a total of 449 B.pseudomallei Malaysian strains submitted to the MLST database from 1964 until 2019 were included in the temporal analysis to determine the endemic sequence types (STs), emergence and re-emergence of ST(s). In addition, strain-specific distribution was evaluated using BURST tool. Genotyping of 45 clinical strains was resolved into 12 STs, and the majority were affiliated with ST46 (n=11) and ST1342 (n=7). Concomitantly, ST46 was the most prevalent ST in Malaysia, which was first reported in 1964. All the Malaysian B.pseudomallei strains were resolved into 76 different STs with 36 of them uniquely present only in Malaysia. ST1342 was most closely related to ST1034, in which both STs were unique to Malaysia and first isolated from soil samples in Pahang, a state in Malaysia. The present study revealed a high diversity of B.pseudomallei in Malaysia. Localized evolution giving rise to the emergence of new STs was observed, suggesting that host and environmental factors play a crucial role in the evolutionary changes in B.pseudomallei.

Comparative virulence of three different strains of Burkholderia pseudomallei in an aerosol non-human primate model.

Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is a major cause of sepsis and mortality in endemic regions of Southeast Asia and Northern Australia. B. pseudomallei is a potential bioterrorism agent due to its high infectivity, especially via inhalation, and its inherent resistance to antimicrobials. There is currently no vaccine for melioidosis and antibiotic treatment can fail due to innate drug resistance, delayed diagnosis and treatment, or insufficient duration of treatment. A well-characterized animal model that mimics human melioidosis is needed for the development of new medical countermeasures. This study first characterized the disease progression of melioidosis in the African green monkey (AGM) and rhesus macaque (RM) for non-human primate model down-selection. All AGMs developed acute lethal disease similar to that described in human acute infection following exposure to aerosolized B. pseudomallei strain HBPUB10134a. Only 20% of RMs succumbed to acute disease. Disease progression, immune response and pathology of two other strains of B. pseudomallei, K96243 and MSHR5855, were also compared using AGMs. These three B. pseudomallei strains represent a highly virulent strain from Thailand (HBPUB101034a), a highly virulent strains from Australia (MSHR5855), and a commonly used laboratory strains originating from Thailand (K96243). Animals were observed for clinical signs of infection and blood samples were analyzed for cytokine responses, blood chemistry and leukocyte changes in order to characterize bacterial infection. AGMs experienced fever after exposure to aerosolized B. pseudomallei at the onset of acute disease. Inflammation, abscesses and/or pyogranulomas were observed in lung with all three strains of B. pseudomallei. Inflammation, abscesses and/or pyogranulomas were observed in lymph nodes, spleen, liver and/or kidney with B. pseudomallei, HBPUB10134a and K96243. Additionally, the Australian strain MSHR5855 induced brain lesions in one AGM similar to clinical cases of melioidosis seen in Australia. Elevated serum levels of IL-1β, IL-1 receptor antagonist, IL-6, MCP-1, G-CSF, HGF, IFNγ, MIG, I-TAC, and MIP-1β at terminal end points can be significantly correlated with non-survivors with B. pseudomallei infection in AGM. The AGM model represents an acute model of B. pseudomallei infection for all three strains from two geographical locations and will be useful for efficacy testing of vaccines and therapeutics against melioidosis. In summary, a dysregulated immune response leading to excessive persistent inflammation and inflammatory cell death is the key driver of acute melioidosis. Early intervention in these pathways will be necessary to counter B. pseudomallei and mitigate the pathological consequences of melioidosis.