Cases Of Melioidosis Research Articles

Misidentification of Burkholderia pseudomallei, China.

We report a case of melioidosis in China and offer a comparison of 5 commercial detection systems for Burkholderia pseudomallei. The organism was misidentified by the VITEK 2 Compact, Phoenix, VITEK mass spectrometry, and API 20NE systems but was eventually identified by the Bruker Biotyper system and 16S rRNA sequencing.

Genomic Diversity of Burkholderia pseudomallei in Ceara, Brazil.

Burkholderia pseudomallei is a Gram-negative bacterium that causes the sapronotic disease melioidosis. An outbreak in 2003 in the state of Ceara, Brazil, resulted in subsequent surveillance and environmental sampling which led to the recognition of B. pseudomallei as an endemic pathogen in that area. From 2003 to 2015, 24 clinical and 12 environmental isolates were collected across Ceara along with one from the state of Alagoas. Using next-generation sequencing, multilocus sequence typing, and single nucleotide polymorphism analysis, we characterized the genomic diversity of this collection to better understand the population structure of B. pseudomallei associated with Ceara. We found that the isolates in this collection form a distinct subclade compared to other examples from the Western Hemisphere. Substantial genetic diversity among the clinical and environmental isolates was observed, with 14 sequence types (STs) identified among the 37 isolates. Of the 31,594 core single-nucleotide polymorphisms (SNPs) identified, a high proportion (59%) were due to recombination. Because recombination events do not follow a molecular clock, the observation of high occurrence underscores the importance of identifying and removing recombination SNPs prior to evolutionary reconstructions and inferences in public health responses to B. pseudomallei outbreaks. Our results suggest long-term B. pseudomallei prevalence in this recently recognized region of melioidosis endemicity.IMPORTANCEB. pseudomallei causes significant morbidity and mortality, but its geographic prevalence and genetic diversity are not well characterized, especially in the Western Hemisphere. A better understanding of the genetic relationships among clinical and environmental isolates will improve knowledge of the population structure of this bacterium as well as the ability to conduct epidemiological investigations of cases of melioidosis.

Trends in laboratory detection of Burkholderia pseudomallei and their antibiotic susceptibility pattern from clinical samples over twenty one years from 2001 to 2021 in a tertiary care hospital of Bangladesh

Melioidosis, a highly fatal infectious disease caused by Burkholderia pseudomallei, is largely under-recognized and underreported due to lack of alertness of health care professionals. The real burden of melioidosis in our country is poorly understood. Here, we have documented laboratory isolation trends of B. pseudomallei from different clinical samples sent to our Microbiology department from 2001 to 2021, with the aim to increase awareness among clinicians and microbiologists in the health care community of Bangladesh. A total of 86 B. pseudomallei, isolated from culture of different clinical samples in 68 melioidosis cases were studied retrospectively from hospital records. Antimicrobial susceptibility result by Kirby Bauer disk diffusion method was also analyzed. The most commonly affected age group was 46-60 years and majority of them (88.2%) had diabetes mellitus. Septicaemia (51.5%) was the most common presentation followed by skin and subcutaneous tissue abscess (29.4%), septic arthritis (16.2%), UTI (13.2%), pneumonia (10.3%), visceral abscess in lung (5.9%), liver (5.9%), spleen (7.3%) etc and death was reported among 32.5% cases. One case of laboratory acquired melioidosis was diagnosed from cleaner of our Microbiology laboratory. Average isolation rate of B. pseudomallei was 5.6 per year in our centre. The organism was isolated most frequently from blood (40.7%) and pus/wound swab (30.2%) samples. All the isolates were highly sensitive (>95%) to ceftazidime, carbapenem, piperacillin-tazobactum, amoxicillin-clavulanic acid and tetracycline, but 53.4% and 67.2% of our strains were recorded sensitive to co-trimoxazole and ciprofloxacin by disc diffusion method. In conclusion, melioidosis might be included as notifiable disease in national surveillance system of Bangladesh to provide key part in priority-setting, planning, also monitoring and evaluation of the disease control programs. Prompt early diagnosis and appropriate antibiotic administration are the critical steps to prevent mortality and morbidity from this deadly disease.
 Bangladesh J Med Microbiol 2021; 15 (1): 8-14

Melioidosis in Children, Brazil, 1989-2019.

We studied 20 confirmed or suspected cases of melioidosis in children in Ceará, Brazil, during 1989–2019. We observed a high death rate, severe signs and symptoms, and substantial environmental exposure. These data suggest that childhood melioidosis might be more severe in Brazil than in other regions.

Incidences, Case Fatality Rates and Epidemiology of Melioidosis Worldwide: A Review Paper

Melioidosis is an uncommon, opportunistic disease caused by Burkholderia pseudomallei that lives freely in soil, water, and harsh environments. Transmission occurs from direct exposure of the bacteria to soil or contaminated water supplies. The case fatality rate (CFR) of Melioidosis is high and increases in children and underdeveloped countries. Unfortunately, the disease remains understudied around the world. We carried out an extensive literature review in a systematic approach. A detailed search strategy and PRISMA chart was used to select the relevant articles from reliable medical databases. Articles published from 2016 to 2020 that addressed the incidences, case fatality rates and epidemiology of Melioidosis are selected based on selection criteria. Finally, a total of 34 articles were included in this review. We identified 15,202 cases of Melioidosis globally from 1913-2018 with a total CFR of 33.9%. We calculated the global incidence of ~2607 per year and a CFR of ~814 (35.4%) per year. There are 80% (n = 2476) of adult cases and 20% (n = 620) of paediatric cases. The total (n = 12,413) male to female ratio of Melioidosis is 2.21:1. We also found that the male to female ratio of adult cases (n = 804) is 3.57:1, whereas that of paediatric cases (n = 318) is 1.39:1. The number of patients found working in the agricultural sector was 36.5% (n = 1068). We found a higher incidence and a lower total CFR which are consistent with previously reported studies. We also found that the percentage of paediatric cases was higher than in previous studies, and there is a considerable difference in male to female ratio between adult cases and paediatric cases. This review provides significant evidence to the public health policy makers to develop an effective preventable intervention to reduce the incidence and case fatality of this neglected tropical disease.

Nonclonal Burkholderia pseudomallei Population in Melioidosis Case Cluster, Sri Lanka.

A melioidosis case cluster of 10 blood culture–positive patients occurred in eastern Sri Lanka after an extreme weather event. Four infections were caused by Burkholderia pseudomallei isolates of sequence type 594. Whole-genome analysis showed that the isolates were genetically diverse and the case cluster was nonclonal.

Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia.

Since 2005, the range of Burkholderia pseudomallei sequence type 562 (ST562) has expanded in northern Australia. During 2005–2019, ST562 caused melioidosis in 61 humans and 3 animals. Cases initially occurred in suburbs surrounding a creek before spreading across urban Darwin, Australia and a nearby island community. In urban Darwin, ST562 caused 12% (53/440) of melioidosis cases, a proportion that increased during the study period. We analyzed 2 clusters of cases with epidemiologic links and used genomic analysis to identify previously unassociated cases. We found that ST562 isolates from Hainan Province, China, and Pingtung County, Taiwan, were distantly related to ST562 strains from Australia. Temporal genomic analysis suggested a single ST562 introduction into the Darwin region in ≈1988. The origin and transmission mode of ST562 into Australia remain uncertain.

Melioidosis- Report of Two Cases

Melioidosis which is caused by burkholderia pseudomallei occurs predominantly in Southeast Asia. Cases are now being reported from india as well. It can present with varying clinical manifestations like pneumonia, septicemia, arthritis, abscess etc. Neurologic meliodiosis, though rare can occur in upto 3-4% cases. Here we present two cases of melioidosis from Indian subcontinent, one involving central nervous system causing cerebral abscess and second one involving multiple splenic and liver abscess with bacteremia. First patient with cerebral abscess was managed with surgical debridement with antibiotics and discharged in a stable condition after 15 days while the bacteremic patient developed septic shock with mutiorgan failure and succumbed to death after 12 days of treatment

1430. Novel Transmission of Burkholderia pseudomallei from a Freshwater Aquarium to a Human — Maryland, 2019

BackgroundNearly all U.S. cases of melioidosis, a potentially fatal disease caused by Burkholderia pseudomallei, are associated with travel to endemic areas. In September 2019, a patient in Maryland with no international travel history developed melioidosis and whole genome sequencing (WGS) of the patient’s clinical isolate showed it clustered most closely with isolates from Southeast Asia. CDC and Maryland Department of Health (MDH) investigated possible sources of B. pseudomallei exposure to identify the source and route of transmission and evaluate risk to others.MethodsMDH interviewed the patient and household members during October–December 2019. In consultation with CDC, MDH conducted environmental sampling of the patient’s home including drains, faucets, potted and ground soil, imported products, and two freshwater aquariums. Samples were tested for B. pseudomallei at CDC by PCR and culture. B. pseudomallei isolates underwent WGS and were analyzed along with a reference panel of geographically diverse, publicly available genomes.ResultsThree environmental samples, all from aquarium #2, were positive for B. pseudomallei. These isolates matched the patient’s clinical isolate by WGS, suggesting the aquarium was the source of exposure. According to interviews, the patient set up both aquariums in July 2019 and all the fish in aquarium #2 died in August 2019. The patient recalled reaching her bare hands and arms into the aquarium in August 2019, one month prior to illness onset.ConclusionThis investigation led to the first documentation of transmission of B. pseudomallei from a freshwater aquarium to a human. Many freshwater ornamental fish are imported from Southeast Asia, so this newly recognized transmission route may have significant implications for the freshwater aquatics trade. Further investigations are underway at the retail location that sold the fish and the commercial vendors that supplied the freshwater animals and plants imported from Southeast Asia.Disclosures All Authors: No reported disclosures

Multi locus sequence typing of clinical Burkholderia pseudomallei isolates from Malaysia.

BackgroundMelioidosis is a neglected tropical disease with rising global public health and clinical importance. Melioidosis is endemic in Southeast Asia and Northern Australia and is of increasing concern in Malaysia. Despite a number of reported studies from Malaysia, these reports are limited to certain parts of the country and do not provide a cohesive link between epidemiology of melioidosis cases and the nation-wide distribution of the causative agent Burkholderia pseudomallei.Methodology/principle findingsHere we report on the distribution of B. pseudomallei sequence types (STs) in Malaysia and how the STs are related to STs globally. We obtained 84 culture-confirmed B. pseudomallei from confirmed septicaemic melioidosis patients from all over Malaysia. Prior to performing Multi Locus Sequence Typing, the isolates were subjected to antimicrobial susceptibility testing and detection of the YLF/BTFC genes and BimA allele. Up to 90.5% of the isolates were sensitive to all antimicrobials tested while resistance was observed for antimicrobials typically administered during the eradication stage of treatment. YLF gene cluster and bimABp allele variant were detected in all the isolates. The epidemiological distribution patterns of the Malaysian B. pseudomallei isolates were analysed in silico using phylogenetic tools and compared to Southeast Asian and world-wide isolates. Genotyping of the 84 Malaysian B. pseudomallei isolates revealed 29 different STs of which 6 (7.1%) were novel. ST50 was identified as the group founder followed by subgroup founders ST376, ST211 and ST84. A low-level diversity is noted for the B. pseudomallei isolates described in this study while phylogenetic analysis associated the Malaysian STs to Southeast Asian isolates especially isolates from Thailand. Further analysis also showed a strong association that implicates agriculture and domestication activities as high-risk routes of infection.Conclusions/significanceIn conclusion, MLST analysis of B. pseudomallei clinical isolates from all states in Malaysia revealed low diversity and a close association to Southeast Asian isolates.

Melioidosis in Andaman’s: A report of two cases and a short review

Melioidosis, caused by Burkholderia pseudomallei, is an emerging infectious disease in the tropical regions of the world. The aetiologic agent is an environmental saprophyte and can be transmitted by percutaneous inoculation, inhalation and ingestion. The risk factors for disease acquisition are type II Diabetes Mellitus (DM), chronic alcohol use, chronic lung or renal disease and immune suppression. The diagnosis is an enigma due to varied manifestations, lack of clinical suspicion and capabilities for conclusive identification. Early diagnosis is crucial for initiating appropriate chemotherapy as Melioidosis respond to only a limited number of antibiotics given over a prolonged period of time and to prevent the worsening of clinical outcome and relapse. We report two cases of Melioidosis with lower extremity involvement, an entity which was probably undiagnosed for long, at Port Blair, Andaman and Nicobar Islands. Keywords: Burkholderia pseudomallaei, Melioidosis, Andaman and Nicobar Islands, Risk factors, Chemotherapy

Neurological melioidosis complicated by cerebral venous sinus thrombosis

Melioidosis is a systemic disease endemic in Southeast Asia and Northern Australia. The spectrum of the disease varies from asymptomatic infection to severe systemic manifestations. Timely diagnosis and treatment of melioidosis is a challenge due to its atypical presentations. We report a case of melioidosis causing cerebral abscesses and cerebral venous sinus thrombosis. Occurrence of these neurological manifestations in melioidosis is rare and it is a difficult condition to diagnose and treat. Timely diagnosis was a challenge in this patient due to the atypical presentation and the use of empirical antibiotics in the primary care setting. Limited laboratory diagnostic capability also contributed to this delay.

A Persisting Nontropical Focus of Burkholderia pseudomallei with Limited Genome Evolution over Five Decades.

Burkholderia pseudomallei is the causative agent of the high-mortality disease melioidosis. Although melioidosis is classified as a tropical disease, rare autochthonous cases have been reported from temperate climatic regions, with uncertainty as to whether B. pseudomallei is persistent in the local environment and whether specific genetic mechanisms facilitate the survival of B. pseudomallei outside the tropics. Sporadic cases of melioidosis occurred in a valley region (latitude 31.6°S) in southwest Western Australia, Australia, between 1966 and 1992. We report a new melioidosis cluster in the same region following high rainfall in January 2017. More than 20 animals died, and B. pseudomallei was isolated from four alpacas, a parrot, and three environmental samples taken from the farm where the alpacas resided. Epidemiological data and genomics revealed that two locations on the farm were the probable sources of the alpaca infections. We determined that B. pseudomallei isolates from the 2017 cluster belonged to sequence type 284 (ST-284), as did all isolates recovered from 1966 to 1992. Genomic analysis confirmed that the ST-284 isolates were clonal and contained conserved genomic islands and limited evidence of recombination. We identified protein-coding regions unique to these isolates that might influence the persistence of B. pseudomallei in this temperate region. We demonstrate the environmental persistence of B. pseudomallei in a temperate region for over 50 years, with limited genetic changes suggesting a latent state and with activation, potential aerosolization, and local dispersal following unusually high rainfall.IMPORTANCE Burkholderia pseudomallei is predominantly a tropical pathogen uncommonly found in the environment of temperate climatic regions. It is unclear if introduction into temperate regions is sporadic and temporary or if B. pseudomallei can persist in such environments. B. pseudomallei was identified in the environment of southwest Western Australia with melioidosis cases between 1966 and 1991. We report a new cluster with 23 animal fatalities in the same region from 2017, with B. pseudomallei again being recovered from the environment. Comparison of the isolates from the first and second clusters using genomics revealed a single sequence type, high clonality, and limited recombination, even though the time of recovery of the isolates spanned 51 years. This is a major contrast to the extensive genomic diversity seen in the tropics. Our data support the suggestion that B. pseudomallei has the ability to persist in nontropical environments, potentially in a latent state, and has the ability to activate following favorable conditions (rainfall) and then infect animals and humans.

Imported melioidosis in the United Kingdom: Increasing incidence but continued under-reporting

Melioidosis, caused by the environmentally-acquired bacterium Burkholderia pseudomallei, is increasingly recognised as a globally significant public health problem, although difficult to diagnose and manage. We aimed to review all cases diagnosed in the UK since 2010, when notification became a legal requirement. This was compared with statutory reporting to assess completeness of surveillance. A novel dataset was compiled comprising routinely collected clinical and demographic details for isolates of B. pseudomallei referred to Public Health England’s reference laboratory. Isolates were cross-referenced with an existing database of mandatory reports of B. pseudomallei made under the Health Protection (Notification) Regulations 2010 to determine completeness of surveillance. The literature was also searched for missed non-referred or reported cases. Forty-six UK cases of melioidosis were identified from January 2010-July 2019. The majority of affected patients were male (65.2%); median age was 53. Four had cystic fibrosis. Other co-morbidities were poorly captured by current surveillance mechanisms. Respiratory disease, sepsis and abscess formation were the most common presenting features. Eighteen had acquired infection in Thailand; two cases were associated with travel to Nigeria. 40 UK cases were confirmed as B. pseudomallei by the reference laboratory. Nineteen of the identified cases were not found on the database of notified causative agents. Five patients had been notified with no confirmatory isolate received. Discordance between mandatory notification and isolate referral emphasises the challenges in routine epidemiological surveillance, even in a well-resourced, high-income country. The wide variety of presentations highlights the difficulties in clinical diagnosis. Cases identified following travel to Africa add further evidence that the disease is more widespread than previously thought. Sixteen patients required intensive care management, underlining challenges faced in resource limited settings. Individualised pre-travel counselling should be performed in travellers with high-risk comorbidities such as cystic fibrosis.

Investigation of Melioidosis Using Blood Culture and Indirect Hemagglutination Assay Serology among Patients with Fever, Northern Tanzania.

.Prediction models indicate that melioidosis may be common in parts of East Africa, but there are few empiric data. We evaluated the prevalence of melioidosis among patients presenting with fever to hospitals in Tanzania. Patients with fever were enrolled at two referral hospitals in Moshi, Tanzania, during 2007–2008, 2012–2014, and 2016–2019. Blood was collected from participants for aerobic culture. Bloodstream isolates were identified by conventional biochemical methods. Non–glucose-fermenting Gram-negative bacilli were further tested using a Burkholderia pseudomallei latex agglutination assay. Also, we performed B. pseudomallei indirect hemagglutination assay (IHA) serology on serum samples from participants enrolled from 2012 to 2014 and considered at high epidemiologic risk of melioidosis on the basis of admission within 30 days of rainfall. We defined confirmed melioidosis as isolation of B. pseudomallei from blood culture, probable melioidosis as a ≥ 4-fold rise in antibody titers between acute and convalescent sera, and seropositivity as a single antibody titer ≥ 40. We enrolled 3,716 participants and isolated non-enteric Gram-negative bacilli in five (2.5%) of 200 with bacteremia. As none of these five isolates was B. pseudomallei, there were no confirmed melioidosis cases. Of 323 participants tested by IHA, 142 (44.0%) were male, and the median (range) age was 27 (0–70) years. We identified two (0.6%) cases of probable melioidosis, and 57 (17.7%) were seropositive. The absence of confirmed melioidosis from 9 years of fever surveillance indicates melioidosis was not a major cause of illness.

An increase in p62/NBR1 levels in melioidosis patients of Sri Lanka exhibit a characteristic of potential host biomarker.

Introduction Melioidosis, caused by Burkholderia pseudomallei , in endemic areas, poses a challenge for treating the diseased populations without accurate diagnosis, and the disease-specific biomarkers linked with the infection have yet to be reported. Due to the invasive nature of the causative agent, Burkholderia pseudomallei , host innate effector mechanisms, including autophagy are known to be activated, resulting in differential expression of cellular proteins and immune markers. Identification of a disease-specific biomarker associated with B. pseudomallei infection will be helpful to facilitate rapid confirmation of melioidosis, which would enable early treatment and therapeutic success.Aim We aimed to assess the levels of a host autophagy component, p62/NBR1, which function as a cargo-receptor in the process of autophagy activation leading to the degradation of ubiquitin-coated intracellular bacteria in which p62/NBR1 itself is degraded in the clearance of the pathogen. We further probed the extent of intracellular p62/NBR1 degradation and assessed its potential as a melioidosis biomarker.Methodology We analysed peripheral blood mononuclear cell (PBMC) lysates using an ELISA-based assay for detecting cytosolic autophagy-related proteins p62/NBR1. We measured p62/NBR1 levels in diseased (confirmed B. pseudomallei infection) and non -diseased populations and utilized receiver operating characteristic (ROC) curve and max Youden index analysis for evaluating potential disease biomarker characteristics.Results Our results revealed a three to fivefold increase in p62/NBR1 levels confirmed melioidosis cases compared to uninfected healthy donors. Comparable to p62/NBR1, levels of cytosolic LC3-I levels also increased, whereas the levels of degraded membrane bound form LC3-II was low, suggesting autophagy deficiency. Proinflammatory serum cytokine response, particularly IL-6, was consistently higher alongside B. pseudomallei infection in comparison to healthy controls.Conclusions ROC curve and max Youden index analysis suggest that increased p62/NBR1 levels in diseased populations display characteristics of a potential disease biomarker in melioidosis and illustrates that an elevated p62/NBR1 level, in conjunction with B. pseudomallei infection associated with autophagy deficiency.

A review of imaging findings in melioidosis: revealing the tropics’ dirty secret

ObjectiveMelioidosis is a neglected tropical disease caused by the Burkholderia pseudomallei bacterium. Currently, serologically-proven cases are likely to represent only the ‘tip of the iceberg’ as culture facilities are not widely available within endemic areas. With globally increasing population and temperatures, it is hypothesised that areas which B. pseudomallei is endemic to will expand. Melioidosis confers significant mortality and morbidity and is associated with a diverse range of imaging findings. This pictorial essay aims to describe the common and life-threatening imaging features of melioidosis. MethodsA retrospective review was undertaken on imaging performed in culture-confirmed cases of melioidosis at a single institution over a 5-year period. ResultsTypical and atypical imaging findings demonstrating involvement of multiple organs are presented. ConclusionEffective treatment for melioidosis requires early diagnosis and a multi-disciplinary approach with involvement of physicians, surgeons, and interventional radiologists. Where available, early CT imaging should be performed to investigate potential bacterial seeding. Radiologists working in endemic areas or examining returned overseas travellers should be familiar with the imaging findings to aid diagnosis and management in these patients.

Melioidosis: Case Report of Confirmed Burkholderia pseudomallei in Saudi Arabia

Melioidosis is an infectious disease of tropical climates. The disease is caused by the bacterium Burkholderia pseudomallei. Most cases are diagnosed in south east Asia and northern Australia. Some imported cases diagnosed in returning tourist, soldiers and immigrants from endemic areas. It caught a lot of attention since the Centers for Disease Control and Prevention (CDC) designated B. pseudomallei as an agent for biological warfare and terrorism. We describe two cases of a 26-year-old Saudi woman who had fulminant sepsis soon after returning from Thailand & 48-year-old woman with a long history of fever. B. pseudomallei was isolated from both patient’s blood cultures and they had different consequences. A confirmed case of melioidosis was not reported before in Saudi Arabia.

Melioidosis and the Heart: A Systematic Review.

Melioidosis is caused by Gram-negative bacterium Burkholderia pseudomallei. Clinical presentation can vary from pneumonia, sepsis and multi-focal abscess formation. The aim of this study was to systemically review the cardiac manifestations of melioidosis in the literature and describe their epidemiology, microbiological diagnosis and outcomes. A systematic review of the peer-reviewed literature was carried out in PubMed and Google Scholar for human melioidosis cases with cardiac involvement. Quantitative data for cases of melioidosis were obtained, including age, sex, microbiological diagnosis, treatment, and outcome. 980 articles were screened, of which 31 articles were eligible. The most common cardiac site of infection was pericarditis, followed by endocarditis and myocarditis. Over 95% of cardiac involvement occurred in males, and mortality was the lowest in pericarditis and highest in myocarditis. Valvular vegetations were all small, left-sided, and did not require surgery. Antibiotic treatment included a bactericidal induction therapy with ceftazidime or a carbapenem ± TMP-SMX, followed by eradication therapy with TMP–SMX in most patients as previously established. In conclusion, melioidosis varies in clinical presentation and is also known as a great imitator. Although cardiac involvement is rare, this is the first systematic review to summarise all cases reported in the literature to date.

A Fatal Case of Melioidosis in a Patient with Chronic Pancreatitis

A Fatal Case of Melioidosis in a Patient with Chronic Pancreatitis