MyMedR

Unrecognised infection in a cystic fibrosis patient

Asiah K, Hanifah YA, Norzila MZ, Hasniah L, Rusanida A

J Paediatr Child Health, 2006 Apr;42(4):217-8.

We report a 17-year-old Malay boy with cystic fibrosis who over a 14-month period experienced worsening respiratory symptoms and deteriorating lung function. Burkholderia pseudomallei was eventually isolated from his sputum. He improved clinically following treatment for meliodosis and his lung function returned to normal.

Matched MeSH terms: Melioidosis/diagnosis*

Transcriptome analysis of Burkholderia pseudomallei T6SS identifies Hcp1 as a potential serodiagnostic marker

Chieng S, Mohamed R, Nathan S

Microb Pathog, 2015 Feb;79:47-56.

PMID: 25616255 DOI: 10.1016/j.micpath.2015.01.006

Burkholderia pseudomallei, the causative agent of melioidosis, is able to survive extreme environments and utilizes various virulence factors for survival and pathogenicity. To compete and survive within these different ecological niches, B. pseudomallei has evolved specialized pathways, including the Type VI secretion systems (T6SSs), that have a role in pathogenesis as well as interbacterial interactions. We examined the expression profile of B. pseudomallei T6SS six gene clusters during infection of U937 macrophage cells. T6SS-5 was robustly transcribed while the other five clusters were not significantly regulated proposing the utility of T6SS-5 as a potential biomarker of exposure to B. pseudomallei. Transcription of T6SS regulators VirAG and BprB was also not significant during infection when compared to bacteria grown in culture. Guided by these findings, three highly expressed T6SS genes, tssJ-4, hcp1 and tssE-5, were expressed as recombinant proteins and screened against melioidosis patient sera by western analysis and ELISA. Only Hcp1 was reactive by both types of analysis. The recombinant Hcp1 protein was further evaluated against a cohort of melioidosis patients (n = 32) and non-melioidosis individuals (n = 20) sera and the data clearly indicates a higher sensitivity (93.7%) and specificity (100%) for Hcp1 compared to bacterial lysate. The detection of anti-Hcp1 antibodies in patients' sera indicating the presence of B. pseudomallei highlights the potential of Hcp1 to be further developed as a serodiagnostic marker for melioidosis.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Systemic lupus erythematosus and melioidosis

Che Rahim MJ, Mohammad N, Kamaruddin MI, Wan Ghazali WS

BMJ Case Rep, 2019 Jul 01;12(7).

PMID: 31266760 DOI: 10.1136/bcr-2019-229974

We reported a case of a young female patient presented with sepsis and diagnosed with melioidosis and systemic lupus erythematosus (SLE) within the same admission. She presented with 1-week history of productive cough, progressive dyspnoea together with prolonged fever, arthralgia, rashes and oral ulcers. She had septicemic shock, respiratory failure requiring intubation and ventilation in intensive care unit and subsequently developed acute renal failure requiring haemodialysis. Antibiotics and immunosuppressive treatment including low-dose intravenous cyclophosphamide were commenced. She had a remarkable recovery and was discharged after 6 weeks. There was no evidence of active SLE or relapse of melioidosis during clinic follow-ups.

Matched MeSH terms: Melioidosis/diagnosis*

Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia

Subakir H, Chong YM, Chan YF, Hasan MS, Jamaluddin MFH, Pang YK, et al.

J Med Microbiol, 2020 Jan;69(1):49-51.

PMID: 31750812 DOI: 10.1099/jmm.0.001108

Introduction.Burkholderia pseudomallei (melioidosis) is an important cause of community-acquired pneumonia (CAP) in the tropics. Selective medium is recommended for laboratory diagnosis with non-sterile respiratory samples, while PCR is not routinely used due to variable reported performance. The effectiveness of these diagnostic modalities varies by site.Aim. To compare selective media and real-time PCR (qPCR) with routine media in detecting B. pseudomallei in CAP respiratory samples in a low-incidence setting in Kuala Lumpur, Malaysia.Methodology. Respiratory samples were routinely cultured on blood, chocolate and MacConkey agar (RESP-ROUTINE), and compared to culture on selective Ashdown medium (RESP-SELECTIVE) and qPCR. The gold standard was routine culture of B. pseudomallei from any site (ALL-ROUTINE).Results.B. pseudomallei was detected in 8/204 (3.9 %) samples. Overall sensitivity rates differed (P=0.03) for qPCR (100%), RESP-SELECTIVE (87.5%) and RESP-ROUTINE (50%). There was a trend towards lower median days to positive culture for RESP-SELECTIVE (1 day) compared to RESP-ROUTINE (2 days, P=0.08) and ALL-ROUTINE (2 days, P=0.06). Reagent costs for each additional detection were USD59 for RESP-SELECTIVE and USD354 for PCR.Conclusions. In a low-incidence setting, selective culture of respiratory samples on Ashdown was more sensitive and allowed quicker identification than routine media, at reasonable cost. Blood cultures are critical, confirming four cases missed by routine respiratory culture. Selective medium is useful in early pneumonia (pre-sepsis) and resource-limited settings where blood cultures are infrequently done. Real-time PCR is costly, but highly sensitive and useful for high-risk patients with diabetes, cancer or immunosuppressants, or requiring ventilation or intensive care.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Relapse of chronic melioidosis in a paediatric cystic fibrosis patient: first case report from Malaysia

Mariappan V, Thavagnanam S, Vellasamy KM, Teh CJS, Atiya N, Ponnampalavanar S, et al.

BMC Infect Dis, 2018 Sep 05;18(1):455.

PMID: 30185168 DOI: 10.1186/s12879-018-3371-7

BACKGROUND: Burkholderia pseudomallei is the causative agent of melioidosis, which is a potentially life threatening disease endemic in Southeast Asian countries. In Malaysia, cystic fibrosis (CF) is an uncommon condition. The association between CF and B.pseudomallei infections has been reported previously. However, this is the first case report of a pediatric melioidosis relapse and co-infection with other Gram-negative bacteria in Malaysia.

CASE PRESENTATION: A 14-year-old Chinese Malaysian boy presented with a history of recurrent pneumonia, poor growth and steatorrhoea since childhood, and was diagnosed with CF. B. pseudomallei was cultured from his sputum during three different admissions between 2013 and 2016. However, the patient succumbed to end stage of respiratory failure in 2017 despite antibiotics treatment against B.pseudomallei. The isolates were compared using multilocus-sequence typing and repetitive-element polymerase chain reaction (PCR), and confirmed that two of the isolates were of same sequence type, which may indicate relapse.

CONCLUSIONS: CF patients should be aware of melioidosis in endemic regions, as it is an emerging infectious disease, especially when persistent or recurrent respiratory symptoms and signs of infection occur. The high prevalence rates of melioidosis in Malaysia warrants better management options to improve quality of life, and life expectancy in patients with CF. Travel activities to endemic regions should also be given more consideration, as this would be crucial to identify and initiate appropriate empiric treatment.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Paediatric melioidosis with septic shock in a previously-well child

Kandasamy Y, Somasundaram P

Singapore Med J, 2007 Apr;48(4):e109-10.

PMID: 17384864

We present a previously-healthy 12-year old girl from a rural community and who was admitted to a district general hospital in Malaysia with coagulopathy and septic shock. Despite receiving intensive care, she succumbed to her illness. Blood cultures grew Burkholderia pseudomallei. Melioidosis is an unusual cause of paediatric Gram-negative sepsis among children in Malaysia.

Matched MeSH terms: Melioidosis/diagnosis*

Pacemaker infection secondary to burkholderia pseudomallei

Zainal Abidin I, Syed Tamin S, Huat Tan L, Chong WP, Azman W

Pacing Clin Electrophysiol, 2007 Nov;30(11):1420-2.

PMID: 17976112

Infection is a relatively rare but devastating complication of intracardiac device implantation. Burkholderia pseudomallei is the organism which causes melioidosis, an endemic and lethal infection in the tropics. We describe a case of pacemaker infection secondary to Burkholderia pseudomallei, which was treated by explantation of the device and appropriate antimicrobial therapy.

Matched MeSH terms: Melioidosis/diagnosis

Fulltext Neonatal meliodosis: very rare but be aware

Ang YM

Med J Malaysia, 2005 Mar;60(1):99-102.

PMID: 16250291 MyJurnal

Meliodosis is an infectious disease encountered mainly in tropics. It is not an uncommon problem in Malaysia especially in areas with agricultural activities. Although it can occur in all age groups, there have been few reported cases in children. Men are more commonly affected than women due to outdoor activities. Neonatal cases have been reported in Hawaii and Thailand. These infants presented with neonatal sepsis or meningitis. The mode of transmission to these infants has not been elucidated. This is the report of such a case first reported in Hospital Tengku Ampun Afzan, Kuantan.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Multiple-antigen ELISA for melioidosis--a novel approach to the improved serodiagnosis of melioidosis

Hara Y, Chin CY, Mohamed R, Puthucheary SD, Nathan S

BMC Infect Dis, 2013;13:165.

PMID: 23556548 DOI: 10.1186/1471-2334-13-165

Burkholderia pseudomallei, the causative agent of melioidosis, is endemic to Southeast Asia and northern Australia. Clinical manifestations of disease are diverse, ranging from chronic infection to acute septicaemia. The current gold standard of diagnosis involves bacterial culture and identification which is time consuming and often too late for early medical intervention. Hence, rapid diagnosis of melioidosis is crucial for the successful management of melioidosis.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Molecular investigations of a locally acquired case of melioidosis in Southern AZ, USA

Engelthaler DM, Bowers J, Schupp JA, Pearson T, Ginther J, Hornstra HM, et al.

PLoS Negl Trop Dis, 2011 Oct;5(10):e1347.

PMID: 22028940 DOI: 10.1371/journal.pntd.0001347

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative bacillus, primarily found in soils in Southeast Asia and northern Australia. A recent case of melioidosis in non-endemic Arizona was determined to be the result of locally acquired infection, as the patient had no travel history to endemic regions and no previous history of disease. Diagnosis of the case was confirmed through multiple microbiologic and molecular techniques. To enhance the epidemiological analysis, we conducted several molecular genotyping procedures, including multi-locus sequence typing, SNP-profiling, and whole genome sequence typing. Each technique has different molecular epidemiologic advantages, all of which provided evidence that the infecting strain was most similar to those found in Southeast Asia, possibly originating in, or around, Malaysia. Advancements in new typing technologies provide genotyping resolution not previously available to public health investigators, allowing for more accurate source identification.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Molecular detection of leptospirosis and melioidosis co-infection: A case report

Mohd Ali MR, Mohamad Safiee AW, Thangarajah P, Fauzi MH, Muhd Besari A, Ismail N, et al.

J Infect Public Health, 2017 Nov-Dec;10(6):894-896.

PMID: 28330585 DOI: 10.1016/j.jiph.2017.02.009

Leptospirosis and melioidosis are important tropical infections caused by Leptospira and Burkholdheria pseudomallei, respectively. As both infections share similar clinical manifestations yet require different managements, complementary laboratory tests are crucial for the diagnosis. We describe a case of Leptospira and B. pseudomallei co-infection in a diabetic 40-year-old woman with history of visit to a freshwater camping site in northern Malaysia. To our knowledge, this is the first case of such double-infection, simultaneously demonstrated by molecular approach. This case highlights the possibility of leptospirosis and melioidosis co-infections and their underlying challenges in the rapid and accurate detection of the etiologic microorganism.

Matched MeSH terms: Melioidosis/diagnosis*

Misidentification of Burkholderia pseudomallei as Burkholderia cepacia by the VITEK 2 system

Zong Z, Wang X, Deng Y, Zhou T

J Med Microbiol, 2012 Oct;61(Pt 10):1483-1484.

PMID: 22820689 DOI: 10.1099/jmm.0.041525-0

A previously healthy Chinese male returned from working in the Malaysian jungle with a fever. A blood culture grew Gram-negative bacilli that were initially identified as Burkholderia cepacia by the VITEK 2 system but were subsequently found to be Burkholderia pseudomallei by partial sequencing of the 16S rRNA gene. The identification of B. pseudomallei using commercially available automated systems is problematic and clinicians in non-endemic areas should be aware of the possibility of melioidosis in patients with a relevant travel history and blood cultures growing Burkholderia spp.

Matched MeSH terms: Melioidosis/diagnosis

Fulltext Melioidotic prostatic abscess in Pahang

Ng TH, How SH, Amran AR, Razali MR, Kuan YC

Singapore Med J, 2009 Apr;50(4):385-9.

PMID: 19421682

Melioidosis is caused by Burkholderia pseudomallei, a Gram-negative bacillus. Melioidosis can affect many organs, including the prostate. However, prostatic abscess due to melioidosis is uncommon. We describe five cases of melioidosis with prostatic abscess. Four of five patients had diabetes mellitus and had more than one organ involvement. The diagnosis of prostatic abscess in our patients was only made with computed tomography of the abdomen and pelvis. None of our patients underwent surgical drainage and all remained well after treatment with antibiotics, except for one mortality secondary to severe septicaemia.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Melioidosis: misdiagnosed in Nepal

Shrestha N, Adhikari M, Pant V, Baral S, Shrestha A, Basnyat B, et al.

BMC Infect Dis, 2019 Feb 19;19(1):176.

PMID: 30782129 DOI: 10.1186/s12879-019-3793-x

BACKGROUND: Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia.

CASE PRESENTATION: Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole.

CONCLUSION: The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Matched MeSH terms: Melioidosis/diagnosis*

Melioidosis: an uncommon cause of neck abscess

Zulkiflee AB, Prepageran N, Philip R

Am J Otolaryngol, 2008 Jan-Feb;29(1):72-4.

PMID: 18061838 DOI: 10.1016/j.amjoto.2007.02.004

INTRODUCTION: Melioidosis is a life-threatening disease caused by B. pseudomallei. It is endemic in Southeast Asia with a few reports from the Western world. It is transmitted via inhalation, ingestion or direct contact with an open wound. Clinically it may present with local or systemic symptoms. Mortality rate is very high in systemic disease; but local infection is usually mild, which causes delay in seeking medical attention.
CASE REPORT: We report a case of neck melioidosis presenting as a parapharyngeal abscess that was successfully managed with incision and drainage and intravenous ceftazidime and co-trimoxazole for 6 weeks followed by eradication therapy with oral co amoxiclav.
CONCLUSION: Neck melioidosis must be considered one of differential diagnoses for "cold abscesses" of the neck, especially in an endemic area, in Asian migrants, or in those with history of previous visit from the endemic regions.

Matched MeSH terms: Melioidosis/diagnosis

Fulltext Melioidosis: an emerging infectious disease

Raja NS, Ahmed MZ, Singh NN

J Postgrad Med, 2005 Apr-Jun;51(2):140-5.

PMID: 16006713

Infectious diseases account for a third of all the deaths in the developing world. Achievements in understanding the basic microbiology, pathogenesis, host defenses and expanded epidemiology of infectious diseases have resulted in better management and reduced mortality. However, an emerging infectious disease, melioidosis, is becoming endemic in the tropical regions of the world and is spreading to non-endemic areas. This article highlights the current understanding of melioidosis including advances in diagnosis, treatment and prevention. Better understanding of melioidosis is essential, as it is life-threatening and if untreated, patients can succumb to it. Our sources include a literature review, information from international consensus meetings on melioidosis and ongoing discussions within the medical and scientific community.

Matched MeSH terms: Melioidosis/diagnosis

Fulltext Melioidosis: Clinical impact and public health threat in the tropics

Perumal Samy R, Stiles BG, Sethi G, Lim LHK

PLoS Negl Trop Dis, 2017 May;11(5):e0004738.

PMID: 28493905 DOI: 10.1371/journal.pntd.0004738

This review briefly summarizes the geographical distribution and clinical impact of melioidosis, especially in the tropics. Burkholderia pseudomallei (a gram-negative bacterium) is the major causative agent for melioidosis, which is prevalent in Singapore, Malaysia, Thailand, Vietnam, and Northern Australia. Melioidosis patients are increasingly being recognized in other parts of the world. The bacteria are intrinsically resistant to many antimicrobial agents, but prolonged treatment, especially with combinations of antibiotics, may be effective. Despite therapy, the overall case fatality rate of septicemia in melioidosis remains significantly high. Intracellular survival of the bacteria within macrophages may progress to chronic infections, and about 10% of patients suffer relapses. In the coming decades, melioidosis will increasingly afflict travelers throughout many global regions. Clinicians managing travelers returning from the subtropics or tropics with severe pneumonia or septicemia should consider acute melioidosis as a differential diagnosis. Patients with open skin wounds, diabetes, or chronic renal disease are at higher risk for melioidosis and should avoid direct contact with soil and standing water in endemic regions. Furthermore, there are fears that B. pseudomallei may be used as a biological weapon. Technological advancements in molecular diagnostics and antibiotic therapy are improving the disease outcomes in endemic areas throughout Asia. Research and development efforts on vaccine candidates against melioidosis are ongoing.

Matched MeSH terms: Melioidosis/diagnosis

Melioidosis presenting as spinal epidural abscess

Ganesan D, Puthucheary SD, Waran V

Br J Neurosurg, 2003 Dec;17(6):568-71.

PMID: 14756491

Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented.

Matched MeSH terms: Melioidosis/diagnosis*

Melioidosis presenting as prostatitis--a case report from Sabah

Kan SPK, Kay RWW

Trans R Soc Trop Med Hyg, 1978;72(5):522-4.

PMID: 725999 DOI: 10.1016/0035-9203(78)90175-X

Previous reports of melioidosis in Sabah are reviewed and a detailed account of a case, presenting as prostatitis, in a 40-year-old British male is given. The history suggested that the organism, Pseudomonas pseudomallei, was transmitted by a fly which entered the eye. Diagnosis was delayed and treatment presented some difficulty, the organism being relatively insensitive to amplicillin and gentamicin. Co-trimoxazole was the most effective, followed by minocycline. Cure was eventually achieved and after four years the patient was fit and normal, except for sterility.

Matched MeSH terms: Melioidosis/diagnosis*

Fulltext Melioidosis presenting as epididymo-orchitis

Koh KB

Singapore Med J, 1995 Aug;36(4):446.

PMID: 8919168

We report a rare case of suppurative epididymo-orchitis caused by Pseudomonas pseudomallei in a 56-year-old male. This is a gram negative bacillus found mainly in tropical zones. Diagnosis was reached by culture of the organisms after drainage of the scrotal abscess, and the patient was treated by a course of oral chloramphenicol 500 mg qid for 6 months.

Matched MeSH terms: Melioidosis/diagnosis*

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