MyMedR

Fulltext Cutaneous melioidosis in a healthy Danish man after travelling to South-East Asia

Bodilsen J, Langgaard H, Nielsen HL

BMJ Case Rep, 2015 Jan 16;2015.

PMID: 25596295 DOI: 10.1136/bcr-2014-207340

A healthy Danish man presented with infected prepatellar bursitis 8 months after being involved in a car accident in Malaysia resulting in exposure of a laceration of his knee to stagnant water. Tissue samples grew Burkholderia pseudomallei and diagnostic work up revealed no secondary foci. The patient was successfully treated with surgical debridement and 3 months of oral trimethoprim-sulfamethoxazole. At 6 months follow-up the patient was without relapse.

Matched MeSH terms: Melioidosis/diagnosis*; Melioidosis/drug therapy; Melioidosis/surgery

Fulltext Infected aneurysm after returning from Southeast Asia: think Burkholderia pseudomallei!

Auvens C, Neuwirth C, Piroth L, Blot M

BMJ Case Rep, 2019 May 22;12(5).

PMID: 31122956 DOI: 10.1136/bcr-2018-228856

Melioidosis is a protean disease which is endemic to Southeast Asia and northern Australia. Here, we report a case of infected aortic aneurysm due to Burkholderia pseudomallei in an immunocompetent man 6 months after a trip to northern Malaysia. This patient initially received inappropriate surgical and antibiotic treatment, leading to a peri-prosthetic aortic infection with lumbar spondylitis and contiguous psoas muscle abscess. This case highlights the difficulty of diagnosing melioidosis given its diverse clinical manifestations and the limits of routine microbiological methods to identify B. pseudomallei Melioidosis should be considered a possible diagnosis in individuals with unexplained fever subsequent to travel in an endemic area.

Matched MeSH terms: Melioidosis/complications; Melioidosis/diagnosis*; Melioidosis/microbiology

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/complications*; Melioidosis/diagnosis*; Melioidosis/drug therapy

Fulltext Honeycomb and necklace signs in liver abscesses secondary to melioidosis

Ong SCL, Alemam MMM, Zakaria NA, Abdul Halim NA

BMJ Case Rep, 2017 Oct 19;2017.

PMID: 29054959 DOI: 10.1136/bcr-2017-222342

Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for Burkholderia pseudomallei He was subsequently treated with ceftazidime for a month followed by oral trimethoprim-sulfamethoxazole for 3 months. Follow-up CT of abdomen a month after diagnosis and treatment showed resolving hepatic and splenic lesions.

Matched MeSH terms: Melioidosis/blood; Melioidosis/complications; Melioidosis/diagnosis*; Melioidosis/drug therapy

Burkholderia pseudomallei pathogenesis and survival in different niches

Yip CH, Ghazali AK, Nathan S

Biochem Soc Trans, 2020 04 29;48(2):569-579.

PMID: 32167134 DOI: 10.1042/BST20190836

Burkholderia pseudomallei (Bp) is the causative agent of melioidosis, a disease of the tropics with high clinical mortality rates. To date, no vaccines are approved for melioidosis and current treatment relies on antibiotics. Conversely, common misdiagnosis and high pathogenicity of Bp hamper efforts to fight melioidosis. This bacterium can be isolated from a wide range of niches such as waterlogged fields, stagnant water bodies, salt water bodies and from human and animal clinical specimens. Although extensive studies have been undertaken to elucidate pathogenesis mechanisms of Bp, little is known about how a harmless soil bacterium adapts to different environmental conditions, in particular, the shift to a human host to become a highly virulent pathogen. The bacterium has a large genome encoding an armory of factors that assist the pathogen in surviving under stressful conditions and assuming its role as a deadly intracellular pathogen. This review presents an overview of what is currently known about how the pathogen adapts to different environments. With in-depth understanding of Bp adaptation and survival, more effective therapies for melioidosis can be developed by targeting related genes or proteins that play a major role in the bacteria's survival.

Matched MeSH terms: Melioidosis

Fulltext Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Rodríguez JY, Álvarez-Moreno CA, Cortés JA, Rodríguez GJ, Esquea K, Pinzón H, et al.

Biomedica, 2019 05 01;39:10-18.

PMID: 31529845 DOI: 10.7705/biomedica.v39i3.4534

Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected.
There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases.
We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Matched MeSH terms: Melioidosis/diagnosis; Melioidosis/drug therapy; Melioidosis/epidemiology*

Fulltext Complications of Melioidosis: a systematic review

Marilyn Charlene Montini Maluda, Michelle May D. Goroh, Tan, Eric Chee How, Syed Sharizman Syed Abdul Rahim, Richard Avoi, Mohammad Saffree Jeffree, et al.

Borneo Epidemiology Journal, 2020;1(1):5-15.

MyJurnal

Introduction: Melioidosis, also known as Whitmore disease, is caused by the gram-negative bacillus, Burkholderia pseudomallei and remains a public health concern in Southeast Asia and northern parts of Australia. This study attempts to identify all possible complications of melioidosis and its outcomes.
Methods: Literature search was conducted from databases such as PubMed, Science Direct and Scopus from 1st January 2000 to 31st August 2019. Medical Subject Headings (MeSH) search strategy was used with the terms ‘Melioidosis’ or ‘Burkholderia pseudomallei’ and ‘Complications’.
Results: A total of 162 titles were identified and 22 articles were included in the review. Findings showed that among the 22 articles, the ratio of male to female melioidosis incidence was 2.3 to 1, with most cases (86.4%) aged older than 14 years old and showed a mean age of 46 years old. A third (7/22) of the papers reported the involvement of the nervous system as a complication of melioidosis followed by cardiovascular complications. Among the 23 cases reported, 13 had underlying medical conditions with most of them (84.6%) having diabetes mellitus or newly diagnosed with diabetes mellitus. Overall, only one case (4.3%) had resulted in mortality, while 17.4% developed complications and 78.3% managed a full recovery after undergoing treatment for melioidosis.
Conclusion: The most commonly found complication of melioidosis involved the nervous system but patient outcomes were favourable. Rare complications included mycotic aneurysm that can be fatal. Melioidosis can affect almost any organ leading to various complications.

Matched MeSH terms: Melioidosis

Fulltext Situation of Melioidosis in Tuaran (2017)

Marilyn Maluda, Noraziah B. Bakri

Borneo Journal of Medical Sciences, 2018;12(101):13-0.

MyJurnal

Melioidosis an infectious disease caused by gram-negative bacteria, Burkholderia pseudomallei is highly endemic in Malaysia, Thailand, Singapore and parts of northern Australia. The district of Tuaran which is located on the west coast of Sabah had reported an increasing trend of Melioidosis cases where in 2017, a total of 19 cases were reported, more than doubling the number of cases reported the prior year (7 cases).

Matched MeSH terms: Melioidosis

Fulltext Melioidosis: Cases Notified to Kota Kinabalu District Health Office Year 2017

Rosfina Ghazali

Borneo Journal of Medical Sciences, 2018;12(101):29-0.

MyJurnal

Melioidosis is a tropical infectious disease cause by gram-negative bacterium, Burkholderia pseudomallei. It is predominantly in tropical climate especially Southeast Asia and Northern Australia. This disease is associated with significant mortality due to early onset of sepsis.

Matched MeSH terms: Melioidosis

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/surgery

Pseudoaneurysm of the renal artery associated with melioidosis

Noordin K, Abdullah MM, Natarajan C, Wahab YA, Abdullah K

Br J Urol, 1995 May;75(5):680-1.

PMID: 7613814

Matched MeSH terms: Melioidosis/complications*

Melioidosis: A disease of rodents communicable to man

Stanton AT, Fletcher W

Bull Inst Med Res Kuala Lumpur, 1924.

Matched MeSH terms: Melioidosis

Melioidosis pneumonia and blast injury

Wang CY, Yap BH, Delilkan AE

Chest, 1993 Jun;103(6):1897-9.

PMID: 8404124

We present the case of a 24-year-old woman with acute septicemic melioidosis resulting from inhaled infective dust during a blast injury. With appropriate antibiotic treatment and supportive therapy in the ICU, the patient made an uneventful recovery.

Matched MeSH terms: Melioidosis/diagnosis; Melioidosis/drug therapy; Melioidosis/etiology*

Fulltext Thalassemia major is a major risk factor for pediatric melioidosis in Kota Kinabalu, Sabah, Malaysia

Fong SM, Wong KJ, Fukushima M, Yeo TW

Clin Infect Dis, 2015 Jun 15;60(12):1802-7.

PMID: 25767257 DOI: 10.1093/cid/civ189

Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas.

Matched MeSH terms: Melioidosis/complications*; Melioidosis/drug therapy; Melioidosis/mortality; Melioidosis/epidemiology*

Acute septicemic melioidosis occurring in a child with acute lymphoblastic leukemia

Lin HP, Puthucheary SD, Sinniah D

Clin Pediatr (Phila), 1980 Oct;19(10):697-9.

PMID: 6931670

A 13-year old boy with acute lymphoblastic leukemia on chemotherapy developed neutropenia and acute cellulitis progressing to fulminating septicemia due to Pseudomonas pseudomallei. Septicemic melioidosis should be considered in the differential diagnosis of a febrile illness in children who are susceptible to infections.

Matched MeSH terms: Melioidosis/complications*; Melioidosis/diagnosis

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

Mardhiah K, Wan-Arfah N, Naing NN, Abu Hassan MR, Chan HK, Hasan H

Clinicoecon Outcomes Res, 2021;13:155-162.

PMID: 33732004 DOI: 10.2147/CEOR.S286283

Purpose: This 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 Methods: Data 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.

Results: The 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.

Conclusion: Despite 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.

Matched MeSH terms: Melioidosis

Fulltext Utilization of Point-of-Care Ultrasound to Detect Splenic Microabscesses in Pediatric Melioidosis

Sakulchit T, Ngu L, Chor YK, Ong GY

Cureus, 2021 Mar 08;13(3):e13760.

PMID: 33842136 DOI: 10.7759/cureus.13760

Melioidosis is an infectious disease most commonly found in places with tropical climates. Definitive diagnosis can be confirmed by culture or pathological results of blood or infected organ. However, imaging study is helpful in providing early provisional diagnosis and guiding therapy. Point-of-care ultrasound can be currently performed bedside by non-radiological staff such as emergency physicians or intensivists. We present the case of a pediatric patient who got diagnosed with melioidosis after detection of multiple splenic and hepatic abscesses by point-of-care ultrasound, leading to early diagnosis and appropriate empirical antibiotic selection, resulting in good treatment outcome.

Matched MeSH terms: Melioidosis

Burkholderia pseudomallei animal and human isolates from Malaysia exhibit different phenotypic characteristics

Lee SH, Chong CE, Lim BS, Chai SJ, Sam KK, Mohamed R, et al.

Diagn Microbiol Infect Dis, 2007 Jul;58(3):263-70.

PMID: 17350202

Burkholderia pseudomallei is a Gram-negative saprophytic soil bacterium, which is the etiologic agent of melioidosis, a severe and fatal infectious disease occurring in human and animals. Distinct clinical and animal isolates have been shown to exhibit differences in phenotypic trait such as growth rate, colony morphology, antimicrobial resistance, and virulence. This study was carried out to gain insight into the intrinsic differences between 4 clinical and 6 animal B. pseudomallei isolates from Malaysia. The 16S rRNA-encoding genes from these 10 isolates of B. pseudomallei were sequenced to confirm the identity of these isolates along with the avirulent Burkholderia thailandensis. The nucleotide sequences indicated that the 16S rRNA-encoding genes among the 10 B. pseudomallei isolates were identical to each other. However, the nucleotide sequence differences in the 16S rRNA-encoding genes appeared to be B. pseudomallei and B. thailandensis specific. The growth rate of all B. pseudomallei isolates was determined by generating growth curves at 37 degrees C for 72 h. The isolates were found to differ in growth rates with doubling time varying from 1.5 to 2.3 h. In addition, the B. pseudomallei isolates exhibited considerable variation in colony morphology when grown on Ashdown media, brain-heart infusion agar, and Luria-Bertani agar over 9 days of observation. Antimicrobial susceptibility tests indicated that 80% of the isolates examined were Amp(R) Cb(R) Kn(R) Gm(R) Chl(S) Te(S). Virulence of the B. pseudomallei clinical and animal isolates was evaluated in B. pseudomallei-susceptible BALB/c mice. Most of the clinical isolates were highly virulent. However, virulence did not correlate with isolate origin since 2 of the animal isolates were also highly virulent.

Matched MeSH terms: Melioidosis/microbiology*; Melioidosis/veterinary*

An improved selective and differential medium for the isolation of Burkholderia pseudomallei from clinical specimens

Francis A, Aiyar S, Yean CY, Naing L, Ravichandran M

Diagn Microbiol Infect Dis, 2006 Jun;55(2):95-9.

PMID: 16626918

Isolation and culture of Burkholderia pseudomallei remains the main stay in the diagnosis of melioidosis. Thus, the search for selective and differential media for B. pseudomallei has been ongoing. A number of such media have been reported with varying efficacy. Ashdown medium is the most established selective medium for the isolation of B. pseudomallei. There are no reports of differential media differentiating B. pseudomallei from Burkholderia cepacia. This report documents such a selective and differentiating medium for B. pseudomallei. Of a total of 1042 clinical specimens containing mixed flora and gram-negative isolates that were tested on this medium, 16 of the specimens yielded B. pseudomallei. The isolation rate was found to be 1.5%. This medium was found to be simple and inexpensive, can be made by small laboratories, and called as Francis medium. Based on the colony morphology and color, a preliminary report can be made within 18-24 h for the presence of B. pseudomallei. Our study showed that this medium had an overall sensitivity of 78.4% with a specificity of 92.2%. The use of this medium as an early diagnostic tool will help to reduce mortality and morbidity of melioidosis patients.

Matched MeSH terms: Melioidosis/diagnosis

Detection of immunoglobulins M and G using culture filtrate antigen of Burkholderia pseudomallei

Chenthamarakshan V, Vadivelu J, Puthucheary SD

Diagn Microbiol Infect Dis, 2001 Jan;39(1):1-7.

PMID: 11173184

IgM and IgG based ELISA systems were developed using the culture filtrate antigen (CFA) of Burkholderia pseudomallei. The assays were evaluated using 95 sera from 66 septicemic cases and 47 sera from 20 cases with localized melioidosis. In addition 65 sera from culture negative cases that were also serologically negative for other endemic infections clinically suspected of melioidosis were included. These were compared with sera from 260 non-melioidosis cases, 169 sera from individuals with high risk of acquiring the infection and 48 sera from healthy controls. The IgG-ELISA was 96% sensitive and 94% specific. All sera from cases with septicemic and localized infections and 61 of 63 sera from clinically suspected melioidosis cases were positive for IgG antibody. The geometric mean titre index (GMTI) values of IgG antibody in melioidosis cases were significantly higher (p < 0.0005) compared to that of healthy subjects, high risk group and subjects with non-melioidosis infections. The sensitivity and specificity of IgM ELISA was 74 and 99% respectively. The GMTI value of IgM antibody in the sera of melioidosis cases was significantly higher as compared to that of non-melioidosis disease controls (p < or = 0.001). These results demonstrate that the detection of IgG is a better indicator of the disease in the diagnosis of melioidosis.

Matched MeSH terms: Melioidosis/diagnosis*; Melioidosis/immunology

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