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Journal of Infection and Public Health Jul 2024Burkholderia pseudomallei, a Gram-negative pathogen, causes melioidosis. Although various clinical laboratory identification methods exist, culture-based techniques lack... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Burkholderia pseudomallei, a Gram-negative pathogen, causes melioidosis. Although various clinical laboratory identification methods exist, culture-based techniques lack comprehensive evaluation. Thus, this systematic review and meta-analysis aimed to assess the diagnostic accuracy of culture-based automation and non-automation methods.
METHODS
Data were collected via PubMed/MEDLINE, EMBASE, and Scopus using specific search strategies. Selected studies underwent bias assessment using QUADAS-2. Sensitivity and specificity were computed, generating pooled estimates. Heterogeneity was assessed using I statistics.
RESULTS
The review encompassed 20 studies with 2988 B. pseudomallei samples and 753 non-B. pseudomallei samples. Automation-based methods, particularly with updating databases, exhibited high pooled sensitivity (82.79%; 95% CI 64.44-95.85%) and specificity (99.94%; 95% CI 98.93-100.00%). Subgroup analysis highlighted superior sensitivity for updating-database automation (96.42%, 95% CI 90.01-99.87%) compared to non-updating (3.31%, 95% CI 0.00-10.28%), while specificity remained high at 99.94% (95% CI 98.93-100%). Non-automation methods displayed varying sensitivity and specificity. In-house latex agglutination demonstrated the highest sensitivity (100%; 95% CI 98.49-100%), followed by commercial latex agglutination (99.24%; 95% CI 96.64-100%). However, API 20E had the lowest sensitivity (19.42%; 95% CI 12.94-28.10%). Overall, non-automation tools showed sensitivity of 88.34% (95% CI 77.30-96.25%) and specificity of 90.76% (95% CI 78.45-98.57%).
CONCLUSION
The study underscores automation's crucial role in accurately identifying B. pseudomallei, supporting evidence-based melioidosis management decisions. Automation technologies, especially those with updating databases, provide reliable and efficient identification.
Topics: Burkholderia pseudomallei; Melioidosis; Humans; Sensitivity and Specificity; Automation, Laboratory; Bacteriological Techniques; Automation
PubMed: 38820898
DOI: 10.1016/j.jiph.2024.04.022 -
Veterinary World Jan 2024, a highly pathogenic bacterium responsible for melioidosis, exhibits ecological ubiquity and thrives within soil and water reservoirs, posing significant infection...
BACKGROUND AND AIM
, a highly pathogenic bacterium responsible for melioidosis, exhibits ecological ubiquity and thrives within soil and water reservoirs, posing significant infection risks to humans and animals through direct contact. The aim of this study was to elucidate the genetic diversity and prevalence patterns of sequence types (STs) across a global spectrum and to understand the relationships between strains isolated from different sources.
MATERIALS AND METHODS
We performed a systematic review and meta-analysis in this study. Extensive research was carried out across three comprehensive databases, including PubMed, Scopus, and ScienceDirect with data collected from 1924 to 2023.
RESULTS
A total of 40 carefully selected articles contributed 2737 isolates attributed to 729 distinct STs and were incorporated into the systematic review. Among these, ST46 emerged as the most prominent, featuring in 35% of the articles and demonstrating a dominant prevalence, particularly within Southeast Asia. Moreover, ST51 consistently appeared across human, animal, and environmental studies. Subsequently, we performed a meta-analysis, focusing on nine specific STs: ST46, ST51, ST54, ST70, ST84, ST109, ST289, ST325, and ST376. Surprisingly, no statistically significant differences in their pooled prevalence proportions were observed across these compartments for ST46, ST70, ST289, ST325, and ST376 (all p > 0.69). Conversely, the remaining STs, including ST51, ST54, ST84, and ST109, displayed notable variations in their prevalence among the three domains (all p < 0.04). Notably, the pooled prevalence of ST51 in animals and environmental samples surpassed that found in human isolates (p < 0.01).
CONCLUSION
To the best of our knowledge, this study is the first systematic review and meta-analysis to investigate the intricate relationships between STs and their sources and contributes significantly to our understanding of diversity within the One Health framework.
PubMed: 38406370
DOI: 10.14202/vetworld.2024.26-36 -
PLoS Neglected Tropical Diseases Nov 2023Neglected tropical diseases (NTDs) affect most impoverished communities in developing countries, like Myanmar in Southeast Asia. NTDs have been understudied and...
BACKGROUND
Neglected tropical diseases (NTDs) affect most impoverished communities in developing countries, like Myanmar in Southeast Asia. NTDs have been understudied and underreported in Myanmar.
METHODS
A systematic review of published and grey literature (1900-2023) on neglected tropical diseases (NTDs) in Myanmar was conducted. The literature search included five international databases: PubMed, EMBASE, Ovid Global Health, and Web of Science Core Collection and one national database: the Myanmar Central Biomedical Library (locally published papers and grey literature). The selection criteria included articles with all types of study designs of current or previous infections conducted in humans, that reported NTDs, recognised by WHO, US CDC, and listed in PLoS NTDs. We included melioidosis and rickettsioses which we consider also meet the definition of an NTD.
RESULTS
A total of 5941 records were retrieved and screened, of which, 672 (11%) met the selection criteria and were included in this review. Of the included articles, 449 (65%) were published after 2000 and 369 (55%) were from two regions (Yangon and Mandalay) of Myanmar. Of the included articles, 238 (35%) reported bacterial NTDs, 212 (32%) viral NTDs, 153 (23%) helminth NTDs, 25 (4%) protozoal NTDs and 39 (6%) reported more than one aetiology. Based on reported frequency in descending order, the bacterial NTDs were leprosy, Escherichia coli enteritis, salmonellosis, cholera, shigellosis, melioidosis, leptospirosis and rickettsioses; the viral NTDs were dengue, chikungunya and Japanese encephalitis virus (JEV) infection; the protozoal NTDs were amoebiasis, giardiasis and leishmaniasis, and the helminth NTDs were ascariasis, trichuriasis, hookworm disease, filariasis and strongyloidiasis.
CONCLUSION
This review summarises NTDs reported in Myanmar over the past 100 years. The findings suggest that most NTDs are likely to be under reported, especially from the majority of the country which is far from academic centres. Research capacity building together with strengthening of laboratory systems would lead to better understanding of the true burden of NTDs in Myanmar.
TRIAL REGISTRATION
PROSPERO registration ID: CRD42018092627.
Topics: Animals; Humans; Myanmar; Melioidosis; Ascariasis; Helminths; Neglected Diseases; Tropical Medicine; Encephalitis, Japanese; Rickettsia Infections
PubMed: 37910592
DOI: 10.1371/journal.pntd.0011706 -
Annals of Clinical Microbiology and... Aug 2023Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei. The two stages of melioidosis treatment are the intense intravenous phase and the... (Review)
Review
BACKGROUND
Melioidosis is an infectious disease caused by the bacterium Burkholderia pseudomallei. The two stages of melioidosis treatment are the intense intravenous phase and the oral eradication phase. Although co-trimoxazole has been in use for several years, the literature does not demonstrate uniformity of the drug doses, combinations, or durations suitable for the eradication phase of melioidosis. The safety profile of co-trimoxazole was not documented in the literature, nor have systematic studies of its effectiveness been done. This systematic review sought to study on the dose, duration and combination of co-trimoxazole therapy in view of clinical efficacy and safety in the eradication phase of melioidosis.
MAIN BODY
This systematic review included all of the published articles that employed co-trimoxazole in the eradication phase after 1989, including, randomized clinical trials, case-control studies, cohorts, case reports, and case series. Throughout the eradication (maintenance) phase, co-trimoxazole usage was permissible in any dose for any period. A total of 40 results were included in the analysis which contained six clinical trials, one cohort study, one Cochrane review, and thirty-two case series/case reports. Clinical and microbial relapse rates are low when co-trimoxazole is used in single therapy than in combination. There were several adverse events of co-trimoxazole, however, a quantitative analysis was not conducted as the data did not include quantitative values in most studies.
SHORT CONCLUSION
The dose of co-trimoxazole, duration of the eradication phase, and other combinations used in the treatment was varying between studies. Compared to combined therapy patients treated with co-trimoxazole alone the mortality and relapse rates were low. The lowest relapse rate and lowest mortality rate occur when using co-trimoxazole 1920 mg twice daily. The duration of therapy varies on the focus of melioidosis and it is ranged from 2 months to one year and minimum treatment duration associated with low relapse rate is 3 months. The use of co-trimoxazole over the maintenance phase of melioidosis is associated with clinical cure but has adverse effects.
Topics: Humans; Melioidosis; Cohort Studies; Administration, Intravenous; Case-Control Studies; Drug-Related Side Effects and Adverse Reactions; Trimethoprim, Sulfamethoxazole Drug Combination
PubMed: 37592339
DOI: 10.1186/s12941-023-00620-z -
PLoS Neglected Tropical Diseases Jun 2023This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of all available treatments for severe melioidosis in decreasing hospital mortality... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of all available treatments for severe melioidosis in decreasing hospital mortality and to identify eradication therapies with low disease recurrence rates and minimal risk of adverse drug events (AEs).
METHODOLOGY
Relevant randomized controlled trials (RCT) were searched from Medline and Scopus databases from their inception until July 31, 2022. RCTs that compared the efficacy between treatment regimens for severe melioidosis or eradication therapy of melioidosis, measured outcomes of in-hospital mortality, disease recurrence, drug discontinuation, or AEs, were included for review. A two-stage NMA with the surface under the cumulative ranking curve (SUCRA) was used to estimate the comparative efficacy of treatment regimens.
PRINCIPAL FINDINGS
Fourteen RCTs were included in the review. Ceftazidime plus granulocyte colony-stimulating factor (G-CSF), ceftazidime plus trimethoprim-sulfamethoxazole (TMP-SMX), and cefoperazone-sulbactam plus TMP-SMX had a lower mortality rate than other treatments and were ranked as the top three most appropriate treatments for severe melioidosis with the SUCRA of 79.7%, 66.6%, and 55.7%, respectively. However, these results were not statistically significant. For eradication therapy, treatment with doxycycline monotherapy for 20 weeks was associated with a significantly higher risk of disease recurrence than regimens containing TMP-SMX (i.e.,TMP-SMX for 20 weeks, TMP-SMX plus doxycycline plus chloramphenicol for more than 12 weeks, and TMP-SMX plus doxycycline for more than 12 weeks). According to the SUCRA, TMP-SMX for 20 weeks was ranked as the most efficacious eradication treatment (87.7%) with the lowest chance of drug discontinuation (86.4%), while TMP-SMX for 12 weeks had the lowest risk of AEs (95.6%).
CONCLUSION
Our results found a non-significant benefit of ceftazidime plus G-CSF and ceftazidime plus TMP-SMX over other treatments for severe melioidosis. TMP-SMX for 20 weeks was associated with a lower recurrence rate and minimal risk of adverse drug events compared to other eradication treatments. However, the validity of our NMA may be compromised by the limited number of included studies and discrepancies in certain study parameters. Thus, additional well-designed RCTs are needed to improve the therapy of melioidosis.
Topics: Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Melioidosis; Doxycycline; Ceftazidime; Network Meta-Analysis; Granulocyte Colony-Stimulating Factor; Drug-Related Side Effects and Adverse Reactions
PubMed: 37307278
DOI: 10.1371/journal.pntd.0011382 -
One Health (Amsterdam, Netherlands) Dec 2022Vietnam is a low- and middle-income country (LMIC), a primary food producer, and an antimicrobial resistance (AMR) hotspot. AMR is recognized as a One Health challenge... (Review)
Review
Vietnam is a low- and middle-income country (LMIC), a primary food producer, and an antimicrobial resistance (AMR) hotspot. AMR is recognized as a One Health challenge since it may transfer between humans, animals and the environment. This study aimed to apply systematic review and meta-analysis to investigate the phenotypic profiles and correlations of antimicrobial-resistant across three compartments: humans, animals and the environment in Vietnam. A total of 89 articles found in PubMed, Science Direct, and Google Scholar databases were retrieved for qualitative synthesis. and non-typhoidal (NTS) were the most common bacterial species in studies of all compartments (60/89 studies). Among antimicrobials classified as critically important, the resistance levels were observed to be highest to quinolones, 3rd generation of cephalosporins, penicillins, and aminoglycosides. Of 89 studies, 55 articles reported the resistance prevalence of and NTS in healthy humans, animals and the environment against ciprofloxacin, ceftazidime, ampicillin, gentamicin, sulfamethoxazole-trimethoprim, chloramphenicol was used for meta-analysis. The pooled prevalence was found highest in against ampicillin 84.0% (95% CI 73.0-91.0%) and sulfamethoxazole-trimethoprim 66.0% (95% CI 56.0-75.0%) while in NTS they were 34.0% (95% CI 24.0-46.0%), 33.0% (95% CI 25.0-42.0%), respectively. There were no significant differences in the pooled prevalence of and NTS to these antimicrobials across healthy humans, animals and the environment, except for ceftazidime-resistant (χ = 8.29, = 0.02), chloramphenicol-resistant (χ = 9.65, < 0.01) and chloramphenicol-resistant NTS (χ = 7.51, p = 0.02). Findings from the multiple meta-regression models indicated that the AMR levels in (β = 1.887, < 0.001) and the North (β = 0.798, = 0.047) had a higher fraction of AMR than NTS and other regions of Vietnam. The outcomes of this study play an important role as the baseline information for further investigation and follow-up intervention strategies to tackle AMR in Vietnam, and more generally, can be adapted to other LMICs.
PubMed: 36561710
DOI: 10.1016/j.onehlt.2022.100465 -
International Journal of Environmental... Nov 2022This scoping review aims to provide a comprehensive overview of human melioidosis in Southeast Asia as well as to highlight knowledge gaps in the prevalence and risk... (Review)
Review
This scoping review aims to provide a comprehensive overview of human melioidosis in Southeast Asia as well as to highlight knowledge gaps in the prevalence and risk factors of this life-threatening disease using available evidence-based data for better diagnosis and treatment. Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was used as the guideline for this review. The literature search was conducted on 23 March 2022 through two electronic databases (PubMed and Scopus) using lists of keywords referring to the Medical Subject Headings (MeSH) thesaurus. A total of 38 articles related to human melioidosis were included from 645 screened articles. These studies were carried out between 1986 and 2019 in six Southeast Asian countries: Thailand, Cambodia, Malaysia, Myanmar, Singapore, and Vietnam. Melioidosis has been reported with a high disease prevalence among high-risk populations. Studies in Thailand (48.0%) and Cambodia (74.4%) revealed disease prevalence in patients with septic arthritis and children with suppurative parotitis, respectively. Other studies in Thailand (63.5%) and Malaysia (54.4% and 65.7%) showed a high seroprevalence of melioidosis among Tsunami survivors and military personnel, respectively. Additionally, this review documented soil and water exposure, diabetes mellitus, chronic renal failure, thalassemia, and children under the age of 15 as the main risk factors for melioidosis. Human melioidosis is currently under-reported in Southeast Asia and its true prevalence is unknown.
Topics: Child; Humans; Seroepidemiologic Studies; Asia, Southeastern; Melioidosis; Malaysia; Risk Factors
PubMed: 36497549
DOI: 10.3390/ijerph192315475 -
Scientific Reports Oct 2022Malaria and pneumonia are the leading causes of childhood mortality in children under 5 years of age. Nevertheless, the proportions and deaths of malaria co-infection... (Meta-Analysis)
Meta-Analysis
Malaria and pneumonia are the leading causes of childhood mortality in children under 5 years of age. Nevertheless, the proportions and deaths of malaria co-infection among patients with severe pneumonia, particularly in children under 5 years of age, and characteristics of co-infection remain poorly explored. Hence, the present study aimed to collate the evidence of malaria among patients with severe pneumonia, severe pneumonia among patients with malaria, and the proportion of deaths among patients with co-infections. Potentially relevant studies were searched in six databases including PubMed, Scopus, Web of Science, Embase, Ovid, and MEDLINE to identify studies on malaria and severe pneumonia co-infections that were published until 21 July 2022 with a restriction for the non-English language but no restriction for the publication year. The quality of the included studies was determined using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The pooled estimates, including the pooled proportion of malaria among patients with severe pneumonia, and the proportion of deaths among patients with co-infections, were estimated by the random-effects model. Of the 4094 studies examined, 11 studies that met the eligibility criteria were included in the review. Meta-analysis results showed that the proportion of malaria (2162 cases) among patients with severe pneumonia (9738 cases) was 19% (95% CI 12-26%, I: 98.79%, 11 studies). The proportion of severe pneumonia (546 cases) among patients with malaria (10,325 cases) was 20% (95% CI 0-40%, I: 99.48%, 4 studies). The proportion of deaths among patients with co-infection was 13% (95% CI 2-23%, I: 85.1%, 3 studies). In conclusion, nearly one-fifth of patients with severe pneumonia have malaria, one-fifth of patients with malaria have severe pneumonia, and about 13% of co-infections lead to deaths. This information raised the clinical importance of diagnosis and management of concurrent infections. Patients with severe pneumonia should be investigated for malaria, and vice versa. Detection of co-infections might provide the information to inform the physician to manage and cure co-infected patients who live in areas where both diseases were endemic.
Topics: Child; Child, Preschool; Coinfection; Humans; Malaria; Pneumonia
PubMed: 36243777
DOI: 10.1038/s41598-022-22151-x -
Tropical Medicine and Infectious Disease Sep 2022Comprehensive data on the relative contribution of bacteremia to malaria outcomes in a large number of participants are lacking. Therefore, we collated data on the... (Review)
Review
Comprehensive data on the relative contribution of bacteremia to malaria outcomes in a large number of participants are lacking. Therefore, we collated data on the co-existence of malaria and bacteremia in the literature to provide evidence-based information for future studies investigating the clinical significance of this co-infection. The study protocol was registered at PROSPERO (ID: CRD42021287971). Relevant studies were identified from PubMed, Web of Science, and Scopus. The pooled prevalence of (1) co-existent malaria and bacteremia among febrile patients, (2) the pooled prevalence of bacteremia among patients with malaria, (3) the probability of co-infection, and (4) the pooled prevalence of deaths were estimated by the random-effects model. Fifty-one studies involving 1583 cases of co-infection were included in the analyses. Typhoidal spp. and were the most common Gram-negative and Gram-positive bacteria, respectively. The prevalence of co-existent malaria and bacteremia among febrile patients was 1.9% (95% confidence interval (CI) = 1.5-2.2%, = 96.64%, 31 studies). The prevalence of bacteremia among patients with malaria was 7.6% (95% CI = 6.7-8.7%, and = 96.68%, 43 studies). Co-infection by malaria and bacteremia did not occur by chance ( = 0.024, odds ratio = 0.64, 95% CI = 0.43-0.94, and = 95.7%, 29 studies). The pooled prevalence of deaths among patients with co-infection was 15.0% (95% CI = 8.0-23.0%, = 75.23%, 8 studies). On the basis of this study, we conclude that although the prevalence of co-infection was low, patients with malaria appear at greater risk of bacteremia and death.
PubMed: 36136654
DOI: 10.3390/tropicalmed7090243 -
Pathogens (Basel, Switzerland) Jan 2022Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium . Globally, more than 35,000 human melioidosis cases have been reported...
Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium . Globally, more than 35,000 human melioidosis cases have been reported since 1911. Soil acts as the natural reservoir of . Humans may become infected this pathogen through direct contact with contaminated soil and/or water. Melioidosis commonly occurs in patients with diabetes mellitus, who increase the occurrence of melioidosis in a population. We carried out a systematic review and meta-analysis to investigate to what extent diabetes mellitus affects the patient in getting melioidosis. We selected 39 articles for meta-analysis. This extensive review also provided the latest updates on the global distribution, clinical manifestation, preexisting underlying diseases, and risk factors of melioidosis. Diabetes mellitus was identified as the predominant predisposing factor for melioidosis in humans. The overall proportion of melioidosis cases having diabetes was 45.68% (95% CI: 44.8-46.57, < 0.001). Patients with diabetes mellitus were three times more likely to develop melioidosis than patients with no diabetes (RR 3.40, 95% CI: 2.92-3.87, < 0.001). The other potential risk factors included old age, exposure to soil and water, preexisting underlying diseases (chronic kidney disease, lung disease, heart disease, and thalassemia), and agricultural activities. Evidence-based clinical practice guidelines for melioidosis in patients with diabetes mellitus may be developed and shared with healthcare professionals of melioidosis endemic countries to reduce morbidity.
PubMed: 35215093
DOI: 10.3390/pathogens11020149