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Seminars in Respiratory Infections Dec 2002Burkholderia cepacia has emerged as an important pathogen in patients with cystic fibrosis (CF) undergoing lung transplantation. Taxonomic analyses have divided B.... (Review)
Review
Burkholderia cepacia has emerged as an important pathogen in patients with cystic fibrosis (CF) undergoing lung transplantation. Taxonomic analyses have divided B. cepacia into 7 closely related species called genomovars. The prevalence of B. cepacia infection ranges from 2% to 13% in CF patients with genomovar III being most prevalent. Risk factors for the acquisition of B. cepacia include greater severity of underlying CF, increasing age, having a sibling colonized with B. cepacia, and previous hospitalizations. One-year survival in patients with CF undergoing lung transplantation usually have been reported to be less than 70%. The antimicrobial resistance pattern of B. cepacia has correlated with inconsistent effect on survival. Presence of genomovar III also has been linked with survival of B. cepacia-infected patients; the survival rates were inferior for genomovar III as compared with non-genomovar III patients. Standard infection control techniques including isolation of both colonized and noncolonized individuals with frequent sputum culture have been recommended to prevent CF patients from acquiring B. cepacia infection. B. cepacia is inherently resistant to antipseudomonal antibiotics, colistin, and polymyxin. The combination of 2 or more antibiotics usually is recommended for the treatment of B. cepacia infections. Studies delineating the epidemiology and influence of B. cepacia infection on lung transplantation are warranted. This is a US government work. There are no restrictions on its use.
Topics: Burkholderia Infections; Burkholderia cepacia; Humans; Lung Transplantation
PubMed: 12497545
DOI: 10.1053/srin.2002.36443 -
The European Respiratory Journal Feb 2001Burkholderia cepacia is a plant phytogen and is known as a hardy and versatile organism. Over the past two decades it has emerged as a pathogen in the cystic fibrosis... (Review)
Review
Burkholderia cepacia is a plant phytogen and is known as a hardy and versatile organism. Over the past two decades it has emerged as a pathogen in the cystic fibrosis (CF) community, with devastating effects. Pulmonary colonisation can lead to an accelerated decline in lung function. In some cases, it causes a rapid and progressive pneumonic illness termed "cepacia syndrome", which is untreatable and fatal. B. cepacia is inherently resistant to multiple antibiotics and highly transmissible and virulent strains have been identified. CF patients colonised with the organism have to be segregated from their peers to try to prevent cross-infection. However, the pathogenicity of B. cepacia is not limited to CF. Other groups, such as individuals with chronic granulomatous disease and immunocompromised patients are vulnerable and it has caused disease in healthy individuals. However, the agricultural and petrochemical industries are attempting to exploit properties of B. cepacia for use as a biopesticide and biodegradation agent. This article provides an up to date review of clinically based literature on the Burkholderia cepacia complex, highlighting clinical management issues for both cystic fibrosis and non-cystic fibrosis patients. The article also addresses the potential conflict between medicine and agriculture on plans to reintroduce strains of Burkholderia cepacia back into the environment.
Topics: Burkholderia Infections; Burkholderia cepacia; Cross Infection; Cystic Fibrosis; Drug Resistance, Microbial; Humans; Lung Diseases; Pest Control, Biological; Virulence
PubMed: 11334134
DOI: 10.1183/09031936.01.17202950 -
Paediatric Respiratory Reviews Sep 2002Burkholderia cepacia is an important opportunistic pathogen in certain compromised hosts, particularly those with either cystic fibrosis (CF) or chronic granulomatous... (Review)
Review
Burkholderia cepacia is an important opportunistic pathogen in certain compromised hosts, particularly those with either cystic fibrosis (CF) or chronic granulomatous disease. The "family" of bacteria known as B. cepacia is highly heterogeneous and is composed of at least nine discrete species or genomovars, constituting the B. cepacia complex. Bacteria from the B. cepacia complex are particularly virulent in susceptible hosts, often causing necrotising invasive infection and death. Whereas the microbial determinants of virulence in B. cepacia complex are currently not defined, the bacteria appear to have features facilitating survival within host cells. Burkholderia cepacia is highly resistant to antibiotics and to neutrophil-mediated non-oxidative killing; infection should be treated with combination antimicrobial therapy. Burkholderia cepacia can spread from one CF patient to another. Transmission appears to be facilitated by close personal contact and by certain bacterial factors.
Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Biofilms; Burkholderia Infections; Burkholderia cepacia; Cystic Fibrosis; Drug Therapy, Combination; Granulomatous Disease, Chronic; Humans; Virulence
PubMed: 12376059
DOI: 10.1016/s1526-0542(02)00185-9 -
Journal of Medical Microbiology Dec 1996The increasing challenge posed by multiresistant saprophytes in medical microbiology is strikingly demonstrated by the emergence of Burkholderia (formerly Pseudomonas)... (Review)
Review
The increasing challenge posed by multiresistant saprophytes in medical microbiology is strikingly demonstrated by the emergence of Burkholderia (formerly Pseudomonas) cepacia as an opportunist pathogen in immunocompromised patients, particularly individuals with chronic granulomatous disease and cystic fibrosis (CF). Best known previously as a phytopathogen and the cause of soft rot of onions, B. cepacia presents three major problems for the CF community: innate multiresistance to antimicrobial agents; person-to-person transmission of epidemic strains through nosocomial or social contacts; and 'cepacia syndrome', a fulminating fatal pneumonia, sometimes associated with septicaemia, that occurs in approximately 20% of colonised patients, including those with previously mild disease. Accumulated evidence to dispel earlier suggestions that the organism is avirulent and merely a marker of existing lung disease includes: case-controlled studies in CF patients; reports of serious infections in non-CF patients; in-vitro and in-vivo evidence that B. cepacia induces production of pro-inflammatory markers, including the major cytokine TNFalpha; and histopathological evidence that exposure of transgenic CF mice to B. cepacia results in pneumonia. By the early 1990s, the use of selective culture media and DNA-based bacterial fingerprinting confirmed suspicions of epidemic person-to-person spread of B. cepacia. This evidence provided scientific justification for draconian and controversial measures for infection control, in particular, segregation of B. cepacia-colonised patients during treatment at CF centres and their exclusion from social gatherings and national conferences. Recently, molecular analyses of type strains and clinical isolates have revealed that isolates identified previously as B. cepacia belong to at least three distinct species and have increased concern regarding the reliability of current laboratory detection and identification systems. Clarification of the taxonomy of B. cepacia-like organisms and the pathogenic potential of environmental isolates remains a high priority, particularly when the organism's antifungal and degradative properties have created interest in its potential use as a biological control agent to improve crop yields and its use for the bioremediation of contaminated soils.
Topics: Allium; Animals; Burkholderia Infections; Burkholderia cepacia; Cross Infection; Cystic Fibrosis; Humans; Mice; Opportunistic Infections; Pest Control, Biological; Plant Diseases; Pneumonia, Bacterial
PubMed: 8958242
DOI: 10.1099/00222615-45-6-395 -
The Pediatric Infectious Disease Journal Sep 1995
Review
Topics: Anti-Bacterial Agents; Burkholderia Infections; Burkholderia cepacia; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Sepsis
PubMed: 8559639
DOI: 10.1097/00006454-199509000-00021 -
Clinics in Chest Medicine Sep 1998Although Burkholderia cepacia colonizes a relatively small proportion of individuals with cystic fibrosis (CF), it is associated with significant morbidity and... (Review)
Review
Although Burkholderia cepacia colonizes a relatively small proportion of individuals with cystic fibrosis (CF), it is associated with significant morbidity and mortality, and has had a profound impact on infection control practices. This article reviews the current understanding of the epidemiology of B. cepacia infection, describes important recent developments in the microbiology and taxonomy of this species, and presents issues that remain obstacles to defining the optimal management of B. cepacia infection in CF.
Topics: Burkholderia Infections; Burkholderia cepacia; Cystic Fibrosis; Humans; Lung Transplantation; Sputum; Virulence
PubMed: 9759550
DOI: 10.1016/s0272-5231(05)70094-0 -
Transplant Infectious Disease : An... Sep 2001Previous studies have indicated that pulmonary infection with Burkholderia cepacia is associated with poor clinical outcome after lung transplantation in cystic fibrosis... (Review)
Review
Previous studies have indicated that pulmonary infection with Burkholderia cepacia is associated with poor clinical outcome after lung transplantation in cystic fibrosis (CF). Many treatment centers consider B. cepacia infection an absolute contraindication to lung transplantation. However, the B. cepacia complex actually consists of several closely related bacterial species. Although each of these has been isolated from CF sputum culture, certain species are much more frequently recovered than others, and it is not yet clear whether all species have the same potential for virulence in CF. Additional study is needed to better define the relative risks associated with each species of the B. cepacia complex.
Topics: Burkholderia Infections; Burkholderia cepacia; Contraindications; Cystic Fibrosis; Humans; Lung Transplantation; Risk Factors; Treatment Outcome; Virulence
PubMed: 11493397
DOI: 10.1034/j.1399-3062.2001.003003149.x -
Current Opinion in Pulmonary Medicine Nov 1998Much has been learned during the past 2 years about the microbiology and taxonomy of Burkholderia cepacia. Several distinct species have been identified in what is now... (Review)
Review
Much has been learned during the past 2 years about the microbiology and taxonomy of Burkholderia cepacia. Several distinct species have been identified in what is now referred to as the B. cepacia complex. Preliminary studies indicate that certain of these species are more likely to colonize and cause severe pulmonary infection in persons with cystic fibrosis. Ongoing investigations will expand these findings and have the potential to modify current infection control policies. The commercial use of B. cepacia as an antifungal biopesticide and in bioremediation has attracted increasing attention from industry recently and raises concerns within the cystic fibrosis community. Consensus regarding the potential threat of such uses to cystic fibrosis patients is being sought by governmental agencies and agricultural and biomedical researchers.
Topics: Anti-Bacterial Agents; Burkholderia Infections; Burkholderia cepacia; Comorbidity; Cystic Fibrosis; Female; Humans; Incidence; Infection Control; Male; Microbial Sensitivity Tests; Opportunistic Infections; Prognosis; Risk Factors
PubMed: 10813212
DOI: 10.1097/00063198-199811000-00005 -
Journal of Medical Microbiology Jul 2002The word 'complex' has several meanings and synonyms such as composite, obsession, heterogeneous, mixed and network, can all be used in its place. Our obsession with... (Review)
Review
The word 'complex' has several meanings and synonyms such as composite, obsession, heterogeneous, mixed and network, can all be used in its place. Our obsession with bacteria from the Burkholderia cepacia complex started in the early 1990s. In less than 10 years, we have seen the status of this bacterium move from: (i) a lesser known pseudomonad opportunist pathogen, (ii) to devastating infections transmitted between patients with cystic fibrosis (CF), (iii) through divisions into several new species, and (iv) now on towards one of the largest gram-negative genome sequencing projects. For microbiologists, hospital infection control officers, caregivers, and most of all the CF community, the changes in our understanding of the taxonomy, epidemiology and pathogenesis of the bacterium 'B. cepacia' are complex.
Topics: Burkholderia Infections; Burkholderia cepacia; Cross Infection; Cystic Fibrosis; Genome, Bacterial; Humans; Patient Care Planning; Phylogeny; Virulence
PubMed: 12132768
DOI: 10.1099/0022-1317-51-7-533 -
Research in Microbiology May 2004Quorum sensing is a cell-density-dependent regulatory mechanism which, in Gram-negative bacteria, usually involves the production and detection of N-acyl homoserine... (Review)
Review
Quorum sensing is a cell-density-dependent regulatory mechanism which, in Gram-negative bacteria, usually involves the production and detection of N-acyl homoserine lactones (HSLs). In the last four years HSL-dependent quorum sensing has been identified in members of the Burkholderia cepacia complex, and this mini-review summarizes initial findings and discusses future perspectives.
Topics: 4-Butyrolactone; Bacterial Proteins; Burkholderia cepacia; Signal Transduction
PubMed: 15142620
DOI: 10.1016/j.resmic.2004.01.006