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Australian Journal of General Practice May 2019Endemic to soils of Northern Australia, Burkholderia pseudomallei is the Gram-negative pathogen responsible for melioidosis, which causes a clinical spectrum ranging... (Review)
Review
BACKGROUND
Endemic to soils of Northern Australia, Burkholderia pseudomallei is the Gram-negative pathogen responsible for melioidosis, which causes a clinical spectrum ranging from pneumonia and/or cutaneous infection to disseminated disease with fulminant septicaemia. Incident cases peak after monsoonal rains, particularly in individuals with immune dysfunction. Early diagnosis of melioidosis is challenging for clinicians, given its ability to mimic many other diseases and high clinical (associated mortality) impact.
OBJECTIVES
The aim of this paper is to provide general practitioners with an overview of melioidosis, covering epidemiology, risk factors for infection, clinical disease spectrum, diagnostic techniques and an approach to management, including public health aspects.
DISCUSSION
Primary care physicians play a key role in early disease recognition, initial patient stabilisation, request of appropriate clinical samples (particularly blood cultures) and prompt commencement of efficacious antibiotics. Patient education is paramount during high-risk periods, chiefly for patients with diabetes and/or those who engage in hazardous alcohol use, living in endemic areas of Australia.
Topics: Adult; Anti-Bacterial Agents; Australia; Burkholderia pseudomallei; Female; Humans; Male; Melioidosis; Middle Aged; Risk Factors
PubMed: 31129946
DOI: 10.31128/AJGP-04-18-4558 -
Clinical Microbiology Reviews Mar 2020The causative agent of melioidosis, , a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of... (Review)
Review
The causative agent of melioidosis, , a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.
Topics: Africa; Americas; Animals; Anti-Bacterial Agents; Asia, Southeastern; Bacteremia; Burkholderia pseudomallei; Humans; Melioidosis; Microbiological Techniques; Molecular Diagnostic Techniques; Oceania; Risk Factors; Virulence
PubMed: 32161067
DOI: 10.1128/CMR.00006-19 -
Clinical Medicine (London, England) Jan 2022Melioidosis is an infectious disease with high mortality and a wide spectrum of clinical manifestations. Successful treatment requires lengthy antibiotic regimens,...
Melioidosis is an infectious disease with high mortality and a wide spectrum of clinical manifestations. Successful treatment requires lengthy antibiotic regimens, making microbiological diagnosis crucial. In this article, we briefly review the diagnosis and management of melioidosis from the clinician's viewpoint.
Topics: Anti-Bacterial Agents; Burkholderia pseudomallei; Humans; Melioidosis
PubMed: 35078788
DOI: 10.7861/clinmed.2022-0014 -
Emerging Infectious Diseases Jan 2018In contrast with northern Australia and Thailand, in Singapore the incidence of melioidosis and co-incidence of melioidosis and pneumonia have declined. Burkholderia...
In contrast with northern Australia and Thailand, in Singapore the incidence of melioidosis and co-incidence of melioidosis and pneumonia have declined. Burkholderia pseudomallei deep abscesses increased 20.4% during 2003-2014. These trends could not be explained by the environmental and climatic factors conventionally ascribed to melioidosis.
Topics: Adult; Aged; Aged, 80 and over; Burkholderia pseudomallei; Climate; Environment; Female; Humans; Incidence; Male; Melioidosis; Middle Aged; Singapore; Young Adult
PubMed: 29260679
DOI: 10.3201/eid2401.161449 -
The Indian Journal of Medical Research Apr 2019
Topics: Burkholderia pseudomallei; Female; Gram-Negative Bacteria; Humans; Liver; Magnetic Resonance Imaging; Melioidosis; Spleen; Young Adult
PubMed: 31411183
DOI: 10.4103/ijmr.IJMR_2018_17 -
Chest Nov 1995Melioidosis is the name given to all diseases caused by the bacterium Pseudomonas pseudomallei. Melioidosis is a tropical disease and prevails in parts of Southeast... (Review)
Review
Melioidosis is the name given to all diseases caused by the bacterium Pseudomonas pseudomallei. Melioidosis is a tropical disease and prevails in parts of Southeast Asia, northern Australia, and Central and South America. However, in recent years, cases of melioidosis have been reported in the United States and other areas. The organism can infect any organ system, although the lung is the most common organ affected. Pulmonary melioidosis presents either as an acute fulminant pneumonia or as an indolent cavitary disease. In northeastern Thailand, the incidence of P pseudomallei infection is extremely high with significant mortality. One of the key problems with treating melioidosis is its recalcitrance to therapy and high relapse rate. In addition, this Gram-negative rod is resistant to aminoglycosides. In nonendemic regions, patients with melioidosis more typically present with reactivation disease occurring months to years after initial exposure to the organism. The pulmonary disease is mainly in the apices and resembles tuberculosis. With the increasing mobility of people throughout the world and the influx of immigrants from endemic to nonendemic areas, it is important that clinicians be aware of this disease. This article will review the epidemiology, clinical presentations, diagnosis, and treatment of pulmonary melioidosis.
Topics: Burkholderia pseudomallei; Humans; Lung Diseases; Melioidosis
PubMed: 7587451
DOI: 10.1378/chest.108.5.1420 -
Current Opinion in Infectious Diseases Jun 2022Melioidosis, caused by the soil-dwelling bacterium Burkholderia pseudomallei, is a tropical infection associated with high morbidity and mortality. This review... (Review)
Review
PURPOSE OF REVIEW
Melioidosis, caused by the soil-dwelling bacterium Burkholderia pseudomallei, is a tropical infection associated with high morbidity and mortality. This review summarizes current insights into melioidosis' endemicity, focusing on epidemiological transitions, zoonosis, and climate change.
RECENT FINDINGS
Estimates of the global burden of melioidosis affirm the significance of hot-spots in Australia and Thailand. However, it also highlights the paucity of systematic data from South Asia, The Americas, and Africa. Globally, the growing incidence of diabetes, chronic renal and (alcoholic) liver diseases further increase the susceptibility of individuals to B. pseudomallei infection. Recent outbreaks in nonendemic regions have further exposed the hazard from the trade of animals and products as potential reservoirs for B. pseudomallei. Lastly, global warming will increase precipitation, severe weather events, soil salinity and anthrosol, all associated with the occurrence of B. pseudomallei.
SUMMARY
Epidemiological transitions, zoonotic hazards, and climate change are all contributing to the emergence of novel melioidosis-endemic areas. The adoption of the One Health approach involving multidisciplinary collaboration is important in unraveling the real incidence of B. pseudomallei, as well as reducing the spread and associated mortality.
Topics: Animals; Burkholderia pseudomallei; Climate Change; Humans; Melioidosis; Soil; Soil Microbiology; Zoonoses
PubMed: 35665713
DOI: 10.1097/QCO.0000000000000827 -
PLoS Neglected Tropical Diseases May 2017This review briefly summarizes the geographical distribution and clinical impact of melioidosis, especially in the tropics. Burkholderia pseudomallei (a gram-negative... (Review)
Review
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.
Topics: Animals; Anti-Bacterial Agents; Australia; Bacterial Vaccines; Biological Warfare Agents; Burkholderia pseudomallei; Chronic Disease; Drug Resistance, Bacterial; Humans; Malaysia; Melioidosis; Mice; Public Health; Singapore; Soil Microbiology; Thailand; Vietnam; Virulence; Water Microbiology
PubMed: 28493905
DOI: 10.1371/journal.pntd.0004738 -
The American Journal of Tropical... Jun 2023
Topics: Humans; Burkholderia pseudomallei; Melioidosis
PubMed: 37160279
DOI: 10.4269/ajtmh.23-0223 -
International Journal of Antimicrobial... Apr 2014Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment... (Review)
Review
Melioidosis, infection with Burkholderia pseudomallei, is being recognised with increasing frequency and is probably more common than currently appreciated. Treatment recommendations are based on a series of clinical trials conducted in Thailand over the past 25 years. Treatment is usually divided into two phases: in the first, or acute phase, parenteral drugs are given for ≥10 days with the aim of preventing death from overwhelming sepsis; in the second, or eradication phase, oral drugs are given, usually to complete a total of 20 weeks, with the aim of preventing relapse. Specific treatment for individual patients needs to be tailored according to clinical manifestations and response, and there remain many unanswered questions. Some patients with very mild infections can probably be cured by oral agents alone. Ceftazidime is the mainstay of acute-phase treatment, with carbapenems reserved for severe infections or treatment failures and amoxicillin/clavulanic acid (co-amoxiclav) as second-line therapy. Trimethoprim/sulfamethoxazole (co-trimoxazole) is preferred for the eradication phase, with the alternative of co-amoxiclav. In addition, the best available supportive care is needed, along with drainage of abscesses whenever possible. Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade. Unfortunately there is no likelihood of any new or cheaper options becoming available in the immediate future. Recommendations for prophylaxis following exposure to B. pseudomallei have been made, but the evidence suggests that they would probably only delay rather than prevent the development of infection.
Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Burkholderia pseudomallei; Carbapenems; Ceftazidime; Clavulanic Acid; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Humans; Infusions, Parenteral; Melioidosis; Sulfamethoxazole; Trimethoprim
PubMed: 24613038
DOI: 10.1016/j.ijantimicag.2014.01.005