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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 -
Radiologia 2022Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from... (Review)
Review
Melioidosis is an endemic disease in Southeast Asia and Oceania caused by the gram-negative bacillus Burkholderia pseudomallei. We studied 15 adult patients from Colombia with microbiologically diagnosed pulmonary melioidosis. We reviewed 15 chest X-rays and 10 chest computed tomography (CT) studies. Of the 15 patients, 87% met the criteria for acute infection and 13% met the criteria for chronic infection. The most common findings on chest X-rays were consolidation (86%), nodules (26%), and cavitation (20%). On CT studies, consolidation and nodules were observed in 90% of cases; the areas of consolidation were predominantly located in the basal and central zones in 60%. Areas of cavitation were observed in 50%, pleural effusion in 60%, and mediastinal lymph nodes in 30%. In patients with acute pulmonary melioidosis (n=8), the findings observed were nodules (100%), mixed pattern with nodules and consolidation (87%), pleural effusion (88%), and mediastinal lymph nodes (25%). The two patients with chronic pulmonary melioidosis both had cavitation. Acute lung infection with B. Pseudomallei has radiologic manifestations similar to those of pneumonia due to other causes. In areas where the disease is endemic, it is essential to include acute melioidosis in the differential diagnosis of pulmonary nodules and chronic melioidosis in the differential diagnosis of cavitated chronic lung lesions.
Topics: Adult; Burkholderia pseudomallei; Humans; Lung Diseases; Melioidosis; Pleural Effusion; Pneumonia; Tuberculosis, Pleural
PubMed: 36243448
DOI: 10.1016/j.rxeng.2022.09.002 -
Clinical Microbiology Reviews Jan 1991For nearly 80 years clinical melioidosis has been considered a rare disease. This bacterial infection is caused by Pseudomonas pseudomallei, a saprophyte found in soil... (Review)
Review
For nearly 80 years clinical melioidosis has been considered a rare disease. This bacterial infection is caused by Pseudomonas pseudomallei, a saprophyte found in soil and surface water of endemic areas. Consequently, those who have most contact with soil, the rural poor, are likely to be at greatest risk of infection. Since the diversity of clinical manifestations necessitates the isolation and identification of the causative organism for a definitive diagnosis of melioidosis and the population at greatest risk within endemic areas rarely have access to an appropriate level of health care, the disease has probably been underrecognized. Melioidosis is now known to be an important cause of human morbidity and mortality in Thailand, and this may be true throughout Southeast Asia, which is usually regarded as the main endemic area for the disease. In Australia, melioidosis causes a smaller number of human infections, while disease among livestock has important economic and possible public health implications. Sporadic reports of the infection indicate its presence in several other tropical regions: in the Indian subcontinent, Africa, and Central and South America. Clinical melioidosis may be highly prevalent in these areas, but underdiagnosed as a result of a lack of awareness of the clinical and microbiological features of the disease, or simply because of a lack of health care facilities. Furthermore, during the last two decades the importation and transmission of melioidosis within nontropical zones have been documented. The causative organism is not difficult to grow, and modern antibiotics have improved disease prognosis. Further studies are needed to determine the true worldwide distribution and prevalence of melioidosis so that improved therapeutic and preventive measures can be developed and applied.
Topics: Global Health; Humans; Melioidosis
PubMed: 2004347
DOI: 10.1128/CMR.4.1.52 -
British Medical Journal Apr 1959
Topics: Melioidosis
PubMed: 13638596
DOI: 10.1136/bmj.1.5127.949 -
Expert Review of Anti-infective Therapy Dec 2014Burkholderia pseudomallei is a gram-negative bacterium that causes melioidosis, a multifaceted disease that is highly endemic in southeast Asia and northern Australia.... (Review)
Review
Burkholderia pseudomallei is a gram-negative bacterium that causes melioidosis, a multifaceted disease that is highly endemic in southeast Asia and northern Australia. This facultative intracellular pathogen possesses a large genome that encodes a wide array of virulence factors that promote survival in vivo by manipulating host cell processes and disarming elements of the host immune system. Antigens and systems that play key roles in B. pseudomallei virulence include capsular polysaccharide, lipopolysaccharide, adhesins, specialized secretion systems, actin-based motility and various secreted factors. This review provides an overview of the current and steadily expanding knowledge regarding the molecular mechanisms used by this organism to survive within a host and their contribution to the pathogenesis of melioidosis.
Topics: Bacterial Adhesion; Bacterial Secretion Systems; Burkholderia pseudomallei; Drug Resistance, Bacterial; Host-Pathogen Interactions; Humans; Melioidosis; Virulence Factors
PubMed: 25312349
DOI: 10.1586/14787210.2014.970634 -
The Medical Journal of Malaysia Dec 2009Melioidosis is an important cause of sepsis in the tropics, is caused by an environmental saprophyte--B. pseudomallei. It affects mainly adults with underlying... (Review)
Review
Melioidosis is an important cause of sepsis in the tropics, is caused by an environmental saprophyte--B. pseudomallei. It affects mainly adults with underlying predisposing condition such as diabetes. The range of symptoms varies from benign and localized abscesses, to severe community-acquired pneumonia to acute fulminating septicaemia with multiple abscesses often leading to death. B. pseudomallei is an intracellular pathogen and some of the virulence mechanisms that govern the complex interaction between the organism and the host have been elucidated. Isolation of B. pseudomallei from bodily fluids of patients remains the "gold standard" in diagnosis but a sensitive and specific serological test can lend support to the diagnosis of melioidosis. Ceftazidime is the treatment of choice for severe melioidosis, but the response is slow. Maintenance or eradication therapy for a prolonged period is necessary to prevent relapse and recurrence. Monitoring IgG antibody levels may be useful as a guideline to determine the duration of eradication therapy.
Topics: Burkholderia pseudomallei; Ecology; Humans; Malaysia; Melioidosis; Recurrence; Risk Factors
PubMed: 20954549
DOI: No ID Found -
Expert Opinion on Biological Therapy Dec 2019: Two important pathogenic species within the genus , namely () and (), are the causative agents of the life-threatening diseases melioidosis and glanders,... (Review)
Review
: Two important pathogenic species within the genus , namely () and (), are the causative agents of the life-threatening diseases melioidosis and glanders, respectively. Due to their high mortality rate and potential for aerosolization, they have gained interest as potential biothreat agents and are classified as Tier 1 Select Agents.: The manuscript provides an overview of the literature covering the efforts taken in the last 10 years to develop new therapeutics measures against both and , with attention on novel therapeutic agents.: As a result of the complicated antibiotic regimens necessary to treat these infections, development of novel therapeutics is needed to treat both diseases. In recent years, the understanding of the pathogenesis of has improved significantly and so have the efforts to develop novel therapeutic agents with high efficacy, either alone, or in combination with conventional antibiotics.
Topics: Animals; Biological Products; Burkholderia mallei; Burkholderia pseudomallei; Glanders; Humans; Melioidosis
PubMed: 31590578
DOI: 10.1080/14712598.2019.1677602 -
Journal of Nephrology Dec 2021Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described. (Observational Study)
Observational Study
BACKGROUND
Melioidosis is a potentially fatal tropical infection caused by Burkholderia pseudomallei. Kidney involvement is possible, but has not been well described.
AIM
This study aimed to assess the risk of acute kidney injury (AKI) and its outcomes in melioidosis.
METHODS
A retrospective observational cohort study was performed. Case records of consecutive patients with culture-confirmed melioidosis, observed from January 1st, 2012 through December 31st, 2019 were analysed for demographics, presence of comorbidities, including chronic kidney disease (CKD), diabetes mellitus (DM), and presence of bacteraemia, sepsis, shock, AKI, and urinary abnormalities. The outcomes we studied were: mortality, need for hospitalisation in an intensive care unit (ICU), duration of hospitalization. We then compared the outcomes between patients with and without AKI.
RESULTS
Of 164 patients, AKI was observed in 59 (35.98%), and haemodialysis was required in eight (13.56%). In the univariate analysis, AKI was associated with CKD (OR 5.83; CI 1.140-29.90, P = 0.03), bacteraemia (OR 8.82; CI 3.67-21.22, P < 0.001) and shock (OR 3.75; CI 1.63-8.65, P = 0.04). In the multivariate analysis, CKD (adjusted OR 10.68; 95% CI 1.66-68.77; P = 0.013) and bacteraemia (adjusted OR 8.22; 95% CI 3.15-21.47, P < 0.001) predicted AKI. AKI was associated with a greater need for ICU care (37.3% vs. 13.3%, P = 0.001), and mortality (32.2% vs. 5.7%, P < 0.001). Mortality increased with increasing AKI stage, i.e. stage 1 (OR 3.52, CI 0.9-13.7, P = 0.07), stage 2 (OR 6.79, CI 1.92-24, P = 0.002) and stage 3 (OR 17.8, CI 5.05-62.8, P < 0.001), however kidney function recovered in survivors. Hyponatremia was observed in 138 patients (84.15%) and isolated urinary abnormalities were seen in 31(18.9%).
CONCLUSIONS
AKI is frequent in melioidosis and occurred in 35.9% of our cases. Hyponatremia is likewise common. AKI was predicted by bacteraemia and CKD, and was associated with higher mortality and need for ICU care; however kidney function recovery was observed in survivors.
Topics: Acute Kidney Injury; Humans; Intensive Care Units; Melioidosis; Prognosis; Retrospective Studies; Risk Factors
PubMed: 33515381
DOI: 10.1007/s40620-021-00970-x -
Emerging Infectious Diseases Feb 2015Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for...
Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions.
Topics: Humans; Melioidosis; Practice Guidelines as Topic
PubMed: 25626057
DOI: 10.3201/eid2102.141045 -
Rural and Remote Health 2014The disease melioidosis, caused by the bacterium Burkholderia pseudomallei, remains an important and sometimes neglected cause of disease in tropical regions of... (Review)
Review
The disease melioidosis, caused by the bacterium Burkholderia pseudomallei, remains an important and sometimes neglected cause of disease in tropical regions of Australia. Infection may present in myriad ways, and diagnosis often requires consideration of this organism prior to culture. Laboratory identification of B. pseudomallei requires specialised testing beyond that available in many routine diagnostic microbiology laboratories. For this reason, cases outside of the traditional endemic zone, often occurring years after initial exposure to the organism, may remain undiagnosed or are delayed in diagnosis. Furthermore, the high levels of intrinsic antimicrobial resistance associated with B. pseudomallei often render empirical therapies ineffective. Health professionals, particularly those in rural and remote areas of Australia, must consider melioidosis in their differential diagnoses and remain abreast of advances in the field of this important emerging disease.
Topics: Anti-Bacterial Agents; Australia; Burkholderia pseudomallei; Diagnosis, Differential; Diagnostic Techniques and Procedures; Humans; Melioidosis; Risk Factors; Rural Population
PubMed: 25359677
DOI: No ID Found