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A review of melioidosis cases imported into Europe. Eur J Clin Microbiol Infect Dis 2019; 38:1395-1408. [PMID: 30949898 DOI: 10.1007/s10096-019-03548-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 03/25/2019] [Indexed: 12/31/2022]
Abstract
Melioidosis is a tropical bacterial infection, rarely encountered, and poorly known by clinicians. In non-endemic areas, a misdiagnosis can lead to a fatal outcome. This study aims to identify the main characteristics of imported and diagnosed melioidosis cases in Europe to increase clinician's awareness of this diagnosis. A literature review of imported and diagnosed human melioidosis cases in Europe was performed. PubMed and Web of Science search engines were used for retrieving articles from 2000 to November 2018. Seventy-seven cases of imported melioidosis into Europe described in the literature were identified. More than half of the cases were acquired in Thailand (53%) by men (73%). Patients were usually exposed to Burkholderia pseudomallei during a holiday stay (58%) of less than 1 month (23%) and were hospitalized during the month following their return to Europe (58%). Among travelers, melioidosis is less often associated with risk factor (16%), diabetes being the most frequently comorbidity related (19%). The clinical presentation was multifaceted, pneumonia being the most common symptom (52%), followed by cardiovascular form (45%) and skin and soft tissues damages (35%). The diagnosis was obtained by culture (92%), often supplemented by morphological, biochemical, and molecular identification (23%). Misdiagnoses were common (21%). Over half of the patients received a complete and adapted treatment (56%). Mortality is lower for returning traveler (6%). Imported melioidosis cases into Europe have their own characteristics. This possibility should be considered in patients with pneumonia, fever, and/or abscess returning from endemic areas even years after.
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Merritt AJ, Peck M, Gayle D, Levy A, Ler YH, Raby E, Gibbs TM, Inglis TJJ. Cutaneous Melioidosis Cluster Caused by Contaminated Wound Irrigation Fluid. Emerg Infect Dis 2018; 22. [PMID: 27438887 PMCID: PMC4982149 DOI: 10.3201/eid2208.151149] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Burkholderia pseudomallei can cause healthcare-associated infections outside its recognized tropical zone. Melioidosis usually occurs after environmental exposure to Burkholderia pseudomallei in the tropics. A cluster of 5 cutaneous melioidosis cases occurred in suburban southwest Australia after an earlier case in January 2012. We collected environmental samples at the first patient’s home in January 2012 and from a nearby health center in December 2013 after 2 new cases occurred in the same postal district. We isolated genotypically identical B. pseudomallei from the first patient and 5 other patients in the district. Environmental sampling implicated an opened bottle of saline wound irrigation fluid containing >106B. pseudomallei/mL. The bottle included instructions to discard within 24 hours of opening. No further cases of B. pseudomallei infection occurred after removing the contaminated bottle. This cutaneous melioidosis cluster demonstrates that B. pseudomallei can survive and disseminate in widely used medical fluids beyond its known geographic distribution, highlighting a need to use these products according to manufacturers’ instructions.
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Dan M. Melioidosis in Travelers: Review of the Literature. J Travel Med 2015; 22:410-4. [PMID: 26503093 DOI: 10.1111/jtm.12236] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 07/29/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Melioidosis is a bacterial infection endemic essentially in Southeast Asia and northern Australia. In temperate areas, the infection is extremely rare and is almost always imported by travelers or immigrants. The infection may affect almost any organ in the body, with various degrees of severity. METHODS We reviewed the literature on melioidosis in travelers. For this purpose we searched PubMed and Google for relevant articles up to July 2015. RESULTS We have identified 72 cases of melioidosis in travelers published in the literature. Melioidosis in travelers was acquired mostly in Thailand (46% of cases). The mean duration of stay in the endemic area was 36 days (range 7-330 days). Symptoms usually started at 23 days (range 1-360 days) after leaving the endemic area. The clinical presentation was varied, sepsis being the most common (34%) followed by pneumonia (29%) and abscess formation (25%). Melioidosis in travelers was less often associated with predisposing risk factors (37.5%), diabetes mellitus being the most common (21%), and had lower mortality (17%) than had the infection in autochthonous cases in Southeast Asia. CONCLUSIONS Melioidosis in travelers has its own characteristics, which distinguish it from other autochthonous diseases in indigenous populations. The possibility of melioidosis should be considered not only in patients originating from endemic areas, but also in patients returning from travel in those regions.
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Affiliation(s)
- Michael Dan
- Infectious Disease Clinic, Maccabi Health Services, Bat Yam, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Monecke S, Friedrichs A, Pöhlmann C, Hochauf K, Gunzer F, Wiesner D, Sickert W, Steinmetz I, Scholz H, Ehricht R, Schmoock G, Jacobs E. An imported case of melioidosis presenting as pyelonephritis/urosepsis. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Stefan Monecke
- Alere Technologies GmbH, Löbstedter Strasse 103-105, D-07749 Jena, Germany
- Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Anette Friedrichs
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Schittenhelmstrasse12, D-24105 Kiel, Germany
| | - Christoph Pöhlmann
- Department of Laboratory Medicine, Robert-Bosch-Hospital, Auerbachstraße 110, D-70376 Stuttgart, Germany
| | - Kristina Hochauf
- Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Florian Gunzer
- Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Diana Wiesner
- Deaconesses' Hospital Dessau, Gropiusallee 3, D-06846 Dessau-Roßlau, Germany
| | | | - Ivo Steinmetz
- Friedrich-Loeffler-Institute for Medical Microbiology, University of Greifswald, Lutherstrasse 6, D-17489 Greifswald, Germany
| | - Holger Scholz
- Bundeswehr Institute of Microbiology, Neuherbergstrasse 11, D-80937 Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Ralf Ehricht
- Alere Technologies GmbH, Löbstedter Strasse 103-105, D-07749 Jena, Germany
| | - Gernot Schmoock
- Friedrich Loeffler Institute, Institute of Bacterial Infections and Zoonoses, Naumburger Strasse 96a, D-07743 Jena, Germany
| | - Enno Jacobs
- Institute for Medical Microbiology and Hygiene, Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
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Saïdani N, Griffiths K, Million M, Gautret P, Dubourg G, Parola P, Brouqui P, Lagier JC. Melioidosis as a travel-associated infection: Case report and review of the literature. Travel Med Infect Dis 2015; 13:367-81. [DOI: 10.1016/j.tmaid.2015.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/05/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
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Fang Y, Chen H, Li YL, Li Q, Ye ZJ, Mao XH. Melioidosis in Hainan, China: a restrospective study. Trans R Soc Trop Med Hyg 2015; 109:636-42. [PMID: 26276499 DOI: 10.1093/trstmh/trv065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 07/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Melioidosis is a tropical disease caused by infection with Burkholderia pseudomallei. Here, we report an 11 year (2002-2013) retrospective study of melioidosis cases in China. METHODS A total of 170 culture-confirmed melioidosis cases were included in our analysis, with culture-positive confirmation, biochemical identification and 16S DNA sequencing. A retrospective study design was employed and a correlational analysis of potential risk factors for mortality was carried out with logistic regression. RESULTS We observed a year-over-year increasing trend in the incidence of melioidosis in Hainan, particularly after 2007 (annual peak of 64 cases in 2012). Farmers and fishers were the main group susceptible to melioidosis (75/170; 44.1%). Forty-six (27.1%) of the cases were fatal. Pneumonia (58/170; 34.1%) and septicaemia (44/170; 25.9%) were common presentations. Meanwhile, pre-existing diabetes (74/170; 43.5%) and being employed in a job that involves outdoor labour (148/170; 87.1%) emerged as common factors among affected patients. We did not observe a significant effect of seasonal variation on melioidosis mortality, but the greatest number of cases did occur in the rainiest season. CONCLUSIONS This was the first clinical retrospective study of melioidosis in Hainan, China. The present data will be a useful resource to melioidosis researchers worldwide.
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Affiliation(s)
- Yao Fang
- Department of Clinical Microbiology and Immunology of Southwest Hospital & the College of Medical Laboratory Science, Department of Microbiology and Biochemical Pharmacy of the College of Pharmacy, and the National Engineering Research Centre for Immunobiological Products, Third Military Medical University, Chongqing, 400038, China
| | - Hai Chen
- Department of Clinical Laboratory, People's Hospital of Sanya City, Hainan Province 572000, China
| | - Yuan-Li Li
- Department of Clinical Laboratory, People's Hospital of Sanya City, Hainan Province 572000, China
| | - Qian Li
- Department of Clinical Microbiology and Immunology of Southwest Hospital & the College of Medical Laboratory Science, Department of Microbiology and Biochemical Pharmacy of the College of Pharmacy, and the National Engineering Research Centre for Immunobiological Products, Third Military Medical University, Chongqing, 400038, China
| | - Zhi-Jia Ye
- Institute of Tropical Medicine, Third Military Medical University, Chongqing, 400038, China
| | - Xu-Hu Mao
- Department of Clinical Microbiology and Immunology of Southwest Hospital & the College of Medical Laboratory Science, Department of Microbiology and Biochemical Pharmacy of the College of Pharmacy, and the National Engineering Research Centre for Immunobiological Products, Third Military Medical University, Chongqing, 400038, China
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Al-Maleki AR, Mariappan V, Vellasamy KM, Tay ST, Vadivelu J. Altered Proteome of Burkholderia pseudomallei Colony Variants Induced by Exposure to Human Lung Epithelial Cells. PLoS One 2015; 10:e0127398. [PMID: 25996927 PMCID: PMC4440636 DOI: 10.1371/journal.pone.0127398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 04/14/2015] [Indexed: 12/19/2022] Open
Abstract
Burkholderia pseudomallei primary diagnostic cultures demonstrate colony morphology variation associated with expression of virulence and adaptation proteins. This study aims to examine the ability of B. pseudomallei colony variants (wild type [WT] and small colony variant [SCV]) to survive and replicate intracellularly in A549 cells and to identify the alterations in the protein expression of these variants, post-exposure to the A549 cells. Intracellular survival and cytotoxicity assays were performed followed by proteomics analysis using two-dimensional gel electrophoresis. B. pseudomallei SCV survive longer than the WT. During post-exposure, among 259 and 260 protein spots of SCV and WT, respectively, 19 were differentially expressed. Among SCV post-exposure up-regulated proteins, glyceraldehyde 3-phosphate dehydrogenase, fructose-bisphosphate aldolase (CbbA) and betaine aldehyde dehydrogenase were associated with adhesion and virulence. Among the down-regulated proteins, enolase (Eno) is implicated in adhesion and virulence. Additionally, post-exposure expression profiles of both variants were compared with pre-exposure. In WT pre- vs post-exposure, 36 proteins were differentially expressed. Of the up-regulated proteins, translocator protein, Eno, nucleoside diphosphate kinase (Ndk), ferritin Dps-family DNA binding protein and peptidyl-prolyl cis-trans isomerase B were implicated in invasion and virulence. In SCV pre- vs post-exposure, 27 proteins were differentially expressed. Among the up-regulated proteins, flagellin, Eno, CbbA, Ndk and phenylacetate-coenzyme A ligase have similarly been implicated in adhesion, invasion. Protein profiles differences post-exposure provide insights into association between morphotypic and phenotypic characteristics of colony variants, strengthening the role of B. pseudomallei morphotypes in pathogenesis of melioidosis.
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Affiliation(s)
- Anis Rageh Al-Maleki
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Vanitha Mariappan
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kumutha Malar Vellasamy
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sun Tee Tay
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jamuna Vadivelu
- Tropical Infectious Disease Research and Education Center (TIDREC), Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Huber K, Thoma B, Löscher T, Wieser A. Primary skin melioidosis in a returning traveler. Infection 2015; 43:507-8. [PMID: 25657032 DOI: 10.1007/s15010-015-0735-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 01/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Kristina Huber
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), Leopoldstr. 5, 80802, Munich, Germany,
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In Vitro and In Vivo studies of monoclonal antibodies with prominent bactericidal activity against Burkholderia pseudomallei and Burkholderia mallei. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2011; 18:825-34. [PMID: 21450976 DOI: 10.1128/cvi.00533-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Our laboratory has developed more than a hundred mouse monoclonal antibodies (MAbs) against Burkholderia pseudomallei and Burkholderia mallei. These antibodies have been categorized into different groups based on their specificities and the biochemical natures of their target antigens. The current study first examined the bactericidal activities of a number of these MAbs by an in vitro opsonic assay. Then, the in vivo protective efficacy of selected MAbs was evaluated using BALB/c mice challenged intranasally with a lethal dose of the bacteria. The opsonic assay using dimethyl sulfoxide-treated human HL-60 cells as phagocytes revealed that 19 out of 47 tested MAbs (40%) have prominent bactericidal activities against B. pseudomallei and/or B. mallei. Interestingly, all MAbs with strong opsonic activities are those with specificity against either the capsular polysaccharides (PS) or the lipopolysaccharides (LPS) of the bacteria. On the other hand, none of the MAbs reacting to bacterial proteins or glycoproteins showed prominent bactericidal activity. Further study revealed that the antigenic epitopes on either the capsular PS or LPS molecules were readily available for binding in intact bacteria, while the epitopes on proteins/glycoproteins were less accessible to the MAbs. Our in vivo study showed that four MAbs reactive to either the capsular PS or LPS were highly effective in protecting mice against lethal bacterial challenge. The result is compatible with that of our in vitro study. The MAbs with the highest protective efficacy are those reactive to either the capsular PS or LPS of the Burkholderia bacteria.
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