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Hussin A, Nathan S, Shahidan MA, Nor Rahim MY, Zainun MY, Khairuddin NAN, Ibrahim N. Identification and mechanism determination of the efflux pump subunit amrB gene mutations linked to gentamicin susceptibility in clinical Burkholderia pseudomallei from Malaysian Borneo. Mol Genet Genomics 2024; 299:12. [PMID: 38381232 DOI: 10.1007/s00438-024-02105-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/29/2023] [Indexed: 02/22/2024]
Abstract
The bacterium Burkholderia pseudomallei is typically resistant to gentamicin but rare susceptible strains have been isolated in certain regions, such as Thailand and Sarawak, Malaysia. Recently, several amino acid substitutions have been reported in the amrB gene (a subunit of the amrAB-oprA efflux pump gene) that confer gentamicin susceptibility. However, information regarding the mechanism of the substitutions conferring the susceptibility is lacking. To understand the mechanism of amino acid substitution that confers susceptibility, this study identifies the corresponding mutations in clinical gentamicin-susceptible B. pseudomallei isolates from the Malaysian Borneo (n = 46; Sarawak: 5; Sabah: 41). Three phenotypically confirmed gentamicin-susceptible (GENs) strains from Sarawak, Malaysia, were screened for mutations in the amrB gene using gene sequences of gentamicin-resistant (GENr) strains (QEH 56, QEH 57, QEH20, and QEH26) and publicly available sequences (AF072887.1 and BX571965.1) as the comparator. The effect of missense mutations on the stability of the AmrB protein was determined by calculating the average energy change value (ΔΔG). Mutagenesis analysis identified a polymorphism-associated mutation, g.1056 T > G, a possible susceptible-associated in-frame deletion, Delta V412, and a previously confirmed susceptible-associated amino acid substitution, T368R, in each of the three GENs isolates. The contribution of Delta V412 needs further confirmation by experimental mutagenesis analysis. The mechanism by which T368R confers susceptibility, as elucidated by in silico mutagenesis analysis using AmrB-modeled protein structures, is proposed to be due to the location of T368R in a highly conserved region, rather than destabilization of the AmrB protein structure.
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Affiliation(s)
- Ainulkhir Hussin
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Muhammad Ashraf Shahidan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Mohd Yusof Nor Rahim
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Mohamad Yusof Zainun
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | | | - Nazlina Ibrahim
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia.
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Jayaweera JAAS, Ranasinghe G. Development of neutropenic sepsis during the eradication phase with co-trimoxazole in patients with melioidosis: two case reports. Germs 2023; 13:266-272. [PMID: 38146382 PMCID: PMC10748846 DOI: 10.18683/germs.2023.1393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/16/2023] [Accepted: 08/05/2023] [Indexed: 12/27/2023]
Abstract
Introduction Burkholderia pseudomallei is the bacterium that causes melioidosis. It is mostly a tropical disease, and particularly common in Southeast Asia and northern Australia. The intensive intravenous phase and the oral prolonged eradication phase are the two phases of melioidosis treatment. The current recommended treatment for melioidosis eradication is oral co-trimoxazole (TMP/SMX). Case report Two patients were diagnosed with B. pseudomallei bacteremia without a focus and were treated with oral TMP/SMX with folic acid during the eradication phase. Both presented with neutropenic sepsis with pneumonia and pyelonephritis at days 48 and 45 following TMP/SMX 320/1600 mg q12h (4 tablets) and in both of them, the folic acid compliance was poor. One patient died and the other survived following intensive treatment for neutropenia. At the presentation following neutropenic sepsis among both patients, the red blood cells and platelets were within normal limits. Both patients were on a high dose of TMP/SMX, as both were within 40-60 kg of body weight the ideal TMP/SMX dose would be 240/1200 mg q12h (3 tablets). Pancytopenia caused by TMP/SMX can frequently develop gradually over time. Alternately, it can develop rapidly and swiftly escalate to fulminant sepsis, disseminated intravascular coagulation, and fast hemolysis. However, the development of isolated neutropenia is rarely described in the literature. Conclusions Prolonged use of TMP/SMX is important to eradicate B. pseudomallei and always the possibility of rare adverse effects has to be considered. Always weight-based TMP-SMX dosing has to be encouraged with need to ensure the compliance of folic acid. During the eradication phase, continuous monitoring of blood cell lines with weekly full blood count would be essential to identify neutropenia in advance.
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Affiliation(s)
- Jayaweera Arachchige Asela Sampath Jayaweera
- MBBS, PG Dip in Med Micro, MSc-Bio Stat, MPhil, MD in Micro, FRSPH (UK), Senior Lecturer Department of Microbiology Faculty of Medicine and Allied Sciences Rajarata University of Sri Lanka, Saliyapura, 50008 Sri Lanka
| | - Gerard Ranasinghe
- MBBS, MD in Micro, Consultant Microbiologist Department of Microbiology, Teaching Hospital Kurunegala 60000, Sri Lanka
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Keragala KARK, Gunathilaka MGRSS, Senevirathna RMISK, Jayaweera JAAS. Efficacy and safety of co-trimoxazole in eradication phase of melioidosis; systematic review. Ann Clin Microbiol Antimicrob 2023; 22:74. [PMID: 37592339 PMCID: PMC10436656 DOI: 10.1186/s12941-023-00620-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/23/2023] [Indexed: 08/19/2023] Open
Abstract
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.
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Dalugama C, Tennegedara A, Gawarammana IB. De novo subgaleal abscess - a rare presentation of melioidosis: a case report. J Med Case Rep 2018; 12:115. [PMID: 29706135 PMCID: PMC5925829 DOI: 10.1186/s13256-018-1643-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melioidosis is an emerging infection in the tropics caused by the bacterium Burkholderia pseudomallei. Poorly controlled diabetes is a known risk factor. Melioidosis has a broad spectrum of clinical manifestations ranging from a localized abscess to pneumonia to disseminated sepsis with multiorgan failure. Pyrexia of unknown origin is a common presentation. Abscesses in unusual anatomical locations are well known to be associated with melioidosis. CASE PRESENTATION We report a case of a 64-year-old Sri Lankan Sinhalese man with prolonged fever and constitutional symptoms with a neglected swelling over the back of the scalp who was found to have an abscess in the subgaleal space of the scalp during surgical drainage. Burkholderia pseudomallei was isolated in pus culture, and melioidosis serology was highly positive. The patient was treated with ceftazidime for 2 weeks, followed by co-trimoxazole for another 3 months. He made a complete clinical recovery with normalization of inflammatory markers. To the best of our knowledge, this is the first case of subgaleal abscess following melioidosis infection reported in the literature. CONCLUSIONS Abscesses in anatomically unusual locations should raise suspicion for melioidosis infection, particularly among patients with risk factors such as diabetes mellitus.
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Affiliation(s)
- Chamara Dalugama
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | - Asanka Tennegedara
- Department of Microbiology, University of Peradeniya, Peradeniya, Sri Lanka
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Sim SH, Ong CEL, Gan YH, Wang D, Koh VWH, Tan YK, Wong MSY, Chew JSW, Ling SF, Tan BZY, Ye AZ, Bay PCK, Wong WK, Fernandez CJ, Xie S, Jayarajah P, Tahar T, Oh PY, Luz S, Chien JMF, Tan TT, Chai LYA, Fisher D, Liu Y, Loh JJP, Tan GGY. Melioidosis in Singapore: Clinical, Veterinary, and Environmental Perspectives. Trop Med Infect Dis 2018; 3:tropicalmed3010031. [PMID: 30274428 PMCID: PMC6136607 DOI: 10.3390/tropicalmed3010031] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/23/2018] [Accepted: 03/07/2018] [Indexed: 12/11/2022] Open
Abstract
Melioidosis is a notifiable infectious disease registered with the Ministry of Health (MOH) and Agri-Food & Veterinary Authority (AVA), Singapore. From a clinical perspective, increased awareness of the disease has led to early detection and treatment initiation, thus resulting in decreasing mortality rates in recent years. However, the disease still poses a threat to local pet, zoo and farm animals, where early diagnosis is a challenge. The lack of routine environmental surveillance studies also makes prevention of the disease in animals difficult. To date, there have been no reports that provide a complete picture of how the disease impacts the local human and animal populations in Singapore. Information on the distribution of Burkholderia pseudomallei in the environment is also lacking. The aim of this review is to provide a comprehensive overview of both published and unpublished clinical, veterinary and environmental studies on melioidosis in Singapore to achieve better awareness and management of the disease.
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Affiliation(s)
- Siew Hoon Sim
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Catherine Ee Ling Ong
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Yunn Hwen Gan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Dongling Wang
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Victor Wee Hong Koh
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Yian Kim Tan
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Michelle Su Yen Wong
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Janet Seok Wei Chew
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Sian Foong Ling
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Brian Zi Yan Tan
- Laboratories Group, Agri-Food & Veterinary Authority of Singapore, Singapore 718827, Singapore.
| | - Agnes Zhengyu Ye
- Laboratories Group, Agri-Food & Veterinary Authority of Singapore, Singapore 718827, Singapore.
| | - Patrick Chuan Kiat Bay
- Food Establishment Regulation Group, Agri-Food & Veterinary Authority of Singapore, Singapore 608550, Singapore.
| | - Wai Kwan Wong
- Laboratories Group, Agri-Food & Veterinary Authority of Singapore, Singapore 718827, Singapore.
| | | | - Shangzhe Xie
- Conservation, Research and Veterinary Services, Wildlife Reserves Singapore, Singapore 729826, Singapore.
| | - Praveena Jayarajah
- Conservation, Research and Veterinary Services, Wildlife Reserves Singapore, Singapore 729826, Singapore.
| | - Tasha Tahar
- Conservation, Research and Veterinary Services, Wildlife Reserves Singapore, Singapore 729826, Singapore.
| | - Pei Yee Oh
- Conservation, Research and Veterinary Services, Wildlife Reserves Singapore, Singapore 729826, Singapore.
| | - Sonja Luz
- Conservation, Research and Veterinary Services, Wildlife Reserves Singapore, Singapore 729826, Singapore.
| | - Jaime Mei Fong Chien
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore.
| | - Thuan Tong Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore.
| | - Louis Yi Ann Chai
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
- National University Cancer Institute, Singapore 119074, Singapore.
| | - Dale Fisher
- Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore 119228, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
| | - Yichun Liu
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Jimmy Jin Phang Loh
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
| | - Gladys Gek Yen Tan
- Defence Medical and Environmental Research Institute, DSO National Laboratories, Singapore 117510, Singapore.
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Corea EM, de Silva AD, Thevanesam V. Melioidosis in Sri Lanka. Trop Med Infect Dis 2018; 3:tropicalmed3010022. [PMID: 30274420 PMCID: PMC6136624 DOI: 10.3390/tropicalmed3010022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/16/2018] [Accepted: 02/16/2018] [Indexed: 12/16/2022] Open
Abstract
Until recently, Sri Lanka was not considered a country with endemic melioidosis. However, an increasing number of cases is being reported. National surveillance for melioidosis was instituted after 2008. A total of 250 culture-positive cases was recorded between 2006 and May 2017. Males predominated (71.6%). The age range was wide (2⁻92 years) reflecting a ubiquity of exposure. The majority (201/250, 80%) lived in rural areas. All provinces were affected. Case load increased during the two monsoonal periods (67%). There was representation of every population group including farmers (n = 44), housewives (n = 24), school children (n = 10), professionals (n = 5), businesspersons (n = 6), white-collar workers (n = 10) and blue-collar workers (n = 8). Diabetes was the predominant risk factor (n = 163, 65.2%). Clinical presentations included community-acquired sepsis and pneumonia, superficial and deep abscesses, and septic arthritis. Mortality was 20.4% (51/250). A majority (n = 212) of isolates belonged to the YLF (Yersinia-like fimbrial) clade but 38 were BTFC (B. thailandensis-like flagellum and chemotaxis). A total of 108 isolates was genotyped and 46 sequence types (STs) were identified, 40 being novel. It is clear that melioidosis is endemic in Sri Lanka with a wide geographic and demographic distribution. There is an urgent need to extend surveillance of melioidosis to under-resourced parts of the country and to populations at high risk.
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Affiliation(s)
- Enoka M Corea
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka.
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Weerasinghe NP, Herath HMM, Liyanage TMU. Isolated septic arthritis of hip joint: a rare presentation of melioidosis. A case report. BMC Res Notes 2018; 11:50. [PMID: 29351806 PMCID: PMC5775616 DOI: 10.1186/s13104-018-3171-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/12/2018] [Indexed: 11/25/2022] Open
Abstract
Background Despite, Sri Lanka lies in the melioidosis endemic belt between 5°N and 10°N surrounded by countries known to have endemic melioidosis for many years, comparatively fewer cases of melioidosis infection have been reported in Sri Lanka. Melioidosis has a wide spectrum of clinical presentation, ranging from severe pneumonia to abscess formation in various organs. Isolated septic arthritis, which is a rare but well-recognized manifestation of melioidosis, could be the sole presenting problem in some patients with melioidosis. Case presentation We report a middle aged diabetic female who has been on azathioprine for autoimmune hepatitis, presenting with pain and swelling of left hip joint. Investigations confirmed the clinical suspicion of septic arthritis, but all relevant microbiological investigations failed to isolate a causative organism. Due to the history of diabetes, possible immunosuppression with azathioprine, and failure to recognise the possible causative organism by initial investigations prompted us to investigate for melioidosis. Diagnosis of melioidosis was made by presence high titre of antibodies to melioidin antigen, and rapid response to appropriate treatment. The patient was treated with intravenous imipenem 1000 mg 6 hourly and oral cotrimoxazole (1920 mg 12 hourly) for 4 weeks followed by eradication therapy with cotrimoxazole and doxycycline. Conclusion Given that melioidosis-induced septic arthritis share common features with septic arthritis due to other common pyogenic bacteria, differentiation of these two conditions is extremely difficult. Therefore, melioidosis needs to be considered as a possibility, when a patient with risk factors for melioidosis such as diabetes or immunosuppression presents with isolated septic arthritis. This case report has been presented to raise the awareness of an unusual presentation of melioidosis; isolated septic arthritis.
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Affiliation(s)
- N P Weerasinghe
- Department of Microbiology, Faculty of Medicine, University of Ruhuna, P.O. Box 70, Galle, Sri Lanka.
| | - H M M Herath
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.,University Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka
| | - T M U Liyanage
- University Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka
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