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Pownell C, Marsden BE, Lam W, Smith S, Hanson J. Prosthetic valve infective endocarditis due to Burkholderia pseudomallei: A case report and review of the literature. Acta Trop 2025; 261:107492. [PMID: 39647681 DOI: 10.1016/j.actatropica.2024.107492] [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: 07/03/2024] [Revised: 11/18/2024] [Accepted: 12/04/2024] [Indexed: 12/10/2024]
Abstract
Endocarditis is a very rare complication of Burkholderia pseudomallei infection and prosthetic valve endocarditis rarer still. We present, to our knowledge, the first confirmed Australian case of prosthetic valve endocarditis in a patient with melioidosis. Blood cultures were persistently positive for B. pseudomallei, a transoesophageal echocardiogram demonstrated a mobile vegetation on his bioprosthetic aortic valve, and computed tomography and magnetic resonance imaging identified no other focus of infection. Infection of prosthetic material appears to be rare in cases of melioidosis, however, if present, its removal should be strongly considered to effect cure. Fortunately, in our case, clinical response to 8 weeks of intravenous therapy and 6 months of high-dose oral co-trimoxazole obviated the requirement for valve replacement surgery. However, sadly, the patient died from complications of a stroke 4 months after cessation of his antibiotic treatment. The stroke was not felt to be directly related to his infection; however, his clinical course highlights the importance of aggressively addressing the comorbidities that predispose an individual to melioidosis and which also increase their risk of premature death.
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Affiliation(s)
- Callum Pownell
- Department of Medicine, Cairns Hospital, Cairns, Queensland Australia
| | | | - Willis Lam
- Department of Medicine, Cairns Hospital, Cairns, Queensland Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland Australia; Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
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Zheng W, Kuang S, Zhong C, Zhou J, Long W, Xiao S, Wu B. Risk Factors for Melioidosis Mortality and Epidemics: A Multicentre, 10-Year Retrospective Cohort Study in Northern Hainan. Infect Dis Ther 2023; 12:951-964. [PMID: 36800150 PMCID: PMC9936936 DOI: 10.1007/s40121-023-00768-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Burkholderia pseudomallei is a gram-negative environmental bacterium and aetiological agent of melioidosis, a tropical infectious disease with diverse clinical presentations. We aimed to describe the epidemiological and clinical characteristics of melioidosis in northern Hainan and to determine the meteorological factors affecting its morbidity. METHODS We conducted a retrospective, multicentre, observational cohort study of 90 patients with melioidosis admitted to four general hospitals in northern Hainan from 2010 to 2020. Epidemiological, clinical presentation, laboratory and treatment outcome data were collected and analysed. The monthly incidence of melioidosis and meteorological data, including precipitation, temperature, humidity, air pressure and wind speed, for the same period were collected to analyse the relationship between meteorological factors and the incidence of melioidosis. RESULTS Of the 90 patients included in the study, 79 (87.78%) were male. Patient age ranged from 10 to 81 years old, but most patients, namely, 78 (86.67%), were middle-aged and elderly people aged 41-81 years old. Forty-six patients (51.11%) were farmers. The number of cases increased significantly after 2014, with the highest numbers occurring in 2014 and 2016. The highest number of cases occurred in summer and autumn and were associated with abundant rainfall, and 58 cases (64.44%) occurred from July to December. The patients showed diverse presentations and abnormal laboratory parameters: 69 patients (76.67%) had a history of diabetes mellitus; bacteremia was present in 50 patients (55.56%), sepsis was present in 39 patients (43.33%) and pneumonia in 19 patients (21.11%). An average high-sensitivity C-reactive protein (hs-CRP) level of 149.57 ± 13.65 mg/L and a median procalcitonin (PCT) level of 1.31 (0.39, 6.21) ng/mL were observed. Among all the cases, 21 (23.33%) were identified as acute infections, 51 (56.67%) as subacute infections and 18 (20.00%) as chronic infections. Six patients (6.67%) died of illness; five of these patients were male, and five of these patients were middle-aged and elderly patients. The monthly average precipitation was significantly positively correlated with the monthly average incidence of melioidosis (r = 0.74, P < 0.01). CONCLUSION Male patients, farmers and especially middle-aged and elderly individuals with a history of diabetes mellitus accounted for most of the patients. The majority of cases were concentrated in coastal areas. Most cases of melioidosis occurred during the rainy seasons, and the monthly average precipitation was an independent factor affecting the average monthly incidence of melioidosis.
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Affiliation(s)
- Wanting Zheng
- International School of Public Health and One Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, 571199, China
| | - Shicheng Kuang
- Department of Pharmacy, Hainan Affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, 570311, China
| | - Chengwang Zhong
- International School of Public Health and One Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, 571199, China
| | - Jing Zhou
- International School of Public Health and One Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, 571199, China
| | - Wenfang Long
- International School of Public Health and One Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, 571199, China
| | - Sha Xiao
- International School of Public Health and One Health, Heinz Mehlhorn Academician Workstation, Hainan Medical University, Haikou, 571199, China.
| | - Biao Wu
- Department of Hospital Infection Management and Diseases Control and Prevention, Center for Infection Diseases, Hainan Affiliated Hospital of Hainan Medical University, Hainan General Hospital, Haikou, 570311, China.
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Lynch BC, Swanson DR, Marmor WA, Gibb B, Komatsu DE, Wang ED. The Relationship between Bacterial Load and Initial Run Time of a Surgical Helmet. J Shoulder Elb Arthroplast 2022; 6:24715492221142688. [DOI: 10.1177/24715492221142688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/09/2022] [Accepted: 11/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Periprosthetic joint infection (PJI) is a complication of arthroplasty surgery with significant morbidity and mortality. Surgical helmets are a possible source of infection. Pre-existing dust and microorganisms on its surface may be blown into the surgical field by the helmet ventilation system. Methods Twenty surgical helmets at our institution were assessed through microscopy and polymerase chain reaction testing. Helmets were arranged with agar plates under the front and rear outflow vents. Helmets ran while plates were exchanged at different time points. Bacterial growth was assessed via colony counts and correlated with fan operating time. Gram staining and 16S sequencing were performed to identify bacterial species. Results The primary microbiological contaminate identified was Burkholderia. There was an inverse relationship between colony formation and fan operating time. The highest number of colonies was found within the first minute of fan operating time. There was a significant decrease in the number of colonies formed from the zero-minute to the three (27 vs 5; P = <.01), four (27 vs 3; P = <.01), and five-minute (27 vs 4; P = <.01) time points for the front outflow plates. A significant difference was also observed between the one-minute and four-minute time points ( P = .046). Conclusion We observed an inverse relationship between bacterial spread helmet fan operation time, which may correlate with dispersion of pre-existing contaminates. To decrease contamination risk, we recommend that helmets are run for at least 3 min prior to entering the operating room.
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Affiliation(s)
- Brian C Lynch
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - David R Swanson
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - William A Marmor
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Bryan Gibb
- Department of Biological and Chemical Sciences, New York Institute of Technology, Old Westbury, NY, USA
| | - David E Komatsu
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
| | - Edward D Wang
- Department of Orthopaedics and Rehabilitation, Stony Brook University, Stony Brook, NY, USA
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Wu H, Wang X, Zhou X, Chen S, Mai W, Huang H, You Z, Zhang S, Zhang X, Lu B. Osteomyelitis and Septic Arthritis Due to Burkholderia pseudomallei: A 10-Year Retrospective Melioidosis Study From South China. Front Cell Infect Microbiol 2021; 11:654745. [PMID: 34123870 PMCID: PMC8194086 DOI: 10.3389/fcimb.2021.654745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/04/2021] [Indexed: 01/07/2023] Open
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis, endemic mainly in tropical and subtropical areas. Its clinical manifestation is broad ranging from a localized skin lesion to a life-threatening systemic disease. Osteomyelitis and septic arthritis caused by B. pseudomallei are a rare, fatal illness, whose clinical features have not been illustrated in mainland China. Over 10 years (2010 to 2019), of 334 culture-confirmed melioidosis in Hainan province, China, 44 patients (13.2%) were confirmed to have osteomyelitis and septic arthritis through the combination of clinical features, imaging examination and microbiological culture. Herein, we summarized these 44 patients' clinical manifestations, demographical features, antibiotic treatment, and outcomes. Of them, osteomyelitis and septic arthritis accounted for 25 (56.8%) and 15 (34.1%), respectively, and 4 patients (9.1%) had both. The gender ratio of male/female was approximately 13.7:1; diabetes mellitus was the most common risk factor (38/44, 86.4%); imipenem and trimethoprim/sulfamethoxazole were the most frequently used antibiotics. Most B. pseudomallei strains were isolated from blood samples (41/44, 93.2%). After surgical handling, antibiotic treatment, or both, 9 patients died, with a mortality rate of 20.5%. In summary, in melioidosis endemic areas, for patients with both localized manifestations of joint and bone and a positive B. pseudomallei blood culture, increased awareness is required for melioidotic osteomyelitis and septic arthritis.
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Affiliation(s)
- Hua Wu
- Department of Laboratory Medicine, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Xuming Wang
- Department of Laboratory Medicine, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Xiaojun Zhou
- Department of Laboratory Medicine, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Shaowen Chen
- Department of Laboratory Medicine, Second Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Wenhui Mai
- Department of Laboratory Medicine, Haikou Third People’s Hospital, Haikou, China
| | - Hui Huang
- Department of Laboratory Medicine, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
| | - Zelin You
- Department of Laboratory Medicine, Ling Shui Li Autonomous County People’s Hospital, Lingshui, China
| | - Suling Zhang
- Department of Laboratory Medicine, Danzhou People’s Hospital, Danzhou, China
| | - Xiuxia Zhang
- Department of Laboratory Medicine, The Second People’s Hospital of Ledong County, Ledong, China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Clinical Research Center of Respiratory Diseases, Beijing, China
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Munir MA, Tandiabang PA, Prihantono. Internal fixation of delayed union of fracture with chronic osteomyelitis due to Staphylococcus epidermidis: A case report. Ann Med Surg (Lond) 2020; 56:56-60. [PMID: 32577232 PMCID: PMC7305371 DOI: 10.1016/j.amsu.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The most feared and challenging complication in treating patients with musculoskeletal trauma is infection after fracture fixation, which can delay healing and, in turn, result in permanent functional loss of limbs or even amputation. CASE PRESENTATION Here, we describe a case in which a patient presented with stage 4 chronic osteomyelitis on the right tibia and fibula. To treat the late infection by eradicating or reducing the infection, it was recommended to replace the internal fixation with surgical debridement for 6 weeks and antibiotics for 6-12 weeks until the internal fixation device could be removed. CONCLUSION Delayed union and chronic osteomyelitis are possible complications of IAFF.
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Affiliation(s)
- Muhammad Ardi Munir
- Department of Social Health Science, Bioethics and Medical Law, Faculty of Medicine, Tadulako University, Palu, 94148, Indonesia
- Department of Orthopedic and Traumatology Surgery, Undata General Hospital, Palu, 94118, Indonesia
| | | | - Prihantono
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, 90245, Indonesia
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