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Chayangsu S, Suankratay C, Tantraworasin A, Khorana J. The Predictive Factors Associated with In-Hospital Mortality of Melioidosis: A Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:654. [PMID: 38674300 PMCID: PMC11052379 DOI: 10.3390/medicina60040654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Melioidosis is an infectious disease caused by Burkholderia pseudomallei, and it has a wide range of clinical symptoms. It is endemic in tropical areas, including Southeast Asia. Despite the availability of effective treatment, the mortality rate is still high, especially in patients presenting with septic shock. The aim of this study was to determine and explore clinical characteristics, microbiology, treatment outcomes, and factors associated with in-hospital mortality which could predict prognosis and provide a guide for future treatment. Materials and Methods: The population in this retrospective cohort study included all 262 patients with a diagnosis of melioidosis who were hospitalized at Surin Hospital, Surin, Thailand, from April 2014 to March 2017. We included patients older than 15 years with a positive culture for B. pseudomallei. Data regarding the clinical characteristics, microbiology, and treatment outcomes of the patients were collected and analyzed. The patients were divided into two groups dependent on outcome, specifically non-survival and survival. Logistic regression was performed to determine the risk factors associated with in-hospital mortality. Results: Out of the 262 patients with melioidosis during the study period, 117 (44.7%) patients died. The mean age was 57.2 ± 14.4 years, and 193 (73.7%) patients were male. The most common comorbidity was diabetes (123, 46.9%), followed by chronic kidney disease (35, 13.4%) and chronic liver disease (31, 11.8%). Four risk factors were found to be associated with in-hospital mortality, including age (adjusted odds ratio (aOR) 1.04, 95%CI: 1.01-1.07), respiration rate (aOR 1.18, 95%CI: 1.06-1.32), abnormal chest X-ray finding (aOR 4.79, 95%CI: 1.98-11.59), and bicarbonate levels (CO2) (aOR 0.92, 95%CI: 0.85-0.99). Conclusions: Our study identified age, respiration rate, abnormal chest X-ray finding, and CO2 levels are predictive factors associated with in-hospital mortality in melioidosis patients. Physicians should be aware of these factors, have access to aggressive treatment options, and closely monitor patients with these risk factors.
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Affiliation(s)
- Sunee Chayangsu
- Department of Internal Medicine, Surin Hospital, Surin 32000, Thailand;
| | - Chusana Suankratay
- Department of Internal Medicine, Faculty of Medicine, The King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Apichat Tantraworasin
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Jiraporn Khorana
- Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chiang Mai 50200, Thailand
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Arushothy R, Mohd Ali MR, Zambri HF, Muthu V, Hashim R, Chieng S, Nathan S. Assessing the national antibiotic surveillance data to identify burden for melioidosis in Malaysia. IJID REGIONS 2024; 10:94-99. [PMID: 38179416 PMCID: PMC10764260 DOI: 10.1016/j.ijregi.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
Objectives A leading cause of morbidity and mortality in Southeast Asia, the epidemiological data on melioidosis disease occurrence and mortality in Malaysia is not comprehensive. The aim of this study is to determine the burden of melioidosis and assess the National Surveillance for Antibiotic Resistance (NSAR) data as a potential tool melioidosis surveilance in Malaysia. Methods We performed a retrospective analysis on the B. pseudomallei reposited data submitted to the NSAR network between January 2014 and December 2020. The data were screened for information on patient demographics and specimen types. Additional patient comorbidities and outcomes were drawn from parallel surveillance for bacteremic melioidosis. Results The average annual incidence rate of melioidosis between 2014-2020 was 3.41 per 100,000 population and was significantly different between states (P <0.001). The highest incidence was observed in Pahang at 11.33 per 100,000 population. Individuals of Malay ethnicity, from the states of Pahang, Johor, Perak, and Negeri Sembilan aged 40-49, who were diabetic and working in agriculture-related sectors had a higher risk of succumbing to the infection. Conclusion Assessing the NSAR data proved to be a useful tool for the determination of the incidence and socio-demographic risk factors attributed to melioidosis in Malaysia.
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Affiliation(s)
- Revathy Arushothy
- Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | | | - Hana Farizah Zambri
- Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Vickneshwaran Muthu
- Disease Control Division, Ministry of Health Malaysia, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Rohaidah Hashim
- Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Sylvia Chieng
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Hussin A, Nor Rahim MY, Dalusim F, Shahidan MA, Nathan S, Ibrahim N. Improving the clinical recognition, prognosis, and treatment of melioidosis through epidemiology and clinical findings: The Sabah perspective. PLoS Negl Trop Dis 2023; 17:e0011696. [PMID: 37844130 PMCID: PMC10602235 DOI: 10.1371/journal.pntd.0011696] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/26/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Melioidosis is a deadly endemic disease in northern Australia and Southeast Asia, including Sabah, Malaysia, which is caused by the bacterium Burkholderia pseudomallei. It contributes to high fatality rates, mainly due to misdiagnosis leading to the wrong treatment being administered to the patients. Local epidemiology and data on clinical features could assist clinicians during diagnosis and treatment. However, these details are still scarce, particularly in Sabah. METHODS A retrospective study of 246 culture-confirmed melioidosis cases in Queen Elizabeth Hospital, Sabah, Malaysia was performed between 2016 and 2018. The epidemiological data and clinical and laboratory findings were extracted and analysed. RESULTS The annual incidence of culture-confirmed melioidosis cases was estimated to be 4.97 per 100,000 people. The mean age of the patients was 50±15 years. Males and members of the Kadazan-Dusun ethnic group accounted for the majority of the melioidosis cases. The odds ratio analysis indicated that bacteraemic melioidosis in this region was significantly associated with fever (76%), and patients having at least one underlying illness (43%), including diabetes mellitus (32%). Sixty-eight patients (28%) succumbed to melioidosis. Contrary to what is known regarding factors that promote bacteraemic melioidosis, neither patients with fever nor patients with at least one comorbid disease, including diabetes mellitus, were significantly associated with death from melioidosis. There was no statistically significant difference between patients without comorbidities (24, 27%) and those with at least one comorbid disease (26, 25%), including diabetes mellitus (18, 23%). The odds ratios indicate that melioidosis mortality in this region is related to patients showing respiratory organ-associated symptoms (29%), bacteraemia (30%), and septic shock (47%). Burkholderia pseudomallei isolates in this study were highly susceptible to ceftazidime (100%), imipenem (100%), and trimethoprim-sulfamethoxazole (98%). CONCLUSIONS Information obtained from this study can be used by clinicians to recognise individuals with the highest risk of acquiring melioidosis, estimate an accurate prognosis, and provide effective treatment for melioidosis patients to reduce death from melioidosis.
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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
| | - Mohd Yusof Nor Rahim
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Frederick Dalusim
- Department of Pathology, Queen Elizabeth Hospital, Ministry of Health Malaysia, Kota Kinabalu, Sabah, Malaysia
| | - Muhammad Ashraf Shahidan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Nazlina Ibrahim
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
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Cheah Y, Jumastapha H, Tang IP. A Rare Case of Complicated Sinonasal Meliodosis Mimicking Sinonasal Lymphoproliferative Disease. Indian J Otolaryngol Head Neck Surg 2023; 75:2564-2567. [PMID: 37636706 PMCID: PMC10447696 DOI: 10.1007/s12070-023-03792-4] [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: 03/10/2023] [Accepted: 04/06/2023] [Indexed: 08/29/2023] Open
Abstract
Unilateral nasal obstruction with purulent nasal discharge is one of the presentations for sinonasal melioidosis. However, it may mimic nasal NK/T cell lymphoma. Both causing tissue destruction involving nasal septum, lateral nasal wall and palate. Here, we report a case of disseminated melioidosis involving sinonasal mimicking nasal lymphoma in a 32-year-old immunocompetent lady. She presented with prolonged fever, unilateral nasal blockage, painful facial swelling and knee pain. Clinical findings revealed extensive necrotic tissue and crusting involving right lateral wall of nasal cavity. Tissue and blood culture and sensitivity (C + S) grew Burkholderia pseudomallei. Recovery was complete after surgery and antibiotics.
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Affiliation(s)
- Yuanzhi Cheah
- Otorhinolaryngology Head and Neck Department, Sarawak General Hospital, Kuching, Sarawak Malaysia
| | - Hanzali Jumastapha
- Otorhinolaryngology Head and Neck Department, Sarawak General Hospital, Kuching, Sarawak Malaysia
- Otorhinolaryngology Head and Neck Department, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia
| | - Ing Ping Tang
- Otorhinolaryngology Head and Neck Department, Sarawak General Hospital, Kuching, Sarawak Malaysia
- Otorhinolaryngology Head and Neck Department, Faculty of Medicine and Health Sciences, University Malaysia Sarawak, Kota Samarahan, Malaysia
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Guterres H, Gusmao C, Pinheiro M, Martins J, Odio G, Maia C, da Conceicao V, Soares M, Osorio C, da Silva ES, Tilman A, Givney R, Oakley T, Yan J, Toto L, Amaral E, James R, Buising K, Mayo M, Kaestli M, Webb JR, Baird RW, Currie BJ, Francis JR, Muhi S. Melioidosis in Timor-Leste: First Case Description and Phylogenetic Analysis. Open Forum Infect Dis 2023; 10:ofad405. [PMID: 37577114 PMCID: PMC10414804 DOI: 10.1093/ofid/ofad405] [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: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
Burkholderia pseudomallei, the causative agent of melioidosis, has not yet been reported in Timor-Leste, a sovereign state northwest of Australia. In the context of improved access to diagnostic resources and expanding clinical networks in the Australasian region, we report the first 3 cases of culture-confirmed melioidosis in Timor-Leste. These cases describe a broad range of typical presentations, including sepsis, pneumonia, multifocal abscesses, and cutaneous infection. Phylogenetic analysis revealed that the Timor-Leste isolates belong to the Australasian clade of B. pseudomallei, rather than the Asian clade, consistent with the phylogeographic separation across the Wallace Line. This study underscores an urgent need to increase awareness of this pathogen in Timor-Leste and establish diagnostic laboratories with improved culture capacity in regional hospitals. Clinical suspicion should prompt appropriate sampling and communication with laboratory staff to target diagnostic testing. Local antimicrobial guidelines have recently been revised to include recommendations for empiric treatment of severe sepsis.
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Affiliation(s)
| | - Celia Gusmao
- National Hospital Guido Valadares, Dili, Timor-Leste
| | | | - Joana Martins
- National Hospital Guido Valadares, Dili, Timor-Leste
| | - Gustavo Odio
- National Hospital Guido Valadares, Dili, Timor-Leste
| | | | - Virginia da Conceicao
- National Health Laboratory, Dili, Timor-Leste
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Messias Soares
- National Health Laboratory, Dili, Timor-Leste
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | | | - Rodney Givney
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lucia Toto
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Elfiana Amaral
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rodney James
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark Mayo
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mirjam Kaestli
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jessica R Webb
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Robert W Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephen Muhi
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Jain M, Ratna HVK, Mohanty S, Padhi S, Tripathy S. Coinfection of Melioidosis and Tuberculosis Causing Infective Lumbar Spondylodiscitis: A Rare Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00027. [PMID: 37172118 DOI: 10.2106/jbjs.cc.22.00770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
CASE A 63-year-old farmer who is a known diabetic and chronic alcoholic presented with lower back pain and neurological weakness of lower limbs present for the past 3 months. His acute phase reactants were very high, and magnetic resonance imaging displayed L4-L5 vertebral involvement with epidural, paravertebral, and bilateral psoas abscesses. Cultures of an ultrasound-guided aspiration from the psoas were positive for Burkholderia pseudomallei, and a nucleic acid amplification test also detected Mycobacterium tuberculosis. He underwent posterior decompression and fixation, and intraoperative biopsy confirmed a granulomatous reaction. He received appropriate antibiotics for both diseases. At 1 year, he showed healing on radiographic imaging, with independent ambulation status. CONCLUSION The coexistence of melioidosis and tuberculosis is rare, and as far as we know, a case of infective spondylodiscitis has not been reported. In patients with infective spondylodiscitis, every attempt should be made to confirm the diagnosis before starting empirical antitubercular treatment (ATT).
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, India
| | | | | | - Somanath Padhi
- Department of Pathology and Laboratory Medicine, AIIMS, Bhubaneswar, India
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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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Mariappan V, Vellasamy KM, Anpalagar RR, Lim YM, Zainal Abidin N, Subramaniam S, Nathan S. One Health surveillance approaches for melioidosis and glanders: The Malaysian perspective. Front Vet Sci 2022; 9:1056723. [PMID: 36590813 PMCID: PMC9798326 DOI: 10.3389/fvets.2022.1056723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The One Health concept was initiated to promote the integration of human, animal, and environmental ecosystems into healthcare to ensure effective control and the sustainable governance of multifaceted health matters. Climate change, deforestation, and rigorous farming disrupt the environment, which serves as the natural habitat for many animals and microbes, increasing the likelihood of disease transmission between humans and animals. Melioidosis (neglected tropical diseases) and glanders are of humans and animals caused by the gram-negative bacteria Burkholderia pseudomallei and its close relative Burkholderia mallei, respectively. In Malaysia, although melioidosis is endemic, it is not a notifiable disease. Hence, the true prevalence of melioidosis in Malaysia is unknown and varies in different regions of the country, with reported hotspots associated with agriculture-related activities. To date, no incidence of human glanders has been reported in Malaysia, although occupational exposure for equine handlers and veterinary professionals remains a concern. Additionally, antibiotics are widely used in the healthcare and veterinary sectors to treat or prevent B. pseudomallei and B. mallei infections, leading to the emergence of resistance in B. pseudomallei. Lack of surveillance, research, assessment, and management of glanders and melioidosis is a major issue in Malaysia. Proper assessment systems and cross-discipline cooperation are vital to recognize and manage both diseases. Experts and practitioners from clinical and veterinary disciplines, environmentalists, law enforcement, policymakers, researchers, local communities, and other experts need to communicate, collaborate, and coordinate activities to fill the knowledge gap on glanders and melioidosis to reduce morbidity and mortality rates in the country. This review aims to define the organizational and functional characteristics of One Health surveillance approaches for glanders and melioidosis from a Malaysian perspective.
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Affiliation(s)
- Vanitha Mariappan
- Center for Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kumutha Malar Vellasamy
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rohan Raaj Anpalagar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yue-Min Lim
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nurhamimah Zainal Abidin
- Faculty of Applied Sciences, School of Biology, Universiti Teknologi MARA (UiTM), Cawangan Negeri Sembilan, Kuala Pilah, Negeri Sembilan, Malaysia
| | - Sreeramanan Subramaniam
- School of Biological Sciences, Universiti Sains Malaysia (USM), Georgetown, Penang, Malaysia
- Chemical Centre Biology, Universiti Sains Malaysia (USM), Bayan Lepas, Penang, Malaysia
- National Poison Centre, Universiti Sains Malaysia (USM), Georgetown, Penang, Malaysia
| | - Sheila Nathan
- Faculty of Science and Technology, School of Biosciences and Biotechnology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Pitak-Arnnop P, Sirintawat N, Subbalekha K, Meningaud JP, Auychai P, Tangmanee C, Neff A. Length of hospital stay and complications of mini-facelift versus modified Blair incision for parotid abscess drainage. Eur Oral Res 2022; 56:124-129. [PMID: 36660218 PMCID: PMC9826706 DOI: 10.26650/eor.2022989445] [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: 09/02/2021] [Revised: 12/03/2021] [Accepted: 12/27/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose To compare the length of hospital stay (LHS) and complications between minifacelift (MFL) and modified Blair incisions (MBI) for adult patients undergoing parotid abscess drainage (PAD). Materials and methods A retrospective cohort study design was utilized comprising 2 groups of healthy adult patients (American Society of Anesthesiology [ASA] status I-II) who underwent PAD during a 7-year interval. The primary predictor variable was incision type (MFL vs. MBI). The primary outcomes were LHS and adverse complications resulting from the incision type. Other study variables were grouped into demographic, clinical, microbiological, and therapeutic categories. Difference in the cohort characteristics were analyzed using appropriate descriptive and uni- and bivariate statistics. Multivariate logistic regression was used to measure the effect of the incision type had on the LHS and adverse complication rates. Results The sample included 120 subjects (50% females) with a mean age of 41.7±18.3 years. Patients in the MFL group were hospitalized for 8.2±7.7 days, and the other group stayed in the hospital for 10.2±8 days (adjusted odd ratio [OR] 1.19, 95% confidence interval [95% CI] 0.52 to 2.7; p=0.8). In comparison with MBI, MFL did not significantly increase complication risks in term of facial paralysis (adjusted OR 0.93, 95% CI 0.06 to 15.29; p=1.0) and necessity of re-operation (adjusted OR 0.61, 95% CI 0.1 to 3.8; p=0.7). Conclusion Given no different LHS and complication risks, MFL can replace MBI for ASA I-II adult patients undergoing PAD.
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Affiliation(s)
- Poramate Pitak-Arnnop
- Department of Oral and Maxillofacial Surgery, University
Hospital of Giessen and Marburg, UKGM GmbH, Campus
Marburg, Faculty of Medicine, Philipps-University of
Marburg Germany ,To whom correspondence should be addressed: Dr.Poramate Pitak-Arnnop Department of Oral and Maxillofacial Surgery, University Hospital of Giessen and Marburg, UKGM GmbH, Campus
Marburg, Faculty of Medicine, Philipps-University of Marburg Germany
| | - Nattapong Sirintawat
- Department of Oral and Maxillofacial Surgery, Faculty of
Dentistry, Mahidol University, Bangkok Thailand
| | - Keskanya Subbalekha
- Department of Oral and Maxillofacial Surgery, Faculty of
Dentistry, Chulalongkorn University, Bangkok Thailand
| | - Jean-Paul Meningaud
- Department of Plastic, Reconstructive, Aesthetic and
Maxillofacial Surgery, Henri Mondor University Hospital,
AP-HP, Faculty of Medicine, University Paris-Est Créteil Val de Marne (Paris XII), Créteil France
| | - Prim Auychai
- Department of Paediatric Dentistry, Faculty of Dentistry,
Chulalongkorn University, Bangkok Thailand
| | - Chatpong Tangmanee
- Department of Statistics, Chulalongkorn Business School,
Bangkok Thailand
| | - Andreas Neff
- Department of Oral and Maxillofacial Surgery, University
Hospital of Giessen and Marburg, UKGM GmbH, Campus
Marburg, Faculty of Medicine, Philipps-University of
Marburg Germany
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Tan M, Low HM, Shelat V, Tan CH. Imaging patterns in non-traumatic spleen lesions in adults-a review. Jpn J Radiol 2022; 40:664-677. [PMID: 35099683 DOI: 10.1007/s11604-022-01250-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 01/17/2022] [Indexed: 02/05/2023]
Abstract
The spleen is a complex organ involved in multiple physiological processes in the human body. Elective splenectomy is an uncommon operation, and the precise characterization of the lesion should be achieved to determine the risks and benefits of this operation accurately. Given the significant role of the spleen in homeostasis and the potential risks of the surgery itself and following sequelae such as infection susceptibility, accurate recognition, and classification of splenic lesions is required before surgery. This review provides an overview of malignant (e.g., lymphoma, angiosarcoma) and benign (e.g., cysts, hemangioma, hamartoma) splenic lesions that may warrant an elective splenectomy. Images from a cohort of adult patients undergoing isolated splenectomy for non-traumatic indications in a single center are provided. This review highlights the considerable overlap in imaging patterns between splenic lesions, splenic lesions masquerading as lesions in other organs, increased detection of asymptomatic splenic incidentalomas due to improvements in imaging modalities. This review also provides clinical correlations for each lesion, providing additional information to help clinicians differentiate between lesions and accurately identify diseases amenable to surgical management.
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Affiliation(s)
| | - Hsien Min Low
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishalkumar Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| | - Cher Heng Tan
- Department of Radiology, Tan Tock Seng Hospital, Singapore, Singapore
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11
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Oslan SNH, Yusoff AH, Mazlan M, Lim SJ, Khoo JJ, Oslan SN, Ismail A. Comprehensive approaches for the detection of Burkholderia pseudomallei and diagnosis of melioidosis in human and environmental samples. Microb Pathog 2022; 169:105637. [PMID: 35710088 DOI: 10.1016/j.micpath.2022.105637] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022]
Abstract
Melioidosis is endemic in Southeast Asia and northern Australia. The causative agent of melioidosis is a Gram-negative bacterium, Burkholderia pseudomallei. Its invasion can be fatal if melioidosis is not treated promptly. It is intrinsically resistant to a variety of antibiotics. In this paper, we present a comprehensive overview of the current trends on melioidosis cases, treatments, B. pseudomallei virulence factors, and molecular techniques to detect the bacterium from different samples. The clinical and microbial diagnosis methods of identification and detection of B. pseudomallei are commonly used for the rapid diagnosis and typing of strains, such as polymerase chain reaction or multi-locus sequence typing. The genotyping strategies and techniques have been constantly evolving to identify genomic loci linked to or associated with this human disease. More research strategies for detecting and controlling melioidosis should be encouraged and conducted to understand the current situation. In conclusion, we review existing diagnostic methodologies for melioidosis detection and provide insights on prospective diagnostic methods for the bacterium.
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Affiliation(s)
- Siti Nur Hazwani Oslan
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.
| | - Abdul Hafidz Yusoff
- Gold Rare Earth and Material Technopreneurship Centre (GREAT), Faculty of Bioengineering and Technology, Universiti Malaysia Kelantan, Jeli Campus, Jeli, 17600, Kelantan, Malaysia.
| | - Mazlina Mazlan
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, 43400 UPM, Serdang, Selangor, Malaysia.
| | - Si Jie Lim
- Enzyme Technology and X-Ray Crystallography Laboratory, VacBio 5, Institute of Bioscience, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Enzyme and Microbial Technology (EMTech) Research Centre, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Jing Jing Khoo
- Tropical Infectious Diseases Research and Education Centre (TIDREC), High Impact Research Building, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Siti Nurbaya Oslan
- Enzyme Technology and X-Ray Crystallography Laboratory, VacBio 5, Institute of Bioscience, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Enzyme and Microbial Technology (EMTech) Research Centre, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia; Department of Biochemistry, Faculty of Biotechnology and Biomolecular Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Aziah Ismail
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
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Clinical, Epidemiological and Microbiological Profile of A Potentially Pathogenic Environmental Saprophyte, Burkholderia pseudomallei; at A Tertiary Care Hospital in Coastal India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.1.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Melioidosis is a severe systemic infectious disease caused by Burkholderia pseudomallei, a gram-negative bacillus with bipolar staining. It is an environmental saprophyte endemic to Southeast Asia and Northern Australia. The disease can have varying manifestations. This is a retrospective study of the clinical and microbiological profile of culture-proven cases of melioidosis who presented to a tertiary care hospital in Coastal Karnataka between January 2018 and December 2020. The epidemiological, demographic, clinical and laboratory characteristics were studied and analyzed. A total of 27 cases were seen during the study period. All patients were from the western coastal areas of India. Fever was the most common presenting complaint. Analysis of the clinical manifestations showed 11 (40.74%) with bacteremia. Pneumonia was the most common primary clinical presentation with 11 cases (40.74%). 9 (33.3%) patients had an abscess in some part of the body on presentation. Secondary foci were seen in 5 (18.5%) patients. The prominent risk factors seen were history of type 2 diabetes mellitus, age >40 years, alcoholism and smoking. 13 (48.15%) were started with the treatment regimen for melioidosis. Only 8 (29.63%) were prescribed the eradication treatment regimen. One case which was inadequately treated came back with reactivation of melioidosis. Varied clinical presentation of melioidosis makes the specific clinical diagnosis difficult. Due to the high mortality and morbidity rate, early diagnosis and prompt management is warranted, this requires clinical vigilance and an intensive microbiological workup. Lack of adherence to the treatment protocol can lead to reactivation.
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13
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Tong TK, Shan G, Sibangun FJ, Keung BLD. Melioidosis-related mycotic aneurysm: Three cases. IDCases 2021; 26:e01295. [PMID: 34646734 PMCID: PMC8496099 DOI: 10.1016/j.idcr.2021.e01295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
Background Melioidosis-related mycotic aneurysm (MA) is rare but a potentially life-threatening disease with high morbidity and mortality rate. Case presentation We report a case series of mycotic aneurysm caused by Burkholderia pseudomallei and the subsequent outcomes. Here, we illustrate their clinical characteristics, laboratory results, radiological findings, mode of therapies and clinical outcomes. Conclusion Melioidosis-associated MA may manifest in an atypical presentation. Its outcome is often lethal if antimicrobial therapy and surgical intervention are not offered promptly.
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Key Words
- BA, Blood Agar
- CTA, Aortographic computed tomography
- EVAR, Endovascular repair
- MA, Mycotic aneurysm
- MAC, MacConkey Agar
- MALDI-TOF MS, Matrix-assisted laser desorption/ionisation mass spectrometry
- Melioidosis
- Mycotic aneurysm
- OS, Open surgery
- Outcome
- RRT, renal replacement therapy
- TEVAR, Thoracic endovascular aortic repair
- TMP/SMX, Trimethoprim/Sulfamethoxazole
- WCC, White blood cells, in cells/μL
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Affiliation(s)
- Tan Kok Tong
- Department of Internal Medicine, Queen Elizabeth Hospital II (QEH II) (Ministry of Health, Malaysia), Sabah, Malaysia
| | - Giri Shan
- Department of Internal Medicine, Queen Elizabeth Hospital II (QEH II) (Ministry of Health, Malaysia), Sabah, Malaysia
| | - Feona Joseph Sibangun
- Vascular Unit, Department of Surgery, QEH II (Ministry of Health, Malaysia), Malaysia
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Cheok LH, Tang ASO, Desmond S, Wong YL, Cheong YK, Ng SC, Cheng WM, Chua HH, Teh CL. Central nervous system melioidosis in systemic lupus erythematosus: A clinical vignette. IDCases 2021; 26:e01255. [PMID: 34458097 PMCID: PMC8377557 DOI: 10.1016/j.idcr.2021.e01255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/29/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022] Open
Abstract
A case of a disseminated melioidosis infection with central nervous system, pulmonary, spleen, bone and skin involvement. Central nervous system melioidosis in a patient with underlying systemic lupus erythematosus. Agriculture contact and underlying immunocompromised state predispose to melioidosis infection. Positive cerebrospinal fluid cultures to confirm central nervous system melioidosis. Extension of eradication therapy in view of osteomyelitis and residual cerebral lesion.
Central nervous system melioidosis is an uncommon presentation of melioidosis infection. We report a case of a disseminated melioidosis infection with central nervous system, pulmonary, spleen, bone and cutaneous involvement in a patient with underlying systemic lupus erythematous. The diagnosis was confirmed based on positive blood and cerebrospinal fluid cultures coupled with radiological findings. Agriculture contact and underlying immunocompromised state were the predisposing risk factors for melioidosis infection in this case. Our patient was successfully treated with 10 weeks of intensive antibiotics therapy and 1 year of eradication antibiotics therapy with significant clinical and radiological improvement.
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Affiliation(s)
- Lay Hock Cheok
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Andy Sing Ong Tang
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Samuel Desmond
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Yi-Li Wong
- Department of Radiology, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Yaw Kiet Cheong
- Rheumatology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Malaysia
| | - Say Chiew Ng
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Wee Mee Cheng
- Department of Internal Medicine, Miri Hospital, Sarawak, Ministry of Health, Malaysia
| | - Hock Hin Chua
- Infectious Disease Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Malaysia
| | - Cheng Lay Teh
- Rheumatology Unit, Department of Internal Medicine, Sarawak General Hospital, Ministry of Health, Malaysia
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15
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Mardhiah K, Wan-Arfah N, Naing NN, Hassan MRA, Chan HK. The Cox model of predicting mortality among melioidosis patients in Northern Malaysia: A retrospective study. Medicine (Baltimore) 2021; 100:e26160. [PMID: 34160382 PMCID: PMC8238369 DOI: 10.1097/md.0000000000026160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/15/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Melioidosis is an infectious disease that is initiated by a bacteria recognized as Burkholderia pseudomallei. Despite the high fatality rate from melioidosis, there is a minimal published study about the disease in Malaysia.This study aimed to identify the prognostic factors of mortality among melioidosis patients in northern Malaysia.All inpatient patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis during the period 2014 to 2017 were included in the study. The study retrospectively collected 510 melioidosis patients from the Melioidosis Registry. Hazard ratio (HR) used in advanced multiple Cox regression was used to obtain the final model of prognostic factors of melioidosis. The analysis was performed using STATA/SE 14.0 for Windows software.From the results, among the admitted patients, 50.1% died at the hospital. The mean age for those who died was 55 years old, and they were mostly male. The most common underlying disease was diabetes mellitus (69.8%), followed by hypertension (32.7%). The majority of cases (86.8%) were bacteremic. The final Cox model identified 5 prognostic factors of mortality among melioidosis patients. The factors were diabetes mellitus, type of melioidosis, platelet count, white blood cell count, and urea value. The results showed that bacteremic melioidosis increased the risk of dying by 3.47 (HR: 3.47, 95% confidence intervals [CI]: 1.67-7.23, P = .001) compared to non-bacteremic melioidosis. Based on the blood investigations, the adjusted HRs from the final model showed that all 3 blood investigations were included as the prognostic factors for the disease (low platelet: HR = 1.76, 95% CI: 1.22-2.54, P = .003; high white blood cell: HR = 1.49, 95% CI 1.06-2.11, P = .023; high urea: HR = 2.92, 95% CI: 1.76-4.85, P < .001; and low level of urea: HR = 2.69, 95% CI: 1.69-4.29, P < .001). By contrast, melioidosis patients with diabetic had 30.0% lower risk of dying from melioidosis compared to those with non-diabetic (HR = 0.70, 95% CI: 0.52-0.94, P = .016).Identifying the prognostic factors of mortality in patients with melioidosis allows a guideline of early management in these patients, which may improve patient's survival.
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Affiliation(s)
- Kamaruddin Mardhiah
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Huan-Keat Chan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
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16
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Gao L, Shi YY, Lu Q. Contrast-enhanced ultrasound findings of liver and spleen abscesses due to infection with Burkholderia pseudomallei: A case report. Shijie Huaren Xiaohua Zazhi 2021; 29:378-382. [DOI: 10.11569/wcjd.v29.i7.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Burkholderia pseudomallei is the pathogen of melioidosis. It is generally resistant to commonly used antibiotics. Burkholderia pseudomallei infection is usually severe, with a high mortality rate. Moreover, the clinical manifestations are diverse, leading to a difficult diagnosis. Most of the cases are accompanied by multiple purulent lesions, and ultrasonography can play an important role in the detection and evaluation of abscesses.
CASE SUMMARY The patient was from Hainan Province, an epidemic area of Burkholderia pseudomallei infection. He had a history of diabetes and had suffered from a fever for half a month. Routine ultrasonography revealed multiple mixed lesions in the liver and spleen. The mass has multiple septations with characteristic radial arrangement. On contrast-enhanced ultrasound, thick ring hyperenhancement was demonstrated in the arterial phase. Enhancement of the septations can also be observed with irregular flaky non-enhanced area inside. The patient was diagnosed as having Burkholderia pseudomallei infection by blood culture. After anti-infective treatment based on drug sensitivity, the lesions were significantly reduced.
CONCLUSION We have reported a case of liver and spleen abscesses due to infection with Burkholderia pseudomallei, which was confirmed by blood culture. Routine ultrasonography revealed multiple mixed lesions in the liver and spleen. On contrast-enhanced ultrasound, thick ring hyperenhancement was demonstrated in the arterial phase, while slightly low enhancement in the portal phase and parenchymal phase and the characteristics of radial arrangement were consistent with the reported typical CT findings. Contrast-enhanced ultrasound could help ascertain necrotic area of the abscesses. The recognition of the purulent nature by conventional and contrast-enhanced ultrasound, and the feature of radial septations could assist in ultrasound diagnosis of melioidosis abscess in non-endemic areas.
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Affiliation(s)
- Ling Gao
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Ying-Yu Shi
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qiang Lu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
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Mardhiah K, Wan-Arfah N, Naing NN, Abu Hassan MR, Chan HK, Hasan H. The Trend of Direct Medical Cost of Meliodiosis Patients in Kedah: A Retrospective Study from 2014 to 2017. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:155-162. [PMID: 33732004 PMCID: PMC7959198 DOI: 10.2147/ceor.s286283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study was conducted to determine the direct medical cost of treating melioidosis patients. The calculation was made according to the variables extracted from medical records. MATERIALS AND METHODS Data collection was performed retrospectively on a total of 293 cases from Hospital Sultanah Bahiyah, Kedah, Malaysia. The data consisted of personal information, treatment history, and investigation findings, including blood results, USG abdomen results, and CT scan results. The site of culture and sensitivity were also obtained. The total direct medical cost was based on the antibiotics/treatments received by the patients, diagnostic test and investigations performed. The trend analysis used to see the pattern of costs from 2014 to 2017. All the costs were compared based on patients' status and duration of stay at the hospital using the independent t-test. RESULTS The overall mean of direct medical cost for melioidosis amounted to US $233.61 (RM931.33). Overall, the finding confirms a huge reduction (44.7%) of direct medical cost from 2014 to 2017 (P = 0.001). From 2015 to 2016, there was a 19.1% reduction of direct medical cost (P>0.95), followed by a 38.8% reduction in costs from 2016 to 2017 (P = 0.019). In the case of the duration of stay, the mean of total direct medical cost among patients with ≥14 duration of stay was higher compared to those with <14 duration of stay (p < 0.001). There was no significant mean difference of direct medical cost between patients who were cured and died. CONCLUSION Despite the higher mortality of melioidosis cases compared to other infectious diseases, there is a limitation in the amount of published data on the management cost of melioidosis. The importance of cost in managing this disease should be underlined to perform a fully prepared management toward the disease.
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Affiliation(s)
- Kamaruddin Mardhiah
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Huan-Keat Chan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Hazriah Hasan
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
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18
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Toh V, Tee SP, Lee SH. Clinical characteristics and predictors of mortality in patients with melioidosis: the Kapit experience. Trop Med Int Health 2021; 26:664-671. [PMID: 33590932 DOI: 10.1111/tmi.13563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak. METHODS For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality. RESULTS Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality. CONCLUSION Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.
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Affiliation(s)
- Valerie Toh
- Department of Medicine, Kapit Hospital, Sarawak, Malaysia.,Clinical Research Centre, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Sui Poh Tee
- Department of Medicine, Kapit Hospital, Sarawak, Malaysia.,Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Shen-Han Lee
- Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Kedah, Malaysia
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19
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Gupta AP, Halder R, Chakraborty M, Chakraborty PP. Isolated splenic abscess due to melioidosis in type 1 diabetes mellitus: laboratory diagnosis of Burkholderia pseudomallei in resource-restricted setting. BMJ Case Rep 2021; 14:14/2/e238985. [PMID: 33541991 PMCID: PMC7868293 DOI: 10.1136/bcr-2020-238985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus, type 1 in particular, is a well-recognised risk factor for melioidosis, a disease caused by Burkholderia pseudomallei Melioidosis is endemic in Southeast Asia and in northern Australia and has a variety of clinical presentation, isolated splenic abscess being one of them. B. pseudomallei, however, is an uncommon aetiology of splenic abscess. The diagnosis of melioidosis is often overlooked unless the clinician and the microbiologist are suspicious of the condition. Multiple splenic abscesses and perisplenic collection were noted in CT scan of the abdomen in a patient of type 1 diabetes, presenting with fever for preceding 4 weeks. B. pseudomallei was isolated from the splenic aspirate and the diagnosis was made based on gram stain and routine biochemical tests. He was successfully treated with antibiotics. We postulate that the likely route of infection was inoculation through skin, the integrity of which was compromised by multiple subcutaneous insulin injections.
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Affiliation(s)
| | - Ratan Halder
- Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Mandira Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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20
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Purushotham P, Mohanty S, Chappity P, Mishra TS, Mahapatra A. Identification and Characterization of Burkholderia pseudomallei from Localized Pyogenic Infections in Eastern India: A Clinico-Microbiological Study. Am J Trop Med Hyg 2021; 104:1252-1259. [PMID: 33534740 DOI: 10.4269/ajtmh.20-1386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/15/2020] [Indexed: 11/07/2022] Open
Abstract
Melioidosis, caused by Burkholderia pseudomallei, is increasingly recognized in several regions of the globe. The present study was performed to identify and determine the frequency of B. pseudomallei infection in localized pyogenic lesions in eastern India and describe their clinico-microbiological profile. Pus samples were subjected to standard microbiological techniques for isolation and identification of various bacteria, including B. pseudomallei, which were confirmed by PCR. The clinical and demographic details of patients with melioidosis and antimicrobial susceptibility pattern of B. pseudomallei isolates were analyzed. Of 245 samples, 126 (51.4%) were culture positive, yielding 137 isolates. Staphylococcus aureus was the predominant pathogen accounting for 54 (39.4%) isolates, followed by B. pseudomallei accounting for 34 (24.8%) isolates. The mean age of the patients with melioidosis was 39.1 years, with males (24/34; 70.6%) being affected more than females (10/34; 29.4%). A majority of the patients were laborers (12/34; 35.3), followed by homemakers (8/34; 23.5%). Head and neck abscesses (35.3%) were the most common presentation followed by pyogenic lesions of the musculoskeletal system (32.3%) and deep organ abscesses (23.5%). Clinical resolution of infection was observed in 31 (91.2%) patients, relapse in two (5.9%) patients, and death in one (2.9%) patient, respectively. Susceptibility testing revealed all B. pseudomallei isolates to be completely susceptible to the following antimicrobials: ceftazidime, trimethoprim-sulfamethoxazole, imipenem, and doxycycline, with one (2.9%) resistant to amoxicillin-clavulanic acid. Burkholderia pseudomallei is an emerging etiological agent of localized pyogenic infections in eastern India, affecting a mainly adult male population. An increased vigilance along with appropriate diagnostic techniques helps in accurate diagnosis facilitating appropriate therapy.
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Affiliation(s)
- Prashanth Purushotham
- 1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Srujana Mohanty
- 1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Preetam Chappity
- 2Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Ashoka Mahapatra
- 1Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India
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Mishra B, Vishnu VY, Bhatia R, Garg A, Doddamani RS, Singh P, Chand Sharma M, Singh MB, Rajan R, Gupta A, Srivastava MVP. Case Report: Isolated Central Nervous System Melioidosis from a Non-Endemic Area. Am J Trop Med Hyg 2021; 104:1247-1251. [PMID: 33432911 DOI: 10.4269/ajtmh.20-1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/25/2020] [Indexed: 11/07/2022] Open
Abstract
Central nervous system (CNS) melioidosis is a rare neurological infectious disease which carries a high mortality. We describe a previously healthy middle-aged female, who presented to us with left-sided hemiparesis and was on antitubercular therapy from a previous presumed diagnosis of CNS tuberculoma. Non-characteristic imaging picture, multiple negative body fluid cultures, and positive Cerebrospinal fluid galactomannan led to a further delay in diagnosis. Gram stain of the tissue obtained from brain biopsy revealed Gram-negative rods in "safety pin" appearance. By picking up the colonies that appeared on blood agar and MacConkey agar, the identification of the clinical isolates was performed using VITEK® matrix (BioMerieux)-assisted laser desorption ionization time-of-flight mass spectrometry (VITEK MALDI TOF MS database version 3.2) which revealed Burkholderia pseudomallei. After the institution of appropriate treatment, she survived but with significant morbidity. A high index of suspicion should be kept for such previously healthy individuals belonging to non-endemic areas, where presentation is suspicious of an infective etiology, but not improving despite appropriate therapy. This may help in early recognition and institution of recommended treatment so that mortality can be avoided.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Venugopalan Y Vishnu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Parul Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of NeuroPathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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22
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Corell A, Yilmaz A, Almotairi FS, Farahmand D. Intracranial Manifestation of Melioidosis: A Case Report and Long-Term Follow-Up. Cureus 2020; 12:e12367. [PMID: 33527048 PMCID: PMC7843157 DOI: 10.7759/cureus.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Primary neurological melioidosis is rare with fewer than 50 cases reported world-wide. We report the first documented case of primary neurological melioidosis in Sweden, a 32-year old male who previously lived in Thailand for six years and recently moved to Sweden. He presented with headache, irritability and lack of concentration. Investigation with computerized tomography (CT) and subsequent magnetic resonance imaging (MRI) showed epidural fluid that was interpreted as a chronic epidural hematoma. He underwent surgical evacuation of the epidural collection that was found to be a white collection mixed with pus and bacterial culture results were positive for Burkholderia pseudomallei.
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23
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Wu H, Wang X, Zhou X, Wu Z, Wang Y, Pan M, Lu B. Mycotic aneurysm secondary to melioidosis in China: A series of eight cases and a review of literature. PLoS Negl Trop Dis 2020; 14:e0008525. [PMID: 32785225 PMCID: PMC7446808 DOI: 10.1371/journal.pntd.0008525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 08/24/2020] [Accepted: 06/26/2020] [Indexed: 12/22/2022] Open
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis, endemic in Southeast Asia and Northern Australia, and increasingly recognized in southern China, especially in Hainan Province. Mycotic aneurysm caused by B. pseudomallei is a rare but potentially severe illness with a high mortality rate. The clinical features of the mycotic aneurysm secondary to melioidosis have not been illustrated in China. Over a seven-year period (2013 to 2019), 159 patients with bacteremic melioidosis were retrospectively analyzed in Hainan province, China, of whom eight patients were confirmed to have mycotic aneurysm through the combination of imaging examination, pathologic examination and aneurysm tissue culture. We summarized these eight patients' clinical characteristics, demographical features, treatments and outcomes. The susceptibilities to five commonly-used antibiotics for these eight B. pseudomallei isolates were also determined by E-test strips. Furthermore, the mycotic aneurysm cases secondary to melioidosis retrieved from the literature were also reviewed. Of the eight cases, six had abdominal mycotic aneurysms, one had a left iliac aneurysm, and the other one had an infectious mesenteric aneurysm. They were aged from 48 to 69 years old, and had the underlying risk factors of diabetes mellitus (2 patients), long-term smoking (4 patients), hypertension (6 patients), and soil and water contact history (6 patients), respectively. The positive arterial aneurysm imaging was observed in all patients via computed tomography (CT) or angiography. Eight B. pseudomallei isolates collected from both blood and mycotic aneurysm tissues remained 100% susceptible to imipenem and ceftazidime. After surgery combined with antibiotic administration, six patients survived, with a mortality rate of 25%. In melioidosis endemic areas, the mycotic aneurysm secondary to melioidosis might be underdiagnosed, and increased awareness of predisposing risk factors and clinical features of the mycotic aneurysm is required. Following a positive B. pseudomallei blood culture, the diagnosis of mycotic aneurysm should be under consideration in those with abdominal pain and/or hypertension. Imaging by CT or angiography is indispensable for its timely diagnosis and management.
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Affiliation(s)
- Hua Wu
- Department of Laboratory Medicine, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Xuming Wang
- Department of Laboratory Medicine, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Xiaojun Zhou
- Department of Laboratory Medicine, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Zhicheng Wu
- Department of Laboratory Medicine, First Affiliated Hospital of Hainan Medical College, Haikou, China
| | - Yanyan Wang
- Department of Pathology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, Haikou, China
| | - Mengjie Pan
- Department of Radiology, Hainan General Hospital, Affiliated Hainan Hospital of Hainan Medical College, Haikou, 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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24
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Camargo N, Casadiego GK, Fernandez DA, Millan LV, Hernandez AK, Vargas S, Rios R, Marin-Osorio A, Salcedo S, Rodriguez DL, Bayuelo-Charris IV, Arias CA, Diaz L, Reyes J. A Young Diabetic Patient With Sepsis After Gardening. Open Forum Infect Dis 2020; 7:ofaa159. [PMID: 32494583 PMCID: PMC7252284 DOI: 10.1093/ofid/ofaa159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/11/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of soft tissue infection, sepsis, and bacteremia due to Burkholderia pseudomallei (melioidosis) in a diabetic young patient and the genomic characterization of Burkholderia pseudomallei isolate (COL-5428).
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Affiliation(s)
- Nataly Camargo
- Universidad Libre, Barranquilla, Colombia.,Organización Clínica General del Norte, Barranquilla, Colombia
| | | | | | - Lina V Millan
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Angie K Hernandez
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Sandra Vargas
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | | | - Soraya Salcedo
- Organización Clínica General del Norte, Barranquilla, Colombia
| | | | | | - Cesar A Arias
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Center for Antimicrobial Resistance and Microbial Genomics and Division of Infectious Diseases, UTHealth McGovern School of Medicine, Houston, Texas, USA.,Center for Infectious Diseases, UTHealth School of Public Health, Houston, Texas, USA
| | - Lorena Diaz
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia.,Millennium Initiative for Collaborative Research on Bacterial Resistance (MICROB-R) Santiago, Chile
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
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25
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Choi JY, Hii KC, Bailey ES, Chuang JY, Tang WY, Yuen Wong EK, Ti T, Pau KS, Berita A, Saihidi I, Ting J, Chua TT, Toh TH, AuCoin DP, DeShazer D, Gray GC. Burkholderia pseudomallei Detection among Hospitalized Patients, Sarawak. Am J Trop Med Hyg 2020; 102:388-391. [PMID: 31769397 DOI: 10.4269/ajtmh.19-0625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Burkholderia pseudomallei infections are prevalent in Southeast Asia and northern Australia and often misdiagnosed. Diagnostics are often neither sensitive nor rapid, contributing up to 50% mortality rate. In this 2018 pilot study, we enrolled 100 patients aged 6 months-79 years from Kapit Hospital in Sarawak, Malaysia, with symptoms of B. pseudomallei infection. We used three different methods for the detection of B. pseudomallei: a real-time polymerase chain reaction (PCR) assay, a rapid lateral flow immunoassay, and the standard-of-care bacterial culture-the gold standard. Among the 100 participants, 24 (24%) were positive for B. pseudomallei by one or more of the detection methods. Comparing the two individual diagnostic methods against the gold standard-bacterial culture-of any positive test, there was low sensitivity for each test (25-44%) but high specificity (93-98%). It seems clear that more sensitive diagnostics or a sensitive screening diagnostic followed by specific confirmatory diagnostic is needed for this disease.
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Affiliation(s)
- Jessica Y Choi
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - King Ching Hii
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Emily S Bailey
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Jia Yun Chuang
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Wei Yieng Tang
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | | | - Tiana Ti
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Kat Siong Pau
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Antoinette Berita
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Izreena Saihidi
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Jakie Ting
- Faculty of Medicine, SEGi University, Kota Damansara, Malaysia.,Clinical Research Center, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - Tiing-Tiing Chua
- Clinical Research Center, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - Teck-Hock Toh
- Faculty of Medicine, SEGi University, Kota Damansara, Malaysia.,Clinical Research Center, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | | | - David DeShazer
- US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Gregory C Gray
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Global Health Research Center, Duke-Kunshan University, Kunshan, China.,Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
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26
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Zhu X, Chen H, Li S, Wang LC, Wu DR, Wang XM, Chen RS, Li ZJ, Liu ZG. Molecular Characteristics of Burkholderia pseudomallei Collected From Humans in Hainan, China. Front Microbiol 2020; 11:778. [PMID: 32457710 PMCID: PMC7223694 DOI: 10.3389/fmicb.2020.00778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/01/2020] [Indexed: 12/21/2022] Open
Abstract
Melioidosis is a common infectious disease in Southeast Asia and Northern Australia. In Hainan, several cases have been reported, but no systematic study has yet been done on the molecular epidemiology profiles of the organism. An investigation of the molecular epidemiology links and population structure of Burkholderia pseudomallei would help to better understand the clonally of the isolates and differences among them. In this study, multilocus variable-number tandem repeat analysis (MLVA), and multilocus sequence typing (MLST) were applied to examine the epidemiological relatedness and population structure of 166 B. pseudomallei isolates obtained during 2002–2014 in Hainan, China. Both the MLVA_4 and MLST approaches had high discriminatory power for this population, with diversity indices of 0.9899 and 0.9457, respectively. However, the MLVA_4 assay showed a higher discriminatory power than the MLST approach, and a variable-number tandem repeat (VNTR3 933) found by the MLVA approach was the most useful in discriminating strains from this province. A total of 166 strains yielded 99 MLVA_4 genotypes, of which 34 genotypes were shared by 101 isolates, for a clustering rate of 60.8% (101/166), which suggested that some cases may have a common source. Additionally, 65 isolates showed distinct genotypes, indicating that more than 39.2% (65/166) of melioidosis cases in Hainan had epidemiologically unrelated or sporadic characteristics. The 166 isolates were resolved into 48 STs, of which five STs (ST55, -70, -46, -50, and -58) were here found to be predominant. Phylogenetic analysis of 116 isolates conducted using the eBURST v3 segregated the 48 STs into eight groups with ST50 as predicted founder, and 21 STs were found to be singletons, which suggest that the strains in the Hainan region represent a high diversity of ST clones, indicating that many B. pseudomallei clone groups are endemic to this region. Moreover, ST50 had 5 SLV, 7 DLV, 6 TLV, and 29 satellite STs and formed a radial expansion pattern, suggesting that the melioidosis epidemic in this study was mainly caused by the clonal expansion of ST 50. Phylogenetic analysis on global scale suggests that China’s isolates are closely related to isolates from Southeast Asia, particularly from Thailand and Malaysia.
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Affiliation(s)
- Xiong Zhu
- Sanya People's Hospital, Sanya, China
| | - Hai Chen
- Sanya People's Hospital, Sanya, China
| | - Sha Li
- Sanya People's Hospital, Sanya, China
| | | | | | | | - Ru-Shou Chen
- The Third People's Hospital of Hainan Province, Sanya, China
| | - Zhen-Jun Li
- State Key Laboratory for Infectious Disease Prevention and Control, China Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
| | - Zhi-Guo Liu
- Sanya People's Hospital, Sanya, China.,State Key Laboratory for Infectious Disease Prevention and Control, China Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China
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27
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Abstract
The causative agent of melioidosis, Burkholderia pseudomallei, 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.
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Affiliation(s)
- I Gassiep
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - M Armstrong
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
| | - R Norton
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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28
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Tuberculosis and Melioidosis at Distinct Sites Occurring Simultaneously. Case Rep Infect Dis 2020; 2020:9818129. [PMID: 31984142 PMCID: PMC6964720 DOI: 10.1155/2020/9818129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/19/2019] [Indexed: 12/03/2022] Open
Abstract
Rationale Both tuberculosis and melioidosis are commonly encountered infectious diseases in South East Asia. However, these conditions occur commonly in isolation, cases of coinfection of Mycobacterium tuberculosis and Burkholderia pseudomallei are rare. These cases report of the isolation of both organisms concomitantly in a single disease site. We report the first case of concomitant infection at distinct noncontiguous sites. Patient Concerns A 64-year-old man, with chronic alcohol consumption, presented with a month long history of left-sided abdominal pain, as well as significant weight loss and fever prior to the onset of abdominal pain. Diagnosis Disseminated tuberculosis with pulmonary and gastrointestinal involvement and a splenic abscess due to melioidosis. Interventions The patient was treated concomitantly for pulmonary and gastrointestinal tuberculosis, as well as a splenic abscess due to melioidosis. Outcomes The patient is reported to be well, with resolution of symptoms, as well as radiological resolution of the splenic abscess. Lessons Both melioidosis and tuberculosis can present with a similar clinical picture, and coinfections are rare. Hence, increased awareness among clinicians and microbiologists can help in diagnosing both diseases even when it is not clinically apparent.
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29
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Jakribettu R, Swapna P, George T, Manoj Kumar P, Baliga M. Clinical and laboratory profile of people afflicted with melioidosis: A retrospective study. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_45_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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30
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Sriwijitalai W, Wiwanitkit V. Concurrent melioidosis and tuberculosis: An expected incidence in endemic tropical country. Int J Mycobacteriol 2019; 8:412. [PMID: 31793517 DOI: 10.4103/ijmy.ijmy_148_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Viroj Wiwanitkit
- Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India
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31
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Wu H, Huang D, Wu B, Pan M, Lu B. Fatal deep venous thrombosis and pulmonary embolism secondary to melioidosis in China: case report and literature review. BMC Infect Dis 2019; 19:984. [PMID: 31752745 PMCID: PMC6873490 DOI: 10.1186/s12879-019-4627-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/11/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Burkholderia pseudomallei is a gram-negative bacterium and the causative pathogen of melioidosis, which manifests a variety ranges of infection symptoms. However, deep venous thrombosis (DVT) and pulmonary embolism (PE) secondary to bacteremic melioidosis are rarely documented in the literature. Herein, we reported a fatal case of melioidosis combined with DVT and PE. CASE PRESENTATION A 54-year-old male construction worker and farmer with a history of diabetes was febrile, painful in left thigh, swelling in left lower limb, with chest tightness and shortness of breath for 4 days. He was later diagnosed as DVT of left lower extremity and PE. The culture of his blood, sputum and bone marrow samples grew B. pseudomallei. The subject was administrated with antibiotics (levofloxacin, cefoperazone/tazobactam, and imipenem) according to antimicrobial susceptibility testing and low molecular heparin for venous thrombosis. However, even after appropriate treatment, the patient deteriorated rapidly, and died 2 weeks after admission. CONCLUSIONS This study enhanced awareness of the risk of B. pseudomallei bloodstream infection in those with diabetes. If a patient has predisposing factors of melioidosis, when DVT is suspected, active investigation and multiple therapeutic interventions should be implemented immediately to reduce mortality rate.
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Affiliation(s)
- Hua Wu
- Department of Laboratory Medicine, Hainan General Hospital, No 19 Xiuhua Street, Xiuying District, Haikou, 570311 China
| | - Dongliang Huang
- Department of Emergency, Hainan Armed Police Corps Hospital, Wenmingdong Road, Meilan District, Haikou, 570203 China
| | - Biao Wu
- Department of Infectious Diseases, Hainan General Hospital, No 19 Xiuhua Street, Xiuying District, Haikou, 570311 China
| | - Mengjie Pan
- Department of Radiology, Hainan General Hospital, No 19 Xiuhua Street, Xiuying District, Haikou, 570311 China
| | - Binghuai Lu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
- Center for Respiratory Diseases, China-Japan Friendship Hospital, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
- National Clinical Research Center of Respiratory Diseases, No 2, East Yinghua Road, Chaoyang District, Beijing, 100029 China
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33
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Melioidosis in Colombia, description of a clinical case and epidemiological considerations. ACTA ACUST UNITED AC 2019; 39:10-18. [PMID: 31529845 DOI: 10.7705/biomedica.v39i3.4534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 01/28/2023]
Abstract
Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected.
There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases.
We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.
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34
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Li J, Hu W, Zhang F, Li M, Rao C, Lu W. Evaluation of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for identifying Burkholderia pseudomallei and Burkholderia thailandensis isolates. Eur J Clin Microbiol Infect Dis 2018; 38:191-196. [PMID: 30426332 DOI: 10.1007/s10096-018-3415-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
Abstract
Since Burkholderia thailandensis is included in the reference spectra of the VITEK MS libraries rather than Burkholderia pseudomallei, B. pseudomallei cannot be correctly identified in the current version of VITEK MS. This study was undertaken to evaluate the utility of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with the VITEK MS plus system in the detection of B. pseudomallei and B. thailandensis isolates. For each species, we increased the reference spectra, and then, a SuperSpectrum was created based on the selection of 39 specific masses. In a second step, we validated the SuperSpectra with 106 isolates identified by 16S rRNA gene sequencing. The results showed that there was 100% agreement between the validation strains analyzed by MALDI-TOF MS and those evaluated using 16S rRNA gene sequencing analysis methods. Therefore, MALDI-TOF MS is a promising, rapid, and economical method to monitor the outbreaks and spread of B. pseudomallei and B. thailandensis isolates.
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Affiliation(s)
- Jin Li
- Department of Laboratory Medicine, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Weiwei Hu
- Department of Respiratory and Critical Care Medicine, The first affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Fengling Zhang
- Department of Laboratory Medicine, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Min Li
- Department of Laboratory Medicine, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Chenglong Rao
- Department of Clinical Microbiology and Immunology, College of Medical Laboratory Science, Army Medical University, Chongqing, 400038, People's Republic of China
| | - Weiping Lu
- Department of Laboratory Medicine, Institute of Surgery Research, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
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35
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Nuryastuti T, Umaroh N, Asdie RH, Sari IP, Musthafa A. Pan-drug-resistant and biofilm-producing strain of Burkholderia pseudomallei: first report of melioidosis from a diabetic patient in Yogyakarta, Indonesia. Int Med Case Rep J 2018; 11:319-323. [PMID: 30519120 PMCID: PMC6233691 DOI: 10.2147/imcrj.s173461] [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] [Indexed: 11/23/2022] Open
Abstract
Melioidosis, an infectious disease caused by Burkholderia pseudomallei, has recently gained importance as an emerging infectious disease in Indonesia. Reports of this infection in Indonesia are limited, although cases have been reported in Makassar, South Sulawesi. We report a case of cutaneous melioidosis caused by pan-drug-resistant, moderate biofilm-producer strain of B. pseudomallei in a diabetic patient. To the best of our knowledge, this is the first case of melioidosis caused by multidrug resistant and biofilm-former strain of B. pseudomallei being reported from Yogyakarta Province, Indonesia. The patient was successfully treated with abscess drainage and debridement, including total contact casting and no antibiotic treatment.
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Affiliation(s)
- Titik Nuryastuti
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia,
| | - Nusaibah Umaroh
- Pharmacy Installation of Dr. Kariadi General Hospital, Semarang, Center of Java, Indonesia
| | - Rizka Humardewayanti Asdie
- Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta, Indonesia
| | - Ika Puspita Sari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ahmad Musthafa
- Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia,
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San Martin PFM, Chua JC, Bautista RLP, Nailes JM, Panaligan MM, Dance DAB. Melioidosis in the Philippines. Trop Med Infect Dis 2018; 3:tropicalmed3030099. [PMID: 30274495 PMCID: PMC6161007 DOI: 10.3390/tropicalmed3030099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 11/16/2022] Open
Abstract
The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem.
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Affiliation(s)
- Peter Franz M San Martin
- Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Joseph C Chua
- Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Ralph Louie P Bautista
- Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Jennifer M Nailes
- Department of Preventive and Community Medicine, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Mario M Panaligan
- Department of Medicine, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Old Road Campus, University of Oxford, Oxford OX3 7FZ, UK.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Chen GB, Tuan SH, Chen LH, Lin WS. Neurological melioidosis (Burkholderia pseudomallei) in a chronic psychotic patient treated with antipsychotics: A case report. Medicine (Baltimore) 2018; 97:e11110. [PMID: 29901631 PMCID: PMC6023645 DOI: 10.1097/md.0000000000011110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Neurological melioidosis, an extremely rare condition, is caused by the gram-negative bacterium Burkholderia pseudomallei. If treatment is suboptimal or delayed, this infection can produce diverse clinical symptoms and result in death. PATIENT CONCERNS A healthy 65-year-old female who had been treated with antipsychotic medication for neurotic depression for over 2 years presented with acute-onset fever, headache, lead-pipe rigidity of all limbs, and delirium. DIAGNOSES Melioidosis meningitis was diagnosed by performing blood examinations and cerebrospinal fluid analysis and cultures. INTERVENTIONS Intravenous ceftazidime (2 g/8 h for 3 weeks) was administered in-hospital and 240 mg trimethoprim/1200 mg sulfamethoxazole and 100 mg minocycline twice daily administered out-hospital. OUTCOMES The patient fully recovered after antibiotic therapy without cognitive deficits and associated neurological complications. LESSONS Because melioidosis is endemic in Southern Taiwan and the use of antipsychotics might mask the symptoms, physicians dealing with patients from endemic areas with a medical history of antipsychotics should always consider the possibility of neurological melioidosis and provide prompt empirical management to suspicious cases.
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Affiliation(s)
| | - Sheng-Hui Tuan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan (R.O.C.)
| | | | - Wen-Sou Lin
- Department of Neurology, Kaohsiung Armed Forces General Hospital, National Defense Medical Center, Taipei
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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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Melioidosis in Bangladesh: A Clinical and Epidemiological Analysis of Culture-Confirmed Cases. Trop Med Infect Dis 2018; 3:tropicalmed3020040. [PMID: 30274436 PMCID: PMC6073520 DOI: 10.3390/tropicalmed3020040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022] Open
Abstract
Melioidosis is known to occur in Bangladesh, but there are few reports about the condition in the published international literature. We set out to review all known cases of melioidosis in the country to date, using both retrospective and prospective data. A web-based literature search was conducted to identify all published case reports, original articles and conference abstracts. Cases were also included from a prospective study conducted in 2017. Fifty-one cases were identified between 1961 and 2017. Cases have been reported from sixteen out of the 64 districts of Bangladesh. The median age of the patients at presentation was 45 years (IQR 37–52), with a significant male (77%) predominance. Many patients (14/39; 36%) were farmers and 83% had diabetes mellitus. A skin/soft tissue abscess was the most common primary clinical presentation (13/49; 27%), followed by septic arthritis (10/49; 20%), pneumonia, and a deep-seated abscess/organ abscess (7/49; 14%). The major challenges to the diagnosis and treatment of melioidosis in Bangladesh are the lack of resources and the lack of awareness of melioidosis. Capacity development programs are urgently required to define the burden of disease and to tackle the mortality rates.
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40
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Nathan S, Chieng S, Kingsley PV, Mohan A, Podin Y, Ooi MH, Mariappan V, Vellasamy KM, Vadivelu J, Daim S, How SH. Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis. Trop Med Infect Dis 2018; 3:E25. [PMID: 30274422 PMCID: PMC6136604 DOI: 10.3390/tropicalmed3010025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 02/18/2018] [Accepted: 02/18/2018] [Indexed: 12/12/2022] Open
Abstract
Malaysia is an endemic hot spot for melioidosis; however, a comprehensive picture of the burden of disease, clinical presentations, and challenges faced in diagnosis and treatment of melioidosis is not available. This review provides a nonexhaustive overview of epidemiological data, clinical studies, risk factors, and mortality rates from available literature and case reports. Clinical patterns of melioidosis are generally consistent with those from South and Southeast Asia in terms of common primary presentations with diabetes as a major risk factor. Early diagnosis and appropriate management of Malaysian patients is a key limiting factor, which needs to be addressed to reduce serious complications and high mortality and recurrence rates. Promoting awareness among the local healthcare personnel is crucial to improving diagnostics and early treatment, as well as educating the Malaysian public on disease symptoms and risk factors. A further matter of urgency is the need to make this a notifiable disease and the establishment of a national melioidosis registry. We also highlight local studies on the causative agent, Burkholderia pseudomallei, with regards to bacteriology and identification of virulence factors as well as findings from host⁻pathogen interaction studies. Collectively, these studies have uncovered new correlations and insights for further understanding of the disease.
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Affiliation(s)
- Sheila Nathan
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | - Sylvia Chieng
- School of Biosciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | | | - Anand Mohan
- Department of Paediatrics, Bintulu Hospital, Bintulu 97000, Malaysia.
| | - Yuwana Podin
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia.
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia.
- Department of Paediatrics, Sarawak General Hospital, Kuching 93586, Malaysia.
| | - Vanitha Mariappan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Kumutha Malar Vellasamy
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Jamuna Vadivelu
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
| | - Sylvia Daim
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Science, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia.
| | - Soon-Hin How
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan 25200, Malaysia.
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41
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Pande K, Abd Kadir KA, Asli R, Chong VH. Melioidosis in Brunei Darussalam. Trop Med Infect Dis 2018; 3:tropicalmed3010020. [PMID: 30274418 PMCID: PMC6136610 DOI: 10.3390/tropicalmed3010020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 02/11/2018] [Accepted: 02/14/2018] [Indexed: 11/16/2022] Open
Abstract
Melioidosis continues to be a major health care problem in Brunei Darussalam. The age of patients, gender distribution, risk factors, and clinical presentations are similar to those reported from other countries in the region. The incidence of melioidosis was high during the wet months and in the Temburong district, which has the highest annual rainfall. In spite of adequate facilities for diagnosis and treatment, the mortality remains high (27%). Women and those presenting with septic shock had higher mortality. There is a case for making melioidosis a notifiable disease in Brunei Darussalam. Coordinated efforts between policy-makers and various stakeholders are required to effectively combat the disease.
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Affiliation(s)
- Ketan Pande
- Department of Orthopaedics, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BG 1710, Negara Brunei Darussalam.
| | - Khairul Azmi Abd Kadir
- Department of Orthopaedics, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BG 1710, Negara Brunei Darussalam.
| | - Rosmonaliza Asli
- Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BG 1710, Negara Brunei Darussalam.
| | - Vui Heng Chong
- Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BG 1710, Negara Brunei Darussalam.
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42
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Quraishi MK, Phan YC, Asaad W, Lynn N. Prostatic abscess: a rare complication of staghorn calculi. BMJ Case Rep 2018; 2018:bcr-2017-222917. [PMID: 29391357 DOI: 10.1136/bcr-2017-222917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A staghorn calculus is a calculus accommodating the majority of a renal calyx extending into the renal pelvis. A conservative approach to its treatment may lead to high morbidity and mortality rates. Such morbidity usually manifests with renal failure, obstructed upper urinary tractand/or life-threatening sepsis. Prostatic abscesses have never been associated with staghorn calculi in the literature. We report a case of a 70-year-old man who presented with sepsis, which was found to originate from a complex prostatic abscess. The patient had no history of urinary tract infections or risk factors. The authors believe that the incidentally identified staghorn calculi promoted the growth of Proteus mirabilis which led to the development of the prostatic abscess. The patient underwent a transurethral resection and drainage of the abscess following a failed course of antibiotic therapy. This case also highlights the paucity of guidelines available in treating prostatic abscesses.
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Affiliation(s)
| | - Yih Chyn Phan
- Department of Urology, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Wael Asaad
- Department of Urology, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Naing Lynn
- Department of Urology, Royal Shrewsbury Hospital, Shrewsbury, UK
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43
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Curtis MW, Hahn BL, Zhang K, Li C, Robinson RT, Coburn J. Characterization of Stress and Innate Immunity Resistance of Wild-Type and Δ p66 Borrelia burgdorferi. Infect Immun 2018; 86:e00186-17. [PMID: 29158430 PMCID: PMC5778354 DOI: 10.1128/iai.00186-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023] Open
Abstract
Borrelia burgdorferi is a causative agent of Lyme disease, the most common arthropod-borne disease in the United States. B. burgdorferi evades host immune defenses to establish a persistent, disseminated infection. Previous work showed that P66-deficient B. burgdorferi (Δp66) is cleared quickly after inoculation in mice. We demonstrate that the Δp66 strain is rapidly cleared from the skin inoculation site prior to dissemination. The rapid clearance of Δp66 bacteria is not due to inherent defects in multiple properties that might affect infectivity: bacterial outer membrane integrity, motility, chemotactic response, or nutrient acquisition. This led us to the hypothesis that P66 has a role in mouse cathelicidin-related antimicrobial peptide (mCRAMP; a major skin antimicrobial peptide) and/or neutrophil evasion. Neither wild-type (WT) nor Δp66 B. burgdorferi was susceptible to mCRAMP. To examine the role of neutrophil evasion, we administered neutrophil-depleting antibody anti-Ly6G (1A8) to C3H/HeN mice and subsequently monitored the course of B. burgdorferi infection. Δp66 mutants were unable to establish infection in neutrophil-depleted mice, suggesting that the important role of P66 during early infection is through another mechanism. Neutrophil depletion did not affect WT B. burgdorferi bacterial burdens in the skin (inoculation site), ear, heart, or tibiotarsal joint at early time points postinoculation. This was unexpected given that prior in vitro studies demonstrated neutrophils phagocytose and kill B. burgdorferi These data, together with our previous work, suggest that despite the in vitro ability of host innate defenses to kill B. burgdorferi, individual innate immune mechanisms have limited contributions to controlling early B. burgdorferi infection in the laboratory model used.
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Affiliation(s)
- Michael W Curtis
- Graduate Program in Microbiology, Immunology, and Molecular Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Beth L Hahn
- Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kai Zhang
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, New York, USA
| | - Chunhao Li
- Department of Oral Biology, State University of New York at Buffalo, Buffalo, New York, USA
- Department of Microbiology and Immunology, State University of New York at Buffalo, Buffalo, New York, USA
| | - Richard T Robinson
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jenifer Coburn
- Department of Microbiology and Immunology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Medicine, Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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44
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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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45
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Chee YC, Chee YN. An unusual case of primary melioidotic prostatic abscess complicated by perianal abscess. IDCases 2018; 11:51-52. [PMID: 29349040 PMCID: PMC5767560 DOI: 10.1016/j.idcr.2018.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/29/2022] Open
Abstract
Burkholderia pseudomallei is recognized to cause severe and fatal infections. Most of the infections caused by this facultative intracellular gram-negative bacterium are pneumonia, soft tissue, genito-urinary and central nervous system infection. We report an unusual case of primary prostatic abscess complicated by perianal abscess caused by Burkholderia pseudomallei. Melioidosis related anorectal infections have not been previously reported in the literature.
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Affiliation(s)
- Y C Chee
- Department of Medicine, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Y N Chee
- Department of General Medicine, Monash Health, Victoria, Australia
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46
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Ong SCL, Alemam MMM, Zakaria NA, Abdul Halim NA. Honeycomb and necklace signs in liver abscesses secondary to melioidosis. BMJ Case Rep 2017; 2017:bcr-2017-222342. [PMID: 29054959 DOI: 10.1136/bcr-2017-222342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Melioidosis is endemic in Southeast Asia and tropical Australia with varying clinical features from benign skin lesions to fatal septicaemia. Imaging plays an important role in evaluation of the melioid liver abscesses. A 45-year-old man with underlying diabetes presented with fever and lethargy for 2 weeks and abdominal pain for 2 days. His liver was enlarged on examination. Blood investigations revealed mild leucocytosis and raised liver enzymes. Ultrasound showed multiple multiloculated hypoechoic lesions throughout the liver and spleen. CT of abdomen confirmed that some liver lesions were made up of asymmetric locules of varying sizes (honeycomb sign), while others had hypodense centre with small symmetric peripheral locules in radial fashion (necklace sign). Blood culture was positive for Burkholderia pseudomallei He was subsequently treated with ceftazidime for a month followed by oral trimethoprim-sulfamethoxazole for 3 months. Follow-up CT of abdomen a month after diagnosis and treatment showed resolving hepatic and splenic lesions.
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Affiliation(s)
- Sidney Ching Liang Ong
- Radiology Department, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Mina Mustafa Mahmood Alemam
- Department of Medicine, Clinical Campus, International Medical University, Seremban, Negeri Sembilan, Malaysia
| | - Nor Aniza Zakaria
- Department of Diagnostic Imaging, Hospital Tuanku Ampuan Najihah, Kuala Pilah, Negeri Sembilan, Malaysia
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