Rationale:Melioidosis is a serious opportunistic infection caused by Burkholderia(B.)pseudomallei,primarily affecting immunocompromised individuals,particularly in endemic regions.Timely diagnosis and appropriate trea...Rationale:Melioidosis is a serious opportunistic infection caused by Burkholderia(B.)pseudomallei,primarily affecting immunocompromised individuals,particularly in endemic regions.Timely diagnosis and appropriate treatment are crucial to prevent fatal outcomes.Patient concerns:Case 1 was a 34-year-old male kidney transplant recipient who presented with a 15-day history of intermittent fever,accompanied by liver and spleen abscesses.Case 2 was a 37-year-old female kidney transplant recipient who presented with acute febrile illness and developed leucopenia.Blood cultures for both patients grew B.pseudomallei.Diagnosis:Both patients were diagnosed with melioidosis caused by B.pseudomallei,with the diagnosis confirmed through pus culture from the liver abscess in Case 1 and blood culture in Case 2.Interventions:Both patients were treated with an intensive regimen of meropenem(renal-adjusted doses),followed by a 3-month course of oral cotrimoxazole for eradication therapy.Outcomes:Case 1 experienced resolution of liver and spleen abscesses after 3 months of treatment and continued to recover well.In Case 2,blood cultures became sterile after 4 weeks,with no further complications observed.Lessons:Melioidosis should be suspected in immunocompromised patients,especially kidney transplant recipients,who present with unexplained fever and sepsis-like symptoms.Early diagnosis through aspiration of abscesses and prompt treatment are critical for preventing relapses and improving patient outcomes.展开更多
Burkholderia pseudomallei(B.pseudomallei)is a Gram-negative bacterium that widely exists in soil and water in the tropics.Contacting environment contaminated with B.pseudomallei,such as the inhalation or ingesting of ...Burkholderia pseudomallei(B.pseudomallei)is a Gram-negative bacterium that widely exists in soil and water in the tropics.Contacting environment contaminated with B.pseudomallei,such as the inhalation or ingesting of polluted soil or water,is likely to contribute to the infection of B.pseudomallei,and may further lead to melioidosis pneumonia.[1]As a corollary,the diagnosis of melioidosis pneumonia largely relies on the identification of positive blood culture with B.pseudomallei,clinical symptoms associated with pulmonary inflammation(high fever,cough.展开更多
BACKGROUND Melioidosis,an infectious disease caused by Burkholderia pseudomallei(B.pseudomallei),occurs endemically in Southeast Asia and Northern Australia and is a serious opportunistic infection associated with a h...BACKGROUND Melioidosis,an infectious disease caused by Burkholderia pseudomallei(B.pseudomallei),occurs endemically in Southeast Asia and Northern Australia and is a serious opportunistic infection associated with a high mortality rate.CASE SUMMARY A 58-year-old woman presented with scattered erythema on the skin of her limbs,followed by fever and seizures.B.pseudomallei was isolated successively from the patient’s urine,blood,and pus.Magnetic resonance imaging showed abscess formation involving the right forehead and the right frontal region.Subsequently,abscess resection and drainage were performed.The patient showed no signs of relapse after 4 months of follow-up visits post-treatment.CONCLUSION We present here a unique case of multi-systemic melioidosis that occurs in nonendemic regions in a patient who had no recent travel history.Hence,it is critical to enhance awareness of melioidosis in non-endemic regions.展开更多
This editorial is a commentary on the article by Ni et al,which was published in the World Journal of Clinical Cases.The article discusses the diagnostic and therapeutic challenges of melioidosis caused by Burkholderi...This editorial is a commentary on the article by Ni et al,which was published in the World Journal of Clinical Cases.The article discusses the diagnostic and therapeutic challenges of melioidosis caused by Burkholderia pseudomallei.The case study highlights a rare instance of multisystemic melioidosis in a female patient who did not have a travel history,emphasizing the significance of recognizing this condition in non-endemic regions.Diagnostic complexities and therapeutic strategies are addressed,emphasizing the need for heightened clinical suspicion,comprehensive evaluation,and multidisciplinary collaboration.The editorial delves into the clinical presentation,diagnostic dilemmas,therapeutic approaches,and their implications for patient care in managing multi-systemic melioidosis.展开更多
Introduction: Melioidosis is a tropical infectious disease caused by Gramnegative bacteria Burkholderia pseudomallei (B. pseudomallei). This soil-borne disease is endemic in Southeast Asia and Northern Australia. In o...Introduction: Melioidosis is a tropical infectious disease caused by Gramnegative bacteria Burkholderia pseudomallei (B. pseudomallei). This soil-borne disease is endemic in Southeast Asia and Northern Australia. In our country it was reported once before in 2000 in a patient who presented with subdural empyema. Case Series Report: We are reporting six cases of Melioidosis presented to our hospital in very close time with different clinical presentations. All patients were from Indian subcontinent. In 3 cases we treated with Meropenem plus Trimethoprim-Sulfamethoxazole (TMP-SMX) followed by oral TMP-SMX and Doxycycline for around 6 months with good clinical and radiological response, while the fourth case was treated with oral TMP-SMX and Doxycycline for 1 month but he lost to follow up, the Fifth cases were treated with IV Ceftazidime followed by TMP-SMX and Doxycycline for 9 weeks, the Sixth cases were treated with IV Ceftazidime followed by TMP-SMX and Amoxicillin/Clavulanic acid for 20 days, there was no mortality reported in our case series for both types Bactraemic and Abactraemic Melioidosis. Conclusions: This case series highlights the importance of early identification of B. pseudomallei which requires a high index of clinical suspicion as well as good understanding of demographical and travel history. Microbiological identification of B. pseudomallei is essential and requires notification of the microbiologist for suspicion of that infection. Prolonged antimicrobial therapy is required for a better clinical outcome.展开更多
Objective:To study characteristics,clinical outcomes and factors influencing mortality of patients afflicted with melioidosis.Methods:A total of 134 patients were retrospectively analyzed with a microbiologically-conf...Objective:To study characteristics,clinical outcomes and factors influencing mortality of patients afflicted with melioidosis.Methods:A total of 134 patients were retrospectively analyzed with a microbiologically-confirmed diagnosis of melioidosis,during the period from January 2002 to June 2011 at Songklanagarind Hospital,a tertiary care hospital in southern Thailand.Results:The prevalence of melioidosis among admitted patients was 36.8 per100000 in patients.The median age was 49 years and they were predominantly male.The most common underlying disease was diabetes mellitus(47.01%).The majority of cases(50%)had localized infection.The rates of multifocal,bacteremic,and disseminated infections were12.7%.23.1%.and 14.2%.respectively.The lungs were the most common organ afflicted,resulting in infection(24.63%).Splenic abscess as well as liver abscess accounted for 20.90%and 19.40%.respectively.A total of one eighth of the patients had septic shock at presentation.The overall mortality rate was 8.96%.The factors influencing mortality were pneumonia,septic shock,a positive blood culture for Burkholderia pseudomallei.superimposing with nosocomial infection and inappropriate antibiotic administration.Conclusions:Melioidosis is not uncommon in southern Thailand.The mortality of patients with pneumonia,bacteremia and septic shock is relatively high.Appropriate antibiotics,initially,will improve outcomes.展开更多
Objective:To compare the prognostic factors of mortality among melioidosis patients between lognormal accelerated failure time(AFT),Cox proportional hazards(PH),and Cox PH with time-varying coefficient(TVC)models.Meth...Objective:To compare the prognostic factors of mortality among melioidosis patients between lognormal accelerated failure time(AFT),Cox proportional hazards(PH),and Cox PH with time-varying coefficient(TVC)models.Methods:A retrospective study was conducted from 2014 to 2019 among 453 patients who were admitted to Hospital Sultanah Bahiyah,Kedah and Hospital Tuanku Fauziah,Perlis in Northern Malaysia due to confirmed-cultured melioidosis.The prognostic factors of mortality from melioidosis were obtained from AFT survival analysis,and Cox’s models and the findings were compared by using the goodness of fit methods.The analyses were done by using Stata SE version 14.0.Results:A total of 242 patients(53.4%)survived.In this study,the median survival time of melioidosis patients was 30.0 days(95%CI 0.0-60.9).Six significant prognostic factors were identified in the Cox PH model and Cox PH-TVC model.In AFT survival analysis,a total of seven significant prognostic factors were identified.The results were found to be only a slight difference between the identified prognostic factors among the models.AFT survival showed better results compared to Cox's models,with the lowest Akaike information criteria and best fitted Cox-snell residuals.Conclusions:AFT survival analysis provides more reliable results and can be used as an alternative statistical analysis for determining the prognostic factors of mortality in melioidosis patients in certain situations.展开更多
Objective:To identify the predictors of mortality among in-hospital melioidosis patients.Methods:A total of 453 patients in Hospital Sultanah Bahiyah,Kedah,and Hospital Tuanku Fauziah,Perlis with culture-confirmed mel...Objective:To identify the predictors of mortality among in-hospital melioidosis patients.Methods:A total of 453 patients in Hospital Sultanah Bahiyah,Kedah,and Hospital Tuanku Fauziah,Perlis with culture-confirmed melioidosis were retrospectively included in the study.Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis.The analysis was performed using STATA/SE 14.0.Results:A total of 50.11%(227/453)of the patients died at the hospital,and a majority(86.75%,393/453)of cases were bacteremic.The logistic regression estimated that the bacteremic type of melioidosis,low platelet count,abnormal white blood cell counts,and increased urea value were predictors of mortality.The results showed that bacteremic melioidosis increased the risk of death by 4.39 times(OR 4.39,95%CI 1.83-10.55,P=0.001)compared to non-bacteremic melioidosis.Based on laboratory test,the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease[high white blood cell(>10×10^(9)/L):OR 2.43,95%CI1.41-4.17,P<0.001;low white blood cell(<4×10^(9)/L):OR 3.82,95%CI 1.09-13.34,P=0.036;low platelet(<100×10^(9)/L):OR 4.19,95%CI 1.89-9.30,P<0.001;high urea(>7800μmol/L):OR 5.53,95%CI 2.50-12.30,P<0.001;and low level of urea(<2500μmol/L):OR 3.52,95%CI 1.71-7.23,P=0.001].Conclusions:Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.展开更多
Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality a...Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy:intravenous ceftazidime, eradication therapy: oral trimethoprim-sulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.展开更多
Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia wi...Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melidoidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.展开更多
Melioidosis is an unusual tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei,which was formerly known as Pseudomonas pseudomallei. Melioidosis is characterized by abscess forma...Melioidosis is an unusual tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei,which was formerly known as Pseudomonas pseudomallei. Melioidosis is characterized by abscess formation and it may manifest in any part of the human body,however,musculoskeletal melioidosis is uncommon and chest wall melioidosis is very rare. To determine the exact organism based solely on clinical presentation poses a great challenge to the physician.Yet,delay administration of antibiotic may be harmful.We describe a diabetic patient who had anterior chest wall melioidosis that mimics Staphylococcus aureus infection.A description of his presentation and management,along with a review of literature is presented.展开更多
Objective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further com...Objective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further compared the clinical epidemiology of the melioidosis cases in India with case series from highly endemic areas in Northern Australia and Southeast Asia to elucidate any differences in presentations and risk factors between the regions.Results: We identified a total of 99 cases published between 1953 and June 2016, originating from India(n=85) or Bangladesh(n=14). Cases were predominantly male and ranged in age from 1 month to 90 years. Diabetes mellitus was the most common risk factor reported(58%). About 28% of the cases had history of exposure via high-risk occupations or exposure to contaminated water. The overall case fatality rate(CFR) was 26%. Factors influencing mortality included the occurrence of septic shock(CFR, 80%), environmental exposure(CFR,39%), primary presentation of pneumonia(CFR, 38%), misdiagnosed and/or mistreated cases(CFR, 33%) or the presence of a risk factor(CFR, 29%). Because of the small number of cases in Bangladesh, pattern of clinical epidemiology is limited to India. Soft tissue abscess(37%)was the most common clinical presentation reported from India followed by pneumonia(24%)and osteomyelitis/septic arthritis(18%). Neurological melioidosis(n=10, 12%) presented as pyemic lesions of the brain or meninges. A few cases of prostatic abscess(n=4) in men and parotid abscess(n=4) were also noted. The above patterns were consistent with case series from Southeast Asia and Northern Australia for the most part, in terms of risk factors associated with infection and factors influencing mortality. Differences included clinical presentation of pneumonia which was notably lower than that reported in Southeast Asia and Northern Australia; a higher proportion of neurological and parotid abscess presentation; and a lower CFR compared to that reported in case series in Southeast Asia. About 39% of the cases were misdiagnosed and/or mistreated, suggesting underreporting and under estimation of the true disease burden. Conclusions: The concentration of melioidosis cases in southern and eastern states in India and in Bangladesh, which share climatic conditions and rice farming activities with known endemic areas in Southeast Asia, suggests an endemicity of melioidosis in this region. Thus, increased awareness among healthcare personnel, particularly among clinicians and nurses practicing in rural areas, and improved surveillance through case registries is essential to guide early diagnosis and prompt treatment.展开更多
Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visua...Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.展开更多
Objective:To analyze the clinical and follow-up data of patients with multiple organ failure of melioidosis pneumonia,to strengthen the understanding of melioidosis,and to provide references for the diagnosis and trea...Objective:To analyze the clinical and follow-up data of patients with multiple organ failure of melioidosis pneumonia,to strengthen the understanding of melioidosis,and to provide references for the diagnosis and treatment of clinicians,especially doctors in Hai nan province with high incidence,so as to reduce misdiagnosis,improve the diagnosis rate and reduce the mortality.Methods:The clinical symptoms,signs,laboratory examination and follow-up of patients with multiple organ failure were analyzed retrospectively.Results:Multiple organ failure with melioidosis pneumonia was easily misdiagnosed,Treatment cycle is long,easy to relapse.Conclusion:It is very important to analyze and differentiate the anthrax with multiple organ failure,especially in Hai nan province,which can improve the diagnosis rate and reduce the mortality.展开更多
Melioidosis, an infection caused by Gram-negative Burkholderia pseudomallei (Bp), has high clinical recurrence and mortality rates associated with pneumonia and sepsis. With the limitations in current therapeutic opti...Melioidosis, an infection caused by Gram-negative Burkholderia pseudomallei (Bp), has high clinical recurrence and mortality rates associated with pneumonia and sepsis. With the limitations in current therapeutic options and the lack of available human vaccines, development of novel countermeasures against Bp infection is vital. In this study, we evaluated the efficacy of an aminoalkyl glucosaminide 4-phosphate (AGP), a synthetic toll like receptor 4 agonist (CRX-527), in conferring protection against melioidosis in a murine model. Survival data showed 66% of mice treated with AGP prior to lethal intranasal Bp challenge survived and presented no signs of illness over a 3 months period. In contrast, all control mice succumbed to infection within 4 days. Kinetic study on organ bacterial burden demonstrated mice treated with AGP had dramatically reduced bacterial loads in both the lungs and spleens as compared to control mice. Notably, all but one AGP-treated mouse had no Bp growth in the blood as compared to overwhelming bacteraemia found in all control mice. The protective effect of CRX-527 was associated with a transient increase in pulmonary cytokine/ chemokine levels, which boosted the host’s innate immunity. This enabled rapid clearance of the pulmonary and systemic bacterial burden and prevented the development of sepsis. This study demonstrated the potential use of TLR4 agonist as a prophylactic immunotherapy in preventing melioidosis.展开更多
Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the dela...Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the delay in diagnosing the primary site infection.We present a case of septic arthritis with primary lung melioidosis,whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis.This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients,even in non-endemic areas.It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.展开更多
A deterministic model for the transmission dynamics of melioidosis disease in human population is designed and analyzed.The model is shown to exhibit the phenomenon of backward bifurcation,where a stable disease-free ...A deterministic model for the transmission dynamics of melioidosis disease in human population is designed and analyzed.The model is shown to exhibit the phenomenon of backward bifurcation,where a stable disease-free equilibrium co-exists with a stable endemic equilibrium when the basic reproduction number R_(0) is less than one.It is further shown that the backward bifurcation dynamics is caused by the reinfection of individuals who recovered from the disease and relapse.The existence of backward bifurcation implies that bringing down R_(0) to less than unity is not enough for disease eradication.In the absence of backward bifurcation,the global asymptotic stability of the disease-free equilibrium is shown whenever R_(0)<1.For R_(0)>1,the existence of at least one locally asymptotically stable endemic equilibrium is shown.Sensitivity analysis of the model,using the parameters relevant to the transmission dynamics of the melioidosis disease,is discussed.Numerical experiments are presented to support the theoretical analysis of the model.In the numerical experimentations,it has been observed that screening and treating individuals in the exposed class has a significant impact on the disease dynamics.展开更多
We report a 27-year-old male from Kuwait who died due to melioidosis,and the diagnosis was achieved after the deceased underwent postmortem examination at the Forensic Department,Kuala Lumpur Hospital.While the diseas...We report a 27-year-old male from Kuwait who died due to melioidosis,and the diagnosis was achieved after the deceased underwent postmortem examination at the Forensic Department,Kuala Lumpur Hospital.While the disease is endemic in Southeast Asia and Northern Australia,human melioidosis infection has yet been reported in Kuwait.He was initially diagnosed as acute gastroenteritis at a private clinic before being found dead at a hotel in Kuala Lumpur.The autopsy revealed positive findings of Burkholderia pseudomallei in the deceased brain,lung,liver,and spleen as well as in the blood and cerebrospinal fluid culture.The deceased^death highlights the importance of early accurate diagnosis,the common manifestations,and the need of effective antibiotic treatment of septicemic melioidosis in high prevalent areas.展开更多
Melioidosis,a disease of public health importance in Southeast Asia and Northern Australia,of late has shown an increasing trend in India,particularly Southern India.We describe a ease of a 39-year-old diabetic patien...Melioidosis,a disease of public health importance in Southeast Asia and Northern Australia,of late has shown an increasing trend in India,particularly Southern India.We describe a ease of a 39-year-old diabetic patient with left elbow septic arthritis,multiple liver,splenic abscesses, pneumonia,pleural effusion,followed by sepsis syndrome.Blood cultures and culture of the joint aspirate yielded pure growth of Burkholderia psettdomallei(B.pesudomallei),sensitive to carbapenem,co-trimoxazole and resistant to ceftazidime.The patient was successfully treated with imipenem- cilastin.He was discharged on co-trimoxazole to complete the 24 weeks course and follow-up has continued to date.The patient continues to remain asymptomatic.The case re-emphasizes the need to monitor the trend of B.pseudomallei in India,particularly the development of ceftazidime resistance,which incidentally is the drug of choice.展开更多
Objective:To investigate the banding patterns of whole cell protein(WCP) and outer membrane protein (OMP) of Burkholderia pseudomallei(B.pseudomallei) in clinical isolates from patients with melioidosis. Methods:WCP a...Objective:To investigate the banding patterns of whole cell protein(WCP) and outer membrane protein (OMP) of Burkholderia pseudomallei(B.pseudomallei) in clinical isolates from patients with melioidosis. Methods:WCP and OMP of of B.pseudomallei in 50 clinical isolates,from 47 patients with melioidosis were prepared and separated by polyacrylamide gel electrophoresis(SDS-PAGE) using 10%gels and stained with Coomassie brilliant blue.The banding patterns were compared by using a laser densitometer and dendrogram. Results:There were 6 different banding patterns of WCP and 2 types of OMP.Type 1 -5 WCP had 8 common protein bands at 19.0 - 45.0 kDa with identical OMP pattern.The banding patterns of WCP in type 6 were distinct from the others and also its OMP profile.The majority of clinical isolates(37/50,74%) were in type 1 WCP.Of the remaining isolates,8 were in type 2,2 in type 3,and one each was in type 4 to 6.There was no significant association between the WCP typing and the demographic or clinical features of the investigated patients.Conclusion:Despite the wide variation of clinical features of melioidosis,the results of this study show that B.pseudomallei had a few differences in the WCP and OMP profiles.Therefore typing of WCP and OMP,using SDS-PAGE analysis,could be an alternative method for phenotypic differentiation in clinical isolates of B.pseudomallei.展开更多
文摘Rationale:Melioidosis is a serious opportunistic infection caused by Burkholderia(B.)pseudomallei,primarily affecting immunocompromised individuals,particularly in endemic regions.Timely diagnosis and appropriate treatment are crucial to prevent fatal outcomes.Patient concerns:Case 1 was a 34-year-old male kidney transplant recipient who presented with a 15-day history of intermittent fever,accompanied by liver and spleen abscesses.Case 2 was a 37-year-old female kidney transplant recipient who presented with acute febrile illness and developed leucopenia.Blood cultures for both patients grew B.pseudomallei.Diagnosis:Both patients were diagnosed with melioidosis caused by B.pseudomallei,with the diagnosis confirmed through pus culture from the liver abscess in Case 1 and blood culture in Case 2.Interventions:Both patients were treated with an intensive regimen of meropenem(renal-adjusted doses),followed by a 3-month course of oral cotrimoxazole for eradication therapy.Outcomes:Case 1 experienced resolution of liver and spleen abscesses after 3 months of treatment and continued to recover well.In Case 2,blood cultures became sterile after 4 weeks,with no further complications observed.Lessons:Melioidosis should be suspected in immunocompromised patients,especially kidney transplant recipients,who present with unexplained fever and sepsis-like symptoms.Early diagnosis through aspiration of abscesses and prompt treatment are critical for preventing relapses and improving patient outcomes.
基金supported by the Key Project of Education Department of Hainan Province(Hnky2023ZD-9)the Key Research and Development Project of Hainan Province,China(ZDYF2023SHFZ102).
文摘Burkholderia pseudomallei(B.pseudomallei)is a Gram-negative bacterium that widely exists in soil and water in the tropics.Contacting environment contaminated with B.pseudomallei,such as the inhalation or ingesting of polluted soil or water,is likely to contribute to the infection of B.pseudomallei,and may further lead to melioidosis pneumonia.[1]As a corollary,the diagnosis of melioidosis pneumonia largely relies on the identification of positive blood culture with B.pseudomallei,clinical symptoms associated with pulmonary inflammation(high fever,cough.
文摘BACKGROUND Melioidosis,an infectious disease caused by Burkholderia pseudomallei(B.pseudomallei),occurs endemically in Southeast Asia and Northern Australia and is a serious opportunistic infection associated with a high mortality rate.CASE SUMMARY A 58-year-old woman presented with scattered erythema on the skin of her limbs,followed by fever and seizures.B.pseudomallei was isolated successively from the patient’s urine,blood,and pus.Magnetic resonance imaging showed abscess formation involving the right forehead and the right frontal region.Subsequently,abscess resection and drainage were performed.The patient showed no signs of relapse after 4 months of follow-up visits post-treatment.CONCLUSION We present here a unique case of multi-systemic melioidosis that occurs in nonendemic regions in a patient who had no recent travel history.Hence,it is critical to enhance awareness of melioidosis in non-endemic regions.
文摘This editorial is a commentary on the article by Ni et al,which was published in the World Journal of Clinical Cases.The article discusses the diagnostic and therapeutic challenges of melioidosis caused by Burkholderia pseudomallei.The case study highlights a rare instance of multisystemic melioidosis in a female patient who did not have a travel history,emphasizing the significance of recognizing this condition in non-endemic regions.Diagnostic complexities and therapeutic strategies are addressed,emphasizing the need for heightened clinical suspicion,comprehensive evaluation,and multidisciplinary collaboration.The editorial delves into the clinical presentation,diagnostic dilemmas,therapeutic approaches,and their implications for patient care in managing multi-systemic melioidosis.
文摘Introduction: Melioidosis is a tropical infectious disease caused by Gramnegative bacteria Burkholderia pseudomallei (B. pseudomallei). This soil-borne disease is endemic in Southeast Asia and Northern Australia. In our country it was reported once before in 2000 in a patient who presented with subdural empyema. Case Series Report: We are reporting six cases of Melioidosis presented to our hospital in very close time with different clinical presentations. All patients were from Indian subcontinent. In 3 cases we treated with Meropenem plus Trimethoprim-Sulfamethoxazole (TMP-SMX) followed by oral TMP-SMX and Doxycycline for around 6 months with good clinical and radiological response, while the fourth case was treated with oral TMP-SMX and Doxycycline for 1 month but he lost to follow up, the Fifth cases were treated with IV Ceftazidime followed by TMP-SMX and Doxycycline for 9 weeks, the Sixth cases were treated with IV Ceftazidime followed by TMP-SMX and Amoxicillin/Clavulanic acid for 20 days, there was no mortality reported in our case series for both types Bactraemic and Abactraemic Melioidosis. Conclusions: This case series highlights the importance of early identification of B. pseudomallei which requires a high index of clinical suspicion as well as good understanding of demographical and travel history. Microbiological identification of B. pseudomallei is essential and requires notification of the microbiologist for suspicion of that infection. Prolonged antimicrobial therapy is required for a better clinical outcome.
文摘Objective:To study characteristics,clinical outcomes and factors influencing mortality of patients afflicted with melioidosis.Methods:A total of 134 patients were retrospectively analyzed with a microbiologically-confirmed diagnosis of melioidosis,during the period from January 2002 to June 2011 at Songklanagarind Hospital,a tertiary care hospital in southern Thailand.Results:The prevalence of melioidosis among admitted patients was 36.8 per100000 in patients.The median age was 49 years and they were predominantly male.The most common underlying disease was diabetes mellitus(47.01%).The majority of cases(50%)had localized infection.The rates of multifocal,bacteremic,and disseminated infections were12.7%.23.1%.and 14.2%.respectively.The lungs were the most common organ afflicted,resulting in infection(24.63%).Splenic abscess as well as liver abscess accounted for 20.90%and 19.40%.respectively.A total of one eighth of the patients had septic shock at presentation.The overall mortality rate was 8.96%.The factors influencing mortality were pneumonia,septic shock,a positive blood culture for Burkholderia pseudomallei.superimposing with nosocomial infection and inappropriate antibiotic administration.Conclusions:Melioidosis is not uncommon in southern Thailand.The mortality of patients with pneumonia,bacteremia and septic shock is relatively high.Appropriate antibiotics,initially,will improve outcomes.
文摘Objective:To compare the prognostic factors of mortality among melioidosis patients between lognormal accelerated failure time(AFT),Cox proportional hazards(PH),and Cox PH with time-varying coefficient(TVC)models.Methods:A retrospective study was conducted from 2014 to 2019 among 453 patients who were admitted to Hospital Sultanah Bahiyah,Kedah and Hospital Tuanku Fauziah,Perlis in Northern Malaysia due to confirmed-cultured melioidosis.The prognostic factors of mortality from melioidosis were obtained from AFT survival analysis,and Cox’s models and the findings were compared by using the goodness of fit methods.The analyses were done by using Stata SE version 14.0.Results:A total of 242 patients(53.4%)survived.In this study,the median survival time of melioidosis patients was 30.0 days(95%CI 0.0-60.9).Six significant prognostic factors were identified in the Cox PH model and Cox PH-TVC model.In AFT survival analysis,a total of seven significant prognostic factors were identified.The results were found to be only a slight difference between the identified prognostic factors among the models.AFT survival showed better results compared to Cox's models,with the lowest Akaike information criteria and best fitted Cox-snell residuals.Conclusions:AFT survival analysis provides more reliable results and can be used as an alternative statistical analysis for determining the prognostic factors of mortality in melioidosis patients in certain situations.
基金supported by Universiti Sultan Zainal Abidin(grant number:Uni SZA/2018/DPU/16)
文摘Objective:To identify the predictors of mortality among in-hospital melioidosis patients.Methods:A total of 453 patients in Hospital Sultanah Bahiyah,Kedah,and Hospital Tuanku Fauziah,Perlis with culture-confirmed melioidosis were retrospectively included in the study.Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis.The analysis was performed using STATA/SE 14.0.Results:A total of 50.11%(227/453)of the patients died at the hospital,and a majority(86.75%,393/453)of cases were bacteremic.The logistic regression estimated that the bacteremic type of melioidosis,low platelet count,abnormal white blood cell counts,and increased urea value were predictors of mortality.The results showed that bacteremic melioidosis increased the risk of death by 4.39 times(OR 4.39,95%CI 1.83-10.55,P=0.001)compared to non-bacteremic melioidosis.Based on laboratory test,the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease[high white blood cell(>10×10^(9)/L):OR 2.43,95%CI1.41-4.17,P<0.001;low white blood cell(<4×10^(9)/L):OR 3.82,95%CI 1.09-13.34,P=0.036;low platelet(<100×10^(9)/L):OR 4.19,95%CI 1.89-9.30,P<0.001;high urea(>7800μmol/L):OR 5.53,95%CI 2.50-12.30,P<0.001;and low level of urea(<2500μmol/L):OR 3.52,95%CI 1.71-7.23,P=0.001].Conclusions:Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.
文摘Rationale: Burkholderia pseudomallei is a Gram-negative bacterium and the causative pathogen of melioidosis, which manifests with a broad spectrum of clinical syndromes. Melioidosis is associated with high mortality and is endemic across tropical areas, especially in Southeast Asia and northern Australia. Patient concern: A 24-year-old diabetic male complained of fever and left upper quadrant abdominal pain for one-week duration. Diagnosis: Melioidosis with ruptured splenic abscess and splenic vein thrombosis. Interventions: Antimicrobial therapy (intensive therapy:intravenous ceftazidime, eradication therapy: oral trimethoprim-sulfamethoxazole), and anti-coagulation (enoxaparin, then warfarin). Outcomes: Resolution of splenic abscess and splenic vein thrombosis. Lessons: Both splenic abscess and splenic vein thrombosis are uncommon but severe complications associated with melioidosis. Ultrasound is useful for diagnosis and monitoring response to treatment in such cases.
文摘Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melidoidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.
文摘Melioidosis is an unusual tropical infectious disease caused by the gram-negative bacterium Burkholderia pseudomallei,which was formerly known as Pseudomonas pseudomallei. Melioidosis is characterized by abscess formation and it may manifest in any part of the human body,however,musculoskeletal melioidosis is uncommon and chest wall melioidosis is very rare. To determine the exact organism based solely on clinical presentation poses a great challenge to the physician.Yet,delay administration of antibiotic may be harmful.We describe a diabetic patient who had anterior chest wall melioidosis that mimics Staphylococcus aureus infection.A description of his presentation and management,along with a review of literature is presented.
文摘Objective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further compared the clinical epidemiology of the melioidosis cases in India with case series from highly endemic areas in Northern Australia and Southeast Asia to elucidate any differences in presentations and risk factors between the regions.Results: We identified a total of 99 cases published between 1953 and June 2016, originating from India(n=85) or Bangladesh(n=14). Cases were predominantly male and ranged in age from 1 month to 90 years. Diabetes mellitus was the most common risk factor reported(58%). About 28% of the cases had history of exposure via high-risk occupations or exposure to contaminated water. The overall case fatality rate(CFR) was 26%. Factors influencing mortality included the occurrence of septic shock(CFR, 80%), environmental exposure(CFR,39%), primary presentation of pneumonia(CFR, 38%), misdiagnosed and/or mistreated cases(CFR, 33%) or the presence of a risk factor(CFR, 29%). Because of the small number of cases in Bangladesh, pattern of clinical epidemiology is limited to India. Soft tissue abscess(37%)was the most common clinical presentation reported from India followed by pneumonia(24%)and osteomyelitis/septic arthritis(18%). Neurological melioidosis(n=10, 12%) presented as pyemic lesions of the brain or meninges. A few cases of prostatic abscess(n=4) in men and parotid abscess(n=4) were also noted. The above patterns were consistent with case series from Southeast Asia and Northern Australia for the most part, in terms of risk factors associated with infection and factors influencing mortality. Differences included clinical presentation of pneumonia which was notably lower than that reported in Southeast Asia and Northern Australia; a higher proportion of neurological and parotid abscess presentation; and a lower CFR compared to that reported in case series in Southeast Asia. About 39% of the cases were misdiagnosed and/or mistreated, suggesting underreporting and under estimation of the true disease burden. Conclusions: The concentration of melioidosis cases in southern and eastern states in India and in Bangladesh, which share climatic conditions and rice farming activities with known endemic areas in Southeast Asia, suggests an endemicity of melioidosis in this region. Thus, increased awareness among healthcare personnel, particularly among clinicians and nurses practicing in rural areas, and improved surveillance through case registries is essential to guide early diagnosis and prompt treatment.
文摘Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.
基金National Natural Science Foundation of China(No.81660010,31660329,8191101552)
文摘Objective:To analyze the clinical and follow-up data of patients with multiple organ failure of melioidosis pneumonia,to strengthen the understanding of melioidosis,and to provide references for the diagnosis and treatment of clinicians,especially doctors in Hai nan province with high incidence,so as to reduce misdiagnosis,improve the diagnosis rate and reduce the mortality.Methods:The clinical symptoms,signs,laboratory examination and follow-up of patients with multiple organ failure were analyzed retrospectively.Results:Multiple organ failure with melioidosis pneumonia was easily misdiagnosed,Treatment cycle is long,easy to relapse.Conclusion:It is very important to analyze and differentiate the anthrax with multiple organ failure,especially in Hai nan province,which can improve the diagnosis rate and reduce the mortality.
文摘Melioidosis, an infection caused by Gram-negative Burkholderia pseudomallei (Bp), has high clinical recurrence and mortality rates associated with pneumonia and sepsis. With the limitations in current therapeutic options and the lack of available human vaccines, development of novel countermeasures against Bp infection is vital. In this study, we evaluated the efficacy of an aminoalkyl glucosaminide 4-phosphate (AGP), a synthetic toll like receptor 4 agonist (CRX-527), in conferring protection against melioidosis in a murine model. Survival data showed 66% of mice treated with AGP prior to lethal intranasal Bp challenge survived and presented no signs of illness over a 3 months period. In contrast, all control mice succumbed to infection within 4 days. Kinetic study on organ bacterial burden demonstrated mice treated with AGP had dramatically reduced bacterial loads in both the lungs and spleens as compared to control mice. Notably, all but one AGP-treated mouse had no Bp growth in the blood as compared to overwhelming bacteraemia found in all control mice. The protective effect of CRX-527 was associated with a transient increase in pulmonary cytokine/ chemokine levels, which boosted the host’s innate immunity. This enabled rapid clearance of the pulmonary and systemic bacterial burden and prevented the development of sepsis. This study demonstrated the potential use of TLR4 agonist as a prophylactic immunotherapy in preventing melioidosis.
文摘Clinical spectrum of melioidosis can vary from a simple skin infection and pneumonia to severe septicaemia with multiorgan failure.Bone involvement in melioidosis is generally low,and the major risk factor is the delay in diagnosing the primary site infection.We present a case of septic arthritis with primary lung melioidosis,whose diagnosis of pulmonary melioidosis was delayed for 5 weeks leading to a septicaemia and septic arthritis.This case highlights the importance of improved clinical awareness among health practitioners and a low threshold for radiological screening of high-risk patients,even in non-endemic areas.It also highlights the fact that having adjunctive open arthrotomy in managing joint infection in melioidosis improves the clinical response to treatment.
文摘A deterministic model for the transmission dynamics of melioidosis disease in human population is designed and analyzed.The model is shown to exhibit the phenomenon of backward bifurcation,where a stable disease-free equilibrium co-exists with a stable endemic equilibrium when the basic reproduction number R_(0) is less than one.It is further shown that the backward bifurcation dynamics is caused by the reinfection of individuals who recovered from the disease and relapse.The existence of backward bifurcation implies that bringing down R_(0) to less than unity is not enough for disease eradication.In the absence of backward bifurcation,the global asymptotic stability of the disease-free equilibrium is shown whenever R_(0)<1.For R_(0)>1,the existence of at least one locally asymptotically stable endemic equilibrium is shown.Sensitivity analysis of the model,using the parameters relevant to the transmission dynamics of the melioidosis disease,is discussed.Numerical experiments are presented to support the theoretical analysis of the model.In the numerical experimentations,it has been observed that screening and treating individuals in the exposed class has a significant impact on the disease dynamics.
文摘We report a 27-year-old male from Kuwait who died due to melioidosis,and the diagnosis was achieved after the deceased underwent postmortem examination at the Forensic Department,Kuala Lumpur Hospital.While the disease is endemic in Southeast Asia and Northern Australia,human melioidosis infection has yet been reported in Kuwait.He was initially diagnosed as acute gastroenteritis at a private clinic before being found dead at a hotel in Kuala Lumpur.The autopsy revealed positive findings of Burkholderia pseudomallei in the deceased brain,lung,liver,and spleen as well as in the blood and cerebrospinal fluid culture.The deceased^death highlights the importance of early accurate diagnosis,the common manifestations,and the need of effective antibiotic treatment of septicemic melioidosis in high prevalent areas.
文摘Melioidosis,a disease of public health importance in Southeast Asia and Northern Australia,of late has shown an increasing trend in India,particularly Southern India.We describe a ease of a 39-year-old diabetic patient with left elbow septic arthritis,multiple liver,splenic abscesses, pneumonia,pleural effusion,followed by sepsis syndrome.Blood cultures and culture of the joint aspirate yielded pure growth of Burkholderia psettdomallei(B.pesudomallei),sensitive to carbapenem,co-trimoxazole and resistant to ceftazidime.The patient was successfully treated with imipenem- cilastin.He was discharged on co-trimoxazole to complete the 24 weeks course and follow-up has continued to date.The patient continues to remain asymptomatic.The case re-emphasizes the need to monitor the trend of B.pseudomallei in India,particularly the development of ceftazidime resistance,which incidentally is the drug of choice.
基金supported by the Mahidol-Oxford Tropical Medicine Research Unit,UK.
文摘Objective:To investigate the banding patterns of whole cell protein(WCP) and outer membrane protein (OMP) of Burkholderia pseudomallei(B.pseudomallei) in clinical isolates from patients with melioidosis. Methods:WCP and OMP of of B.pseudomallei in 50 clinical isolates,from 47 patients with melioidosis were prepared and separated by polyacrylamide gel electrophoresis(SDS-PAGE) using 10%gels and stained with Coomassie brilliant blue.The banding patterns were compared by using a laser densitometer and dendrogram. Results:There were 6 different banding patterns of WCP and 2 types of OMP.Type 1 -5 WCP had 8 common protein bands at 19.0 - 45.0 kDa with identical OMP pattern.The banding patterns of WCP in type 6 were distinct from the others and also its OMP profile.The majority of clinical isolates(37/50,74%) were in type 1 WCP.Of the remaining isolates,8 were in type 2,2 in type 3,and one each was in type 4 to 6.There was no significant association between the WCP typing and the demographic or clinical features of the investigated patients.Conclusion:Despite the wide variation of clinical features of melioidosis,the results of this study show that B.pseudomallei had a few differences in the WCP and OMP profiles.Therefore typing of WCP and OMP,using SDS-PAGE analysis,could be an alternative method for phenotypic differentiation in clinical isolates of B.pseudomallei.
