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PubMed1990

Diagnostic value of the indirect hemagglutination test for melioidosis in an endemic area.

The indirect hemagglutination antibody (IHA) test for melioidosis was evaluated in 373 healthy blood donors, 65 cord blood samples from healthy neonates, 30 patients with acute melioidosis (13 of whom were septicemic), and 154 individuals hospitalized with various illnesses. Twenty-one percent of healthy blood donors had titers greater than or equal to 1: 40, demonstrating that Songkla is an endemic area. The sensitivity, specificity, and accuracy at titers greater than or equal to 1:160 were 77%, 92%, and 89%, respectively. This cut-off level is higher than that used in previous reports from non-endemic areas. The test did not recognize patients with the acute fulminating form.

Antibodies, Bacterial↗
PubMed1992

Serial serum C-reactive protein levels as an aid to the management of melioidosis.

Of 46 patients with clinical melioidosis, 35 (22 culture-positive and 13 culture-negative) had relatively uneventful disease courses, with elevated serum C-reactive protein (CRP) concentrations (greater than 5 mg/dl) that decreased with the commencement of appropriate antibiotic therapy, and continued to show an uninterrupted decrease (mean 29.4 days, range 12-52 days) to the normal range (less than 1 mg/dl), with resolution of their infections. In five culture-positive patients with complicated disease courses, CRP concentrations remained elevated (greater than 5 mg/dl) until the underlying disorders were successfully managed, or until the antibiotic regimen was changed, and CRP values then decreased to the normal range. During surveillance, elevated CRP concentrations (greater than 10 mg/dl) led to the diagnosis of reactivation of infection in three afebrile patients, while the serum CRP values in other patients remained within the normal range in the absence of intercurrent complications. The CRP estimations may be helpful in ascertaining active infection in patients with low serum levels of specific IgM antibody, and serial measurements of serum CRP in patients with clinical melioidosis may be useful in determining the optimal duration of treatment and for detecting occult or unresolved infection with Pseudomonas pseudomallei.

Adolescent↗
PubMed1999

Short report: evaluation of a monoclonal antibody-based latex agglutination test for rapid diagnosis of septicemic melioidosis.

A monoclonal antibody (MAb)-based latex agglutination (MAb-LA) test was developed to rapidly identify Burkholderia pseudomallei in hemoculture of patients with septicemic melioidosis. The method was evaluated in a clinical situation on 396 hemocultures positive for bacterial growth, of which 75 cultures were positive for B. pseudomallei by conventional biochemical tests. The sensitivity and specificity of the MAb-LA test were 95% and 100%, respectively. The positive and negative predictive values were 100% and 99%. The method is highly reliable and suitable for rapid diagnosis of septicemic melioidosis, reducing the time normally required from a minimum of 3-4 days by conventional methods to less than 30 hr. Most of these 30 hr are involved in growing up enough bacteria to perform the MAb-LA test, which itself takes only 1 min.

Antibodies, Monoclonal↗
PubMedDate not supplied

Comparison of the polymerase chain reaction and serologic tests for diagnosis of septicemic melioidosis.

For diagnosis of melioidosis, we compared polymerase chain reaction (PCR)-based DNA detection and three serologic methods with the culture method currently used as gold standard. The diagnostic values of the serologic methods were evaluated in 130 patients. All these patients resided in an endemic area. An enzyme-linked immunosorbent assay (ELISA) gave slightly higher specificity (86.2%) than a dot immunoassay (DOT) (85.3%), but was superior to an indirect hemagglutination assay (IHA) (79.8%). The sensitivities of the DOT (85.7%) and ELISA (71.4%) were considerably higher than that of IHA (61.9%). However, the PCR was the most sensitive (95.2%) and specific (91.7%). Nevertheless, DOT and ELISA are more practical for local hospitals. With the high negative predictive value of both the ELISA (94.0%) and DOT (96.9%) in a high prevalence area, clearly these methods can rule out most of the non-melioidosis patients.

Antibodies, Bacterial↗
PubMed1992

A case of human melioidosis originating in south-west Western Australia.

OBJECTIVE: To report the first human case of autochthonous melioidosis in temperate Australia (latitude 31 degrees 10'S) and to describe the extent of the presence of the causative agent, Pseudomonas pseudomallei, in southwest Western Australia. CLINICAL FEATURES: A 45-year-old man living on a hobby farm was admitted to hospital for investigation of lung lesions, weight loss and low grade fevers. P. pseudomallei was cultured from material from an aspiration biopsy of a mediastinal mass. INTERVENTION AND OUTCOME: The patient was successfully treated with a regimen of ceftazidime and trimethoprim-sulfamethoxazole. A review of epidemiological data showed that, since 1967, P. pseudomallei has been cultured from animals and soil in a region 50-250 km north-west of Perth, Western Australia, and that pockets of endemicity are found in the districts of Toodyay (where our patient's farm was), Chittering, Ballidu, Gidgegannup, Badgingarra, and Wongan Hills. CONCLUSION: The persistence of the bacterium in animals and soil in south-west Western Australia demonstrates abundantly that P. pseudomallei can exist opportunely beyond its traditional tropical habitat. It is likely that there will be further clinical cases of melioidosis originating in this region, and that the boundaries of endemicity in Australia will expand further.

Animals↗
PubMed1997

Fatal human melioidosis in south-eastern Queensland.

Two simultaneous human cases of fatal melioidosis in temperate south-eastern Queensland involved patients who had had pre-existing multisystem illnesses, had sustained cutaneous lesions before illness onset, and died from overwhelming sepsis. Onset of disease was preceded by unseasonably heavy rainfall. These and other features of these cases suggest that the source of infection was local, in which case the endemicity of Burkholderia pseudomallei in temperate regional Australia may be broader than is currently recognised, and melioidosis may need to be considered in at-risk patients in these areas, as well as in tropical and subtropical areas, who present with severe pneumonia and septicaemia.

Acute Disease↗
PubMed1970

Melioidosis in imported non-human primates.

In 1969, five cases of melioidosis in three separate outbreaks were diagnosed in nonhuman primates in the United States. In the first outbreak, two stump-tailed macaque monkeys (Macaca arctoides) developed signs of the disease approximately 6 months after purchase. A third animal, a chimpanzee (Pan troglodytes), probably acquired its infection from one of these monkeys. Two other unrelated cases involving a pig-tailed monkey (Macaca nemestrina) and a rhesus monkey (Macaca mulatta) were diagnosed. These monkeys had been imported 3 years and 6 months, respectively, prior to the recognized onset of their disease. These cases represent the first known occurrences of spontaneous melioidosis in nonhuman primates in the United States.

Animals↗
PubMed1998

[Pulmonary melioidosis].

Melioidosis is most frequently encountered in pulmonary localization. Melioidosis is an infectious disease caused by Burkholderia pseudomallei first described by Whitmore in 1912 in Burma. B. pseudomallei is a Gram negative rod belonging to the Pseudomonadaceae family. Soil and water are the natural reservoirs for the germ which is a specific pathogen for several mammal species. Long endemic in Southeast Asia and several tropical zones, B. pseudomallei has recently been found in temperate zones, including France. Human contamination occurs via the transcutaneous route and often leads to dormant inapparent infection. Many conditions, such as diabetes, renal lithiasis, various circumstances of immunodepression or stress, facilitate clinical manifestations which vary greatly. Pulmonary manifestations may be acute and extensive, producing a torpid pseudo-tuberculous condition or a variety of clinical and radiological features mimicking other diseases. Bacteriological and serological tests may be negative. Exposure in an endemic zone, the notion of a favorable context, weight loss, cavitary images on successive chest x-rays and the presence of extra-pulmonary localizations may be suggestive. Ceftazidime or the amoxicillin-clavulanic acid combination are indicated, but mortality in acute forms still reaches 40%. Relapse can be expected if the treatment duration is too short.

Amoxicillin↗
PubMed1976

[Effect of prodigiosin on the lysozyme activity in melioidosis].

Decreased lysozyme activity was observed under conditions of melioidosis intoxication in rats induced by intraperitoneal administration of an acetone-killed 3-day culture of the bacterial mass of the melioidosis causative agent. When prodigiozan was administered 48 hours by the 4th day which was indicative of prodigiozan activation of the factors of the microbial non-specific resistance.

Animals↗
PubMed1997

Diabetic ketoacidosis and melioidosis in a child.

A case of 5 year old diabetic girl with melioidosis was reported. She presented with the symptoms and signs of intraabdominal infection, septicemia and diabetic ketoacidosis. Abdominal ultrasonography showed multiple splenic and liver abscesses, melioidosis was suspected. Hemoculture and pus culture yielded Burkholderia pseudomallei which was susceptible to ceftazidime and cotrimoxazole. Correction of fluid and electrolyte combined with insulin therapy and proper antibiotics resulted in a good outcome in this patient.

Anti-Bacterial Agents↗
PubMed2000

Imipenem therapy for septicemic melioidosis in a child with penicillin and cephalosporin adverse reaction.

The recommended treatment for severe melioidosis is ceftazidime or a combination of ceftazidime and trimethoprim-sulfamethoxazole (TMP/SMX). Amoxicillin-clavulanate has been shown to be an effective alternative therapy. In patient who is allergic to penicillin and cephalosporin, imipenem an alternative drug may be used. We described a 10 year-old boy who was diagnosed as septicemic melioidosis and type 1 diabetes mellitus. He developed fever and rash while being given ceftazidime and TMP/SMX. The fever recurred when amoxicillin-clavulanate was administered orally. He was successfully treated with imipenem.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed2000

Transient asceptic arthritis of knees in a patient with melioidosis.

Osteomyelitis and septic arthritis are known manifestations of melioidosis. Whether reactive arthritis can occur as a sequele to B. pseudomallei infection, is yet to be seen. As more and more cases of melioidosis will be reported in future, this aspect has to be kept in mind.

Arthritis↗
PubMed2001

Melioidosis splenic abscess--an unusual presentation as osteomyelitis of rib.

INTRODUCTION: We report an unusual case of splenic melioidosis abscess presenting as osteomyelitis. CLINICAL PICTURE: A 74-year-old nondiabetic gentleman presents with a non-healing left chest wall abscess from osteomyelitis. TREATMENT: He underwent rib resection and the infection was found to involve the underlying pleura, lung, adjacent stomach, liver and diaphragm with a splenic abscess. Splenectomy was performed. Histology showed suppurative granulomas and cultures grew Burkholderia pseudomallei. OUTCOME: The patient recovered well with antibiotics. CONCLUSION: Melioidosis should not be forgotten as a cause of chronic suppurative infections in our endemic population.

Abscess↗
PubMed2001

Acute respiratory failure in melioidosis.

BACKGROUND: In melioidosis caused by Burkholderia pseudomallei, although every organ in the body may be involved, the highest mortality of 73% occurs when the respiratory system is affected. These patients invariably die of acute respiratory failure. Most of them also have underlying predisposing factors like diabetes mellitus. AIM OF STUDY: A retrospective study of six such cases was carried out in order to elicit the possible causes and mechanisms of acute respiratory failure in patients with melioidosis. METHOD: Patients' records were reviewed for demographic, clinical, laboratory, radiological and histopathological data. RESULTS: The rapidity of onset of respiratory failure was remarkable and was accompanied by relentless hypoxaemia that was refractory to treatment despite the application of high positive end expiratory pressure and other supportive measures. All had bilateral opacities on frontal chest radiographs, focal and diffuse necrotizing pneumonia and presence of hyaline membranes in lung tissues seen histologically, supporting the accepted criteria for ALI/ARDS. CONCLUSION: Patients with sepsis due to B. pseudomallei develop ALI/ARDS very rapidly resulting in high mortality rates. Possible mechanisms involved are discussed. Awareness of the disease in endemic areas, the development of rapid diagnostic methods and appropriate management procedures are urgently needed for the prevention of ARDS and subsequent reduction in mortality in such cases.

Acute Disease↗
PubMed2001

Porphyria cutanea tarda and melioidosis.

Porphyria cutanea tarda is a metabolic disorder in the haem biosynthetic pathway. It includes a heterogeneous group of conditions, which may be inherited or, more commonly, acquired. Although porphyria cutanea tarda presents with cutaneous lesions only, it is often associated with systemic disease. A 64-year-old Chinese patient, who developed sporadic porphyria cutanea tarda 1 year after the diagnosis of pulmonary melioidosis, is discussed. The patient presented with a history of recurrent photosensitive vesicles, blisters, and skin fragility on the sun-exposed areas of both forearms and hands, 6 months after commencing doxycycline and amoxycillin. Both the histological and biochemical findings were characteristic of porphyria cutanea tarda. All the lesions subsided after cessation of these antibiotics. The patient was free of further lesions at follow-up 6 months later. The association seen in this case between porphyria cutanea tarda and melioidosis is unlikely to be coincidental, because these two diseases are both very rare in Hong Kong. In addition, the temporal relationship between the antibiotic therapy and the clinical course of skin lesions in this patient suggests that the drugs were a trigger factor, precipitating their appearance.

Anti-Bacterial Agents↗
PubMed2001

A case of thoracic empyema due to suppurative melioidosis.

Melioidosis is considered a rare disease in Hong Kong, and its diagnosis and treatment can be difficult. We report the case of a patient who presented with thoracic empyema. The material sampled from the empyema was initially labelled Burkholderia cepacia. The diagnosis of melioidosis due to Burkholderia pseudomallei could only be made after repeated cultures, and performing arginine dihydrolase and serological tests. The patient was initially treated with imipenem for 2 weeks, and then with ciprofloxacin as maintenance therapy. A resistant strain of the organism developed after 7 months of treatment. The patient was then given co-amoxiclav. Repeated courses of surgical drainage and debridement were also instituted. Subsequent computed tomographic scanning of the thorax showed gradual resolution of the empyema.

Empyema, Pleural↗
PubMed2001

Retrospective study on the diagnostic value of IgG ELISA, dot immunoassay and indirect hemagglutination in septicemic melioidosis.

Three serological methods for diagnosis of melioidosis were compared with the culture method currently used as the "gold standard". The diagnostic values of the serological methods were evaluated retrospectively in 306 patients residing in an endemic area. The enzyme-linked immunosorbent assay (ELISA), using affinity purified antigen for detecting specific IgG antibody, showed a slightly higher specificity (86.0%) than the dot immunoassay (DOT) (84.0%) and both were superior to indirect hemagglutination (IHA) (72.0%). The sensitivity of DOT (96.4%) and ELISA (85.7%) were considerably higher than that of IHA (50.0%). The primary benefit of the high negative predictive value of both ELISA (96.4%) and DOT (99.0%) in an area of high prevalence is the ability to rule out most of the non-melioidosis patients.

Bacteremia↗
PubMed2002

Melioidosis--a report from Pondicherry, South India.

Melioidosis is an acute infectious disease caused by a safety-pin-shaped gram-negative bacteria called Burkholderia pseudomallei. Here, we report the first case of melioidosis in a middle aged male agricultural worker, from Pondicherry. The isolation of this organism from subcutaneous nodules on the extensor aspect of his limbs underlines the diversity of its clinical presentation. Difficulty in identifying the organism which mimics any other non-fementing gram-negative bacilli (NFGNB) on cursory examination, highlights the importance of identification of NFGNB in endemic areas for specific treatment and prevention.

Anti-Bacterial Agents↗