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An autopsied case is reported concerning fulminant sepsis with predominantly pulmonary lesions, caused by Burkholderia pseudomallei, etiologic agent of melioidosis, originating from interior of Ceará State, Northeastern Brazil where there had been no previous cases reported. Autopsy findings and differential diagnosis are discussed.
From January 1982 to May 2000, 17 infections caused by Burkholderia pseudomallei were diagnosed in 15 patients in Taiwan; almost all the infections were diagnosed from 1994 to May 2000. Of the 15 patients, 9 (60%) had underlying diseases, and 10 (67%) had bacteremic pneumonia. Thirteen (76%) episodes of infection were considered indigenous. Four patients died of melioidosis. Seventeen B. pseudomallei isolates, recovered from eight patients from November 1996 to May 2000, were analyzed to determine their in vitro susceptibilities to 14 antimicrobial agents, cellular fatty acid and biochemical reaction profiles, and randomly amplified polymorphic DNA patterns. Eight strains (highly related isolates) were identified. All isolates were arabinose non-assimilators and were susceptible to amoxicillin-clavulanate, piperacillin-tazobactam, imipenem, and meropenem. No spread of the strain was documented.
We report the first case of human melioidosis from Mauritius, where Burkholderia pseudomallei has never been isolated. The patient was immunocompromised, had never traveled abroad, and had a history of regular exposure to mud. She became ill at a time when rainfall was higher than the monthly average.
During the last 4 years, 20 cases of clinical melioidosis were diagnosed in the geographical area between Tully and Thursday Island. Sixteen were diagnosed by culture of Pseudomonas pseudomallei, and four by positive serology with appropriate clinical features. Most cases occurred during or after a heavy wet season. All patients were adult, and males predominated. Farmers and stockmen represented predisposed populations due to their prolonged soil contact. Ten patients were white Australians, six were Aborigines and four were Torres Strait Islanders. Twelve cases were first diagnosed by positive blood culture and four by sputum culture. The primary site of infection was pulmonary in 14 cases, genitourinary tract in one case, subcutaneous tissues in one case, and joints in two cases. In cases of fulminating infection metastatic abscesses were commonly found in many organs; typically lungs, liver, kidneys and spleen. Six patients had acute fulminating disease and died. Fourteen patients successfully responded to appropriate therapy, but relapse occurred in three, all of whom had an alcohol problem and showed poor drug compliance. The presence of diabetes mellitus in six patients confirmed the important known association of these two diseases. In three fulminating and four subacute infections the serology was negative at the time of diagnosis by culture. Antibiotic therapy for the different forms of this disease is reviewed, and a laboratory protocol for the rapid reporting of positive culture results is included.
Sera from 9,047 individuals from Northern Queensland were examined for the presence of hemagglutinating antibodies to Pseudomonas pseudomallei, the causative agent of melioidosis, and 512 (5.7%) were found to have titers of 1:40 or greater. The distribution of positive reactors in various groups was uneven, and significantly higher prevalences of positive antibody titers were found in the sera from Aborigines (7.9-10.6%), Torres Strait Islanders (7.8%), Vietnamese refugees (29%) and from persons with certain medical conditions including chronic alcoholism (15%), chronic infections (14.8%), diabetes mellitus (8.6%) and liver disease (12.9%). There were significantly fewer positive reactors (1.4%) amongst the armed forces stationed in Northern Queensland. At present, the boundaries of the major endemic region of Australia extend north from Rockhampton along the coast to Darwin and inland, west from Rockhampton to Tennant Creek in central Australia. Townsville was found to have the highest prevalence (5.2%) of positive reactors of all urban populations of Northern Queensland. The extent of the disease is such that it can no longer be considered a rare infection in Northern Queensland.
Monoclonal antibodies (MAbs) specific for Pseudomonas pseudomallei antigens were produced by immunizing BALB/c mice with a crude whole cell extract. Hybrids secreting MAbs specific for P. pseudomallei antigens were identified by an indirect enzyme-linked immunosorbent assay (ELISA) against a panel of crude whole cell extracts from P. pseudomallei, P. cepacia, P. aeruginosa, P. putida, P. alcaligenes, Xanthomonas maltophilia, Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, Salmonella typhi, S. krefeld, S. enteritidis, Proteus mirabilis, and Staphylococcus aureus. Of the six specific clones, clone 5F8, which was IgM-producing and which reacted with all 56 P. pseudomallei isolates, was selected for further characterization and evaluation of its possible diagnostic potential. Results obtained from the indirect ELISA against various P. pseudomallei antigens, from direct bacterial agglutination, and from immunofluorescence tests suggested that 5F8 reacted with the surface envelope, and probably specifically with an epitope of the lipopolysaccharide. The antibody could be readily used to identify P. pseudomallei in primary culture or in a simulated hemoculture. The antibody was also used to prepare an affinity-purified antigen for use in an indirect ELISA that was highly sensitive and specific for the detection of circulating antibody in patients with acute septicemic melioidosis.
We report a case of melioidosis with left adrenal gland abscess in a 51-year-old man from Taiwan who traveled to Rangoon, Burma for a four-day tour on July 15, 1997. The patient developed fever and left upper abdominal pain upon returning to Taiwan on July 19, 1997. Ten days after returning to Taiwan, he was admitted to Chang Gung Memorial Hospital in Keelung, Taiwan and blood culture on admission was positive for Burkholderia pseudomallei. Computerized tomography of the abdomen revealed left adrenal gland swelling and suppuration. Treatment with parenteral ceftazidime and cotrimoxazole for three weeks followed by two months of oral cotrimoxazole cured the infection. The patient remained asymptomatic at 12 months follow-up.
Melioidosis caused by Burkholderia pseudomallei is endemic in southeast Asia. The clinical manifestations range from wound infections to acute septicemia. In some cases, recurrence can also occur following complete recovery. Case fatality rates are high and a major factor is the delay in the culture and identification of the bacterium. An immunofluorescent assay (IFAT) using whole-cell antigen for the detection of total antibodies to B. pseudomallei was tested with 650 sera. Using a cut-off value of 1:80, 66 sera from culture-confirmed cases were positive with titers > or = 320. In another 523 sera from patients in which no other etiology could be found, 149 (23.4%) were positive. To monitor disease activity, persistence of antibody levels was investigated on 61 serial sera samples collected from 14 other confirmed cases on follow-up visits while on oral maintenance therapy. The IFAT demonstrated a reduction in titers in cases of localized infections, suggesting that either the infection was being resolved or arrested while septicemic patients maintained high IFAT titers on follow-up, suggesting the possibility of continuous sequestration of antigen from an intracellular source.
Nine cases of melioidosis with four deaths occurred over a 28-month period in members of a small remote Aboriginal community in the top end of the Northern Territory of Australia. Typing by pulsed-field gel electrophoresis showed isolates of Burkholderia pseudomallei from six of the cases to be clonal and also identical to an isolate from the community water supply, but not to soil isolates. The clonality of the isolates found in this cluster contrasts with the marked genetic diversity of human and environmental isolates found in this region which is hyperendemic for B. pseudomallei. It is possible that the clonal bacteria persisted and were propagated in biofilm in the water supply system. While the exact mode of transmission to humans and the reasons for cessation of the outbreak remain uncertain, contamination of the unchlorinated community water supply is a likely explanation.
A fatal case of melioidosis, thought to be the third recorded from New South Wales, is presented. Infection probably occurred in Queensland. The patients presented with a subcutaneous abscess complicated by pyaemia, extensive lung involvement and septicaemic shock. The diagnosis was bacteriologically confirmed shortly before death, by isolation of Pseudomonas pseudomallei from blood, pus swabs and tracheal aspirates. There is a need for greater awareness of this disease in persons who have resided in South-East Asia and in North-Eastern Australia.
Melioidosis is a rare but potentially fatal infectious disease in Taiwan, although it has been endemic in Southeast Asia, especially northeast Thailand, and northern Australia. In this article, we report a male diabetes with fulminant pneumonia, and septicemia caused by Burkholderia pseudomallei without traveling abroad before this episode. Productive cough and intermittent chills, high fever for one week, followed by progressively deteriorating dyspnea, shock, disturbed consciousness status were the major presentations. Blood culture grew B. pseudomallei on the fifth admission day. Unfortunately, the patient died on the 9th admission day, despite intensive care and the broad-spectrum antimicrobial regimen used.
An instance of melioidosis is described in a five-year-old Papua New Guinean. The disease did not involve the lungs, but the patient presented with an abscess on the abdomen and with numerous abscesses on the feet. The disease was successfully treated with kanamycin and trimethoprim-sulphamethoxazole. This is the fourth case known to have occurred in Papua New Guinea, and the patient is the first to have survived.
This report is of a man who suffered from chronic melioidosis contracted in Malaysia. In the course of the disease he had a lobe of a lung resected, developed empyema and, while this was still draining, developed infection in an ankle. Both the empyema thoracis and the ankle infection were due to Pseudomonas pseudomallel. He now appears to be cured, probably by massive doses of tetracycline.
The authors present the results of in vitro determination of the sensitivity of the causative agent of glanders and melioidosis to 8 preparations-5-nitrofuran derivatives, and also to negram and PASK. The most active against M. mallei and Ps. pseudomallei were furazonal and furacrillin; negram was less active. No naturally resistanct strains to furacrylin and furazonal were revealed among the M. mallei and Ps. pseudomallei strains studied.
The seroprevalence of melioidosis in dairy cattle in Chiang Mai Province was investigated using of the indirect hemagglutination antibody (IHA) method. Two hundred and fifty-three samples were tested for serum antibodies to Burkholderia pseudomallei. The samples were from a total population of 8,688 dairy cattle in the province; random sampling, stratified by the location of cattle, was used. The seroprevalence was determined as 2% at 1:40 cut-off value, which was estimated to equate to 0.3% to 3.7% (95% CI). This report of relatively low disease prevalence in the animal population corresponds to other prevalence studies of the agent in the environment and the human population in the region. The prevalence is markedly different to that reported from northeastern Thailand, where the disease is highly endemic.
Two mechanics working at a garage in tropical northern Australia simultaneously developed upper limb melioidosis ulcers. Both patients had Burkholderia pseudomallei of identical pulsed-field gel electrophoresis (PFGE) type (Spe I). Environmental sampling identified B. pseudomallei in a container of commercial hand wash detergent as the likely source of infection, although there were multiple isolates of different PFGE types to the clinical isolates.
A rare case of pulmonary melioidosis is reported. The patient was a 62-year-old man presenting with subacute fever, dry cough, and significant weight loss. A chest x-ray revealed a right paratracheal mass. The findings from fiberoptic bronchoscopy were a blunt carina and normal tracheobronchial tree. The patient had an underlying disease of poorly controlled diabetes mellitus, heavy smoking, and heavy alcoholic drinking. One of the two cultured blood specimens grew B. pseudomallei. The pathological finding of transbronchial biopsy at the apical segment of the right upper lung showed lymphocytic infiltrates. He was treated with two weeks of intravenous ceftazidime plus cotrimoxazole followed by 5 months of oral doxycycline plus cotrimoxazole. Clinical symptoms significantly improved and the right paratracheal mass disappeared.
Pathogenic Burkholderia--Burkholderia mallei and Burkholderia pseudomallei--are causative agents of glanders and melioidosis, severe infectious diseases of man and animals. They are regarded as potential agents of bioterrorism. The existing bacteriological and immunological methods of identification of B. mallei and B. pseudomallei are not efficient enough for the rapid diagnosis and typing of strains. Described in the paper are molecular methods of detection of the agents by PCR, hybridization and strain typing made on the basis of bacterial total cell protein profiles, RAPD, ribotyping as well as of plasmid and DNA microrestriction analyses.