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PubMed1981

Acute septicaemic melioidosis: a report of seven cases.

A report is presented of seven patients with acute septicaemic melioidosis seen at the University Hospital, Kuala Lumpur, Malaysia, during 1976-1979. All had associated disorders which rendered them more susceptible to infection. As prognosis depends on early diagnosis it is important that this disease be considered in the differential diagnosis of a septicaemic illness in such patients from endemic areas. The treatment of choice is a combination of tetracyclines and chloramphenicol, initially used in massive doses, and continued for at least six month to prevent relapses.

Adult↗
PubMed1980

[Postinfection immunity in melioidosis].

Experiments on the reinfection of laboratory animals with melioidosis revealed that guinea-pigs and white mice developed pronounced resistance to the disease, accompanied by the objective [corrected] signs of immunologic transformation (allergization, the presence of specific humoral antibodies, and increase in the phagocytic activity of the cells of the macrophage system). In golden hamsters, highly sensitive to infection with Pseudomonas pseudomallei culture, the process of the "all or nothing" type occurs, and the degree of resistance depends on the fluctuations of the individual sensitivity level. No phenomena of immunologic transformation were observed in reinfected golden hamsters.

Acute Disease↗
PubMedDate not supplied

[Specific immune complexes and neutrophil injury test in the diagnosis of experimental glanders and melioidosis].

The authors have demonstrated the possibility of using solid-phase enzyme immunoassay to detect specific circulating immune complexes without their preliminary separation in guinea pigs infected with Pseudomonas mallei and Pseudomonas pseudomallei. They have examined the prospects of using neutrophil injury test and solid-phase enzyme immunoassay for the detection of specific immune complexes as additional tests used to predict the outcome of an infectious process in glanders and melioidosis.

Animals↗
PubMed1993

The 1990-1991 outbreak of melioidosis in the Northern Territory of Australia: clinical aspects.

From November 1990 to June 1991, 33 cases of acute melioidosis were diagnosed in tropical Northern Territory, Australia during an exceptionally wet monsoon. Eighteen (55%) were alcoholic, 16 (48%) diabetic and only 4 (12%, all survivors) had no risk factors. Twenty-seven (82%) were considered recent infection, with an incubation period of 3-21 days (mean 14) documented in eight cases with presumed cutaneous inoculation. Fourteen patients presented with pneumonia (4 septicemic) and of 11 others with septicemia 4 had genitourinary foci. Three of 4 with splenic abscesses required splenectomy. Three had only skin/soft tissue infection. One patient with brainstem encephalitis needed prolonged ventilation. Overall mortality was 36% (12 cases, including three relapses), despite therapy with ceftazidime and intensive care facilities. Pseudomonas pseudomallei is the commonest diagnosed cause of fatal bacteremic pneumonia at Royal Darwin Hospital and emphasis is placed on early appropriate antibiotic therapy and compliance with maintenance therapy for at least three months.

Adult↗
PubMed1996

Melioidosis: a rare but not forgotten cause of fever of unknown origin.

Melioidosis is widely prevalent in Southeast Asia and northern Australia. Although it is believed to pose no current threat to the populations of developed countries, the increased mobility of people around the world and of Southeast Asian refugees to Western countries may change this. Its long incubation period may put a relatively large number of currently asymptomatic people at risk. It should be considered in the differential diagnosis of any febrile illness in a person who has visited an endemic area, especially if the presenting features are those of fulminant respiratory failure, if multiple pustular or necrotic skin or subcutaneous lesions develop, or if there is a radiologic pattern of tuberculosis from which tubercle bacilli cannot be demonstrated.

Adult↗
PubMed1996

The laboratory diagnosis of melioidosis.

The recognition of unusual, but important, pathogens such as Burkholderia pseudomallei is essential for the rapid implementation of appropriate antimicrobial therapy--delays can be fatal. Melioidosis should be considered as a potential diagnosis for any patient with exposure to areas of endemicity, and thus laboratories should be aware of the differential features of the disease and the causative organism. Isolation of B. pseudomallei is readily achieved using standard culture media such as blood, MacConkey or cystine-lactose-electrolyte-deficient (CLED) agars, and routine blood culture broths. Selective media, Ashdown's agar and selective broth, are required for respiratory tract specimens to ensure reliable isolation from amongst the normal or contaminating flora. These media are easily prepared from common media constituents. Colonial morphology and simple biochemical tests will suggest the identity of the organism, which can then be confirmed by additional tests for 'non-fermenters', such as the API 20NE.

Bacteriological Techniques↗
PubMed1997

[Pulmonary melioidosis in a German Southeast Asia tourist].

HISTORY AND CLINICAL FINDINGS: A patient who returned from a 3-year stay in Thailand and India one year ago, was admitted with fever of 38.5 degrees C and productive cough for the last four weeks. He remembered wounding his foot three years ago in India with contamination by soil. Subsequently, recurrent pustulae appeared on his feet. One such pustule was found on admittance. The clinical examination showed low body weight, without further abnormalities. INVESTIGATIONS: The blood examinations revealed high inflammation parameters and ruled out any immunodeficiency. Smouldering infiltrates in the upper lobes were found on the chest radiography. Sputum was free of acid fast bacilli and no mycobacterial DNA was detected by polymerase chain reaction. Bronchoscopy showed a normal endobronchal situation, Burkholderia pseudomallei were found to grow from specimens of bronchial mucus. TREATMENT AND COURSE: Under the empirical treatment with ampicillin/sulbactam, we could not find any response. After switching to Ceftazidime and trimethoprim/sulfamethoxazol (TMP/SMZ) we observed quick clinical improvement and normalisation of the inflammation parameters and notable radiological response over three weeks. We continued a five months TMP/SMZ therapy after discharge in order to prevent relapses. CONCLUSION: For travellers and immigrants from Southeast Asia presenting smouldering infiltrations of the upper lobes, one should include Melioidosis in the differential diagnosis.

Adult↗
PubMed1997

[Immunogenic potential of glanders and melioidosis agents].

Unlike the glanders agent, the superficial structures of the melioidosis agent were demonstrated to be responsible for marked was immunosuppressive activity. Some antigenic fractions suppressing the blast transformation of lymphocytes, reducing the count of T helpers and profoundly potentiating the infection in vivo were isolated from P. pseudomallei cells. The immunogenic and immunosuppressive activities of both agents' superficial structures were studied by high performance chromatography. Antigenic complexes that were able to protect immunized laboratory animals against fatal infections and to prevent bacterial carriage due to the activation of T cells and to the bacterial activity of macrophages were identified. A composition comprising several immunogens was found to provide an additive protective action against both causative agents. Therefore, the composition may be considered to be a prototype of a molecular antipseudomonadic vaccine.

Animals↗
PubMed1997

Case report and review of Chromobacterium sepsis--a gram-negative sepsis mimicking melioidosis.

Chromobacterium violaceum has recently been recognised as a pathogen which can cause life-threatening disease. It is the only Chromobacterium species which is pathogenic to humans. Due to its unfamiliarity, clinicians often do not appreciate its importance when it is isolated in sterile cultures and may dismiss it as a "containment". It is therefore important for us to be aware of this infection and its clinical spectrum since it is a disease of the tropics. We report a paediatric case of documented Chromobacterium sepsis in Singapore who presented like septicaemic melioidosis associated with diminished T-cell numbers. A review of both fatal and non-fatal Chromobacterium, infections is also included.

Child↗
PubMed1998

Epidemiological surveillance of melioidosis in Singapore.

During the period 1989 to 1996, a total of 372 cases of melioidosis, with 147 deaths, were reported, giving a mean annual incidence rate of 1.7 per 100,000 population and a case-fatality rate of 39.5%. Majority (89%) of the clinical cases were confirmed by culture of Burkholderia pseudomallei, while the others were presumptive cases based on a single blood specimen with an indirect haemaglutination (IHA) antibody titre of > or = 1:16. The highest incidence rate was reported in those aged 45 years and above (5.7 per 100,000 population), males (2.8 per 100,000 population), and Indian ethnic group (3.0 per 100,000 population). Cases were distributed throughout the island all year round. There was no correlation with rainfall. Most of the cases (77.4%) had other concurrent medical conditions, the most common being diabetes mellitus (57.5%). Factors significantly associated with a higher case-fatality rate were age (55 years and above), septicaemia, smoking history and heart or renal failure. The overall case-fatality rate has been declining from 60% in 1989 to 27% in 1996 due to a greater awareness among medical practitioners to diagnose and treat the disease early. The overall seroprevalence of IHA antibody (titre of > or = 1:16) among asymptomatic population groups was 0.2%. B. pseudomallei isolated from clinical specimens were sensitive to imipenem (100%), ceftazidime (99.1%), piperacillin (99.7%), ampicillin-clavulanate (98.5%), minocycline (97.4%), chloramphenicol (94.3%), doxycycline (94.3%) and tetracycline (93.9%). Of 395 samples of soil collected during epidemiological investigation of reported cases, 1.8% were positive for B. pseudomallei.

Adolescent↗
PubMed2006

Genomic patterns of pathogen evolution revealed by comparison of Burkholderia pseudomallei, the causative agent of melioidosis, to avirulent Burkholderia thailandensis.

BACKGROUND: The Gram-negative bacterium Burkholderia pseudomallei (Bp) is the causative agent of the human disease melioidosis. To understand the evolutionary mechanisms contributing to Bp virulence, we performed a comparative genomic analysis of Bp K96243 and B. thailandensis (Bt) E264, a closely related but avirulent relative. RESULTS: We found the Bp and Bt genomes to be broadly similar, comprising two highly syntenic chromosomes with comparable numbers of coding regions (CDs), protein family distributions, and horizontally acquired genomic islands, which we experimentally validated to be differentially present in multiple Bt isolates. By examining species-specific genomic regions, we derived molecular explanations for previously-known metabolic differences, discovered potentially new ones, and found that the acquisition of a capsular polysaccharide gene cluster in Bp, a key virulence component, is likely to have occurred non-randomly via replacement of an ancestral polysaccharide cluster. Virulence related genes, in particular members of the Type III secretion needle complex, were collectively more divergent between Bp and Bt compared to the rest of the genome, possibly contributing towards the ability of Bp to infect mammalian hosts. An analysis of pseudogenes between the two species revealed that protein inactivation events were significantly biased towards membrane-associated proteins in Bt and transcription factors in Bp. CONCLUSION: Our results suggest that a limited number of horizontal-acquisition events, coupled with the fine-scale functional modulation of existing proteins, are likely to be the major drivers underlying Bp virulence. The extensive genomic similarity between Bp and Bt suggests that, in some cases, Bt could be used as a possible model system for studying certain aspects of Bp behavior.

Burkholderia↗
PubMedDate not supplied

[The effect of the acid exopolysaccharide produced by the causative agent of melioidosis on macrophage function].

Acid exopolysaccharide of the melioidosis agent, isolated from the slime of alysogenic strain of Pseudomonas pseudomallei SVBDO-141 inhibits the capture of sheep erythrocytes--55Fe by mouse peritoneal macrophages. Administration of the sheep erythrocytes--55Fe, sensibilized by acid exopolysaccharide was proved not to have an antiphagocytic effect. Inhibition of phagocytic macrophagal activity depends on the conditions of isolation of acid exopolysaccharide.

Animals↗
PubMedDate not supplied

[The outlook for improving the immunoglobulin preparations for the detection and identification of the causative agents of glanders and melioidosis].

The paper summarizes the data concerning the production and study of monoclonal antibodies (MAb) to the diagnostically significant glanders and melioidosis bacillus antigens. It evaluates the efficiency of using MAb in the gel immunodiffusion and agglutination tests as a basis of new-generation preparations for fluorescent antibody assay, indirect hemagglutination test which are used while detecting and identifying pathogenic pseudomonads. The paper defines the quality indices for monoclonal luminescent immunoglobulins and provides evidence for the benefits of monoclonal diagnostic agents over polyclonal analogues.

Agglutination Tests↗
PubMed1976

[Methods of detecting the agent of melioidosis in objects of the external environment and other material].

On the basis of literature data and personal investigations the authors elaborated a scheme of detection of the causative agent of melioidosis in the objects of external environment, including fluorescent microscopy of crude material, seeding on meat-peptone agar with crystal violet, seeding material treated with penicillin on fluid medium with subsequent transfer on solid Levin medium and infection of animals, seeding on a medium with beta-alanine and neonmycin and infection of sensitive animals with crude material.

Animals↗