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PubMed1998

Serum procalcitonin levels in severe Plasmodium falciparum malaria.

Levels of procalcitonin (ProCT) have been found to be elevated in individuals with severe bacterial infections such as sepsis and peritonitis, and this correlates well with the severity of the disease. Recently, increased levels have been described in melioidosis and Plasmodium falciparum malaria. In this study ProCT levels were measured in 27 Thai patients with complicated malaria before and during/after treatment with artesunate and mefloquine. Initial parasite counts averaged 290,680/microl (range = 533-1,147,040). On admission, ProCT levels were elevated in all but one patient (median = 40 ng/ml, range = 0.04-662, normal values < 0.5 ng/ml). With treatment, levels decreased to 1.3 ng/ml (range = 0.01-6.5). Nitrite/nitrate levels in patients were higher than in controls throughout the study. The ProCT levels correlated with initial parasite density (P < 0.05), which is a marker of disease severity, and with nitrite/nitrate levels (P < 0.05). Based on the changes of ProCT levels over the course of the disease a possible role in the acute-phase reaction seems likely.

Adolescent↗
PubMed2001

Differentiation between non-virulent and virulent Burkholderia pseudomallei with monoclonal antibodies to the Ara+ or Ara- biotypes.

Burkholderia pseudomallei is the causative agent of melioidosis, a fatal tropical infectious disease endemic in Southeast Asia. Environmental isolates of B. pseudomallei have two distinctive biotypes. Some soil isolates are arabinose-assimilators (Ara+ biotype) and are non-virulent in experimental animals. The others cannot assimilate arabinose (Ara- biotype) and are virulent in experimental animals. The Ara- biotype is found in almost all B. pseudomallei clinical isolates. In the present study, a panel of eight monoclonal antibodies that agglutinate the bacteria were produced and tested. The first group, Bps-D2, -D3, -D5, -L1, and -L2 agglutinated 100% of Ara+ clinical and soil isolates of B. pseudomallei. Another group Bps-A1, -A2, and -D1 agglutinated 92.9% and 90.9% of Ara- clinical and soil isolates, respectively. This panel of monoclonal antibodies may be useful for rapid differentiation between non-virulent Ara+ and virulent Ara- B. pseudomallei.

Agglutination Tests↗
PubMed2002

3: Community-acquired pneumonia.

Community-acquired pneumonia is caused by a range of organisms, most commonly Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae and respiratory viruses. Chest x-ray is required for diagnosis. A risk score based on patient age, coexisting illness, physical signs and results of investigations can aid management decisions. Patients at low risk can usually be managed with oral antibiotics at home, while those at higher risk should be further assessed, and may need admission to hospital and intravenous therapy. For S. pneumoniae infection, amoxycillin is the recommended oral drug, while benzylpenicillin is recommended for intravenous use; all patients should also receive a tetracycline (eg, doxycycline) or macrolide (eg, roxithromycin) as part of initial therapy. Flucloxacillin or dicloxacillin should be added if staphylococcal pneumonia is suspected, and gentamicin or other specific therapy if gram-negative pneumonia is suspected; a third-generation cephalosporin plus intravenous erythromycin is recommended as initial therapy for severe cases. Infections that require special therapy should be considered (eg, tuberculosis, melioidosis, Legionella, Acinetobacter baumanii and Pneumocystis carinii infection).

Aged↗
PubMed1998

Effects of Burkholderia pseudomallei and other Burkholderia species on eukaryotic cells in tissue culture.

Burkholderia pseudomallei causes melioidosis, a serious and often fatal bacterial infection. B. pseudomallei can behave as a facultatively intracellular organism and this ability may be important in the pathogenesis of both acute and chronic infection. The uptake of B. pseudomallei and other Burkholderia spp. by cells in tissue culture was examined by electron microscopy. B. pseudomallei can invade cultured cell lines including phagocytic lines such as RAW264, J774 and U937, and non-phagocytic lines such as CaCO-2, Hep2, HeLa, L929, McCoy, Vero and CHO. Uptake was followed by the intracellular multiplication of B. pseudomallei and the induction of cell fusion and multinucleate giant cell formation. Similar effects were produced by B. mallei and B. thailandensis.

Animals↗
PubMed2000

Isolations of enteric pathogens from synanthropic flies trapped in downtown Kuala Lumpur.

Four species of synanthropic flies were trapped in downtown Kuala Lumpur: Chrysomya megacephala, Chrysomya rufifacies, Musca domestica, and Musca sorbens. Burkholderia pseudomallei, the organism causing melioidosis, was the dominant bacteria isolated from Chrysomya megacephala. Klebsiella oxytoca, commonly associated with nosocomial infections, was commonly isolated from Chrysomya megacephala, Musca domestica, and Musca sorbens. Aeromonas hydrophila, the bacteria causing gastroenteritis, was predominantly isolated from Chrysomya megacephala and also from Musca domestica and Musca sorbens. A total of 18 bacterial species was isolated from the synanthropic flies trapped. Burkholderia pseudomallei had been reported for the first time.

Aeromonas↗
PubMedDate not supplied

[Pathogenicity of Burkholderia pseudomallei: extracellular and surface antigen functions].

The data of literature and the results of investigations carried out by the authors on the analysis of B. pseudomallei pathogenicity factors. They include mucoid, endotoxin, lecithinase, proteases, hemolysins, etc. In addition to fimbriae and pili, the adhesive properties of B. pseudomallei are supposed to be associated with surface capsule-like structures whose composition includes Ag8. The characterization of exoproteases, hemolysins and lethal toxins is given. The virulence and immunogenicity of B. pseudomallei were shown to be linked with the components of surface glycoprotein Ag8. The conclusion has been made that the analyzed pathogenicity factors are of importance for deciphering the pathogenesis of melioidosis.

Animals↗
PubMed1999

An Atypical Case of Mycobacterium bovis in a Cynomolgus Macaque (Macaca fascicularis) Imported From the Philippines.

An incidental case of Mycobacterium bovis was confirmed in a cynomolgus macaque from a shipment of 100 animals imported to the University of Southwestern Louisiana New Iberia Research Center from the Philippines. The macaque was euthanized 4 weeks into the quarantine period (October 1997) for failure to thrive and suspected melioidosis. Approximately 6 months later, on 9 March 1998, culture and antigenic probes from kidney tissues identified the etiologic agent as M. bovis. Five remaining cohort animals were euthanized after we obtained the results from the index case. Kidney tissues from two of the cohort animals were positive for M. avium. All animals had negative intradermal skin tests prior to euthanasia. All three animals positive for Mycobacterium were sero-negative for retroviruses. The unusual presentation of this case, coupled with the inability to detect disease by standard means, serves to emphasize the importance of follow-up examination and culture of tissues obtained from imported non-human primates.

Journal Article↗
PubMed1992

Sudden unexplained death syndrome. A review and update.

Sudden unexplained death syndrome (SUDS) among young healthy Thai construction workers in Singapore has been given much publicity recently. From May 1982 to July 1990, 226 SUDS were reported among them. In this article we review and compare studies on SUDS in the United States and South-east Asia. So far, studies to identify the causal factors have been inconclusive and they cannot explain the male preponderance and occurrence of death during sleep. Current hypotheses about the cause of SUDS have included stress, genetic factors, dietary deficiency (particularly thiamine), potassium deficiency, melioidosis and sleep disorders. The following areas are suggested for further research: epidemiological investigations on SUDS at its source; in-depth case studies of families with and without SUDS; role of dietary factors, biochemical studies with respect to thiamine, pyruvate and potassium metabolism in the victims and susceptibles; and histopathological studies of cases and controls.

Adolescent↗
PubMed2004

Detection of virulence attributes of Burkholderia pseudomallei.

BACKGROUND & OBJECTIVES: Melioidosis caused by Burkholderia pseudomallei is an emerging disease in India. This study examined the toxin activity of bacteria-free culture filtrate in three different cell lines (cytotoxic assay) and its effect on Caenorhabditis elegans (nematode toxicity assay). Endotoxic activity of the viable bacteria was also studied in C. elegans (co-culture killing assay). METHODS: For toxin studies, serial doubling dilutions of unheated, heated crude and ultra filtrate of bacteria-free culture supernatants of B. pseudomallei were tested in 96-well microtitre plate containing confluent mono layers of McCoy, Hep-2 and HeLa cell lines. For the effects on C. elegans, the worms were exposed to heated and unheated bacteria-free culture supernatants in 24-well microtitre plate for 24h and then transferred to OP50 Escherichia coli lawn culture. The endotoxic activity of the live bacterium was studied by feeding the worms in the lawn culture of B. pseudomallei. RESULTS: All the clinical isolates (n=38) produced cytotoxic changes in all the cell lines. No difference was observed in the cytotoxicity of unheated, heated and ultra-filtered culture supernatant. The septicaemic isolates were observed to produce cytotoxic changes in high dilutions (1:160) of culture filtrate. None of the unheated and heated crude filtrate had deleterious effect on C. elegans, while all the live bacteria were found to be lethal to the nematode. INTERPRETATION & CONCLUSION: The culture supernatants, though produced cytopathic effect in various tissue cultures, failed to have any deleterious effect on the worms. However, live bacteria were lethal to the worms B. pseudomallei. Use of C. elegans model to detect virulence attributes of B. pseudomallei is recommended as an alternative to tissue culture methods as this can be carried out in laboratories where a tissue culture set up is not available.

Animals↗
PubMed2004

Etiologies of acute undifferentiated febrile illness in Thailand.

BACKGROUND: Acute pyrexia of unknown origin (Acute PUO) was reported to affect approximately 200,000-400,000 patients each year reported by the national Annual Epidemiological Surveillance Report. The patients usually present with fever of less than two-week duration and non-specific symptoms such as malaise, myalgia, headache and loss of appetite. Its mortality rate is less than 0.02 percent. It would be interesting to find the etiologies and propose a management plan if the etiologies are discovered. OBJECTIVE: This prospective epidemiologic study aimed to discover the etiologies of acute undifferentiated febrile illness in a tropical region like Thailand. SUBJECTS AND METHOD: Ten community-based hospitals were chosen as representatives in each part of Thailand to enroll patients into the study. Patients aged over two years old who presented with fever at the participating hospitals during year 1991-1993 were eligible for the study. Entry criteria of acute undifferentiated febrile illnesses (AUFI) included oral temperature over 38.3 degrees C within the last 24 hours, duration of fever ranging from 3-14 days, no specific single organ involvement by history taking and physical examination, normal or non-specific results of the following investigations: complete blood count, thick film for malaria, urinalysis and chest roentgenogram. The patients were hospitalized and a preset diagnostic protocol was performed. Other diagnostic procedures deemed necessary by attending physicians were perform. Patients were followed up within one month after hospital discharge. RESULTS: 1,240 patients were enrolled but only 1,137 case records and results of the serological tests were available for analysis. Etiologies could be found in 471 cases (38.7%). Primary bacteremia was detected in 36 cases (3.2%). E. coli, streptococci, salmonella, Enterobacter spp. and S. aureus were the five most common blood isolates. Serological studies revealed positive results for scrub typhus (7.5%), influenza (6.0%), dengue fever (5.7%), murine typhus (5.3%), enteric fever (1.9%), chikunkunya infection (1.1%), leptospirosis (1.1%) and melioidosis (0.9%). Thirteen cases succumbed (1.1%) in this study. CONCLUSION: The etiologies in the majority (61.3%) of AUFI remained unknown. Rickettsial infection, influenza and dengue fever are the most common identifiable diseases in a tropical country like Thailand especially during the rainy season. A management guideline for diagnosis and treatment of the AUFI with emphasis on primary bacteremia and antimicrobial-treatable AUFI was proposed.

Acute Disease↗
PubMedDate not supplied

[Identification and differentiation of pathogenic Burkholderia].

In this review modern methods for the identification and differential diagnostics of the causative agents of glanders and melioidosis, recently included into the genus Burkholderia, are presented. The known phenotypic signs and genetic markers permitting the identification of two pathogenic microorganisms on the definite taxonomic level are described.

Animals↗
PubMed2004

Etiology and outcome of superior vena cava (SVC) obstruction in adults.

Between 1997 and 2002, 107 patients with symptoms of superior vena cava (SVC) obstruction presented at a university hospital in Northeast Thailand. Age averaged 50.7 years (range, 1 to 84). The male to female ratio was 5.7:1. Duration of symptoms before diagnosis was 29.4 days (range, 2 to 240), including facial swelling, cough, and chest discomfort. About 20% of cases developed respiratory failure and 11.2% died shortly after admission. The mean hospital stay was 23.7 days. Anteroposterior and lateral chest radiographs and computed chest tomography helped locate the lesion. Transbronchial biopsy through bronchoscopy, transthoracic needle biopsy under computed tomography, lymph node biopsy, pleural fluid cytology and/or biopsy were used for histopathologic sampling. High levels of alpha-fetoprotein and beta-HCG indicated an anterior mediastinal mass. The most common etiology of SVC obstruction was bronchogenic carcinoma (51.8%), followed by an anterior mediastinal mass (14.5%), lymphoma (13.6%--with an LDH of 262 to 1459 U/l), metastatic cancer (9.1%), and acute lymphoblastic leukemia (1.8%). Benign SVC thrombosis was found in four patients with Behcet's disease or some other idiopathy. Mediastinal fibrosis from melioidosis occurred in three patients, which is rare, has not been previouly reported. Most patients (63.6%) received a combination of radiotherapy and corticosteroid and this helped 55.2% improve.

Adolescent↗
PubMedDate not supplied

[Cross-reacting antigens of pathogenic Burkholderia and some dangerous causative agents of infectious diseases].

Cross-reacting antigens in B. mallei, B. pseudomallei, B. thailandensis, Francisella tularensis, Yersinia pestis and Mycobacterium tuberculosis were studied with the use of immuno- and electrophoretic techniques. The set of antigens was shown to be almost identical in the causative agents of glanders, melioidosis, as well as in B. thailandensis, though in the latter organism 200-kD glycoprotein was absent. The analysis of immuno- and proteinograms demonstrated the presence of cross-reactions in the representatives of the genus Burkholderia with the causative agents of plague, tularemia and tuberculosis, which served as the basis for making the scheme of their antigenic relationships. The use of immunosorption techniques with subsequent analysis of the preparations by means of the SDS polyacryl gel electrophoresis and immunoblotting made it possible to characterize cross-reacting antigens of the pathogenic microorganisms under study, to establish their molecular weights (81-15 kD) and to show that some detected antigens are analogous to B. pseudomallei outer membrane proteins (34 and 30 kD).

Animals↗
PubMed1979

Veterinary experiences as a Japanese prisoner of war and ex-POW along the Burma railroad from 1942 to January 1946.

As a prisoner of war the writer was working for nearly three years in different POW camps, and outside them, along the Burma railway from Thanbyuyzat in southern Burma up to Kanchanabury in Thiland. In the army of the Netherlands-Indian archipelago (KNIL) he had the military rank of reserve horse-doctor. In civilian life he was attached to the Veterinary Institute in Buitenzorg(now Bogor) as a veterinary bacteriologist. His task as a POW became that of meathygienist and supervisor of the living animals in the camps. In this function he diagnosed swine fever in growing pigs which had mainly been fed on the offal of the Japanese kitchen. The acute course and the pathological alterations observed during the post-mortem examinations were identical with those of the Southern-African type of the disease. In slaughter cattle the author diagnosed some cases of lung tuberculosis, one of anthrax, several of rinderpest, some of rhinal granulomatosis and one of foot and mouth disease. In chickens he found NCD (pseudo-fowlpest) and in ducklings a mortal disease which the author then called 'keeling disease' but which he many years later, recognized as virus hepatitis. As assistant bacteriologist and ex-POW he joined the British regimental hospital in Bangkok. Here he had the apportunity to assist the bacteriologist pathologist, Maj. C. R. Peck IMS/IAMC in diagnosing the first case of melioidosis in an ex-POW of the KNIL who died from the sub-acute infection, notwithstanding treatment in the hospital with sulfa-drugs and penicillin.

Concentration Camps↗
PubMedDate not supplied

[Use of infusoria Paramecium caudatum for the evaluation of the toxicity of antigens of different causative quarantine agents].

The results of the evaluation of the toxicity of bacterial antigens obtained from the causative agents of plaque, glanders, melioidosis, cholera on infusoria of the species P. caudatum, as well as on cell lines L-929, CHO K-1 and peritoneal macrophages of BALB/c mice, are presented. As revealed in this study, the method of toxicity determination on infusoria is similar in its sensitivity to the methods of testing on. CHO K-1 and L-929 cells, but the former is simpler, more available and permits the determination of toxic doses producing disturbances in the vital activity of the infusoria, but not leading to their death.

Animals↗
PubMed2005

Wound infections in tsunami survivors: a commentary.

Survivors of the December 2004 Indian Ocean tsunami sustained a variety of wound infections, ranging from common pathogens to rarely seen organisms. This article discusses the likely microbiology potentially seen in wound infections with exposure to freshwater, seawater, soil, faecal or other contamination, and attempts to provide an organising framework for choosing empiric antibiotics for such infections. Therapy for less frequently encountered clinical entities is also discussed, including tetanus, cutaneous and septicaemic melioidosis, post-traumatic mucormycosis, Vibrio vulnificus and Aeromonas hydrophila.

Disasters↗
PubMed2006

Computed tomography of focal splenic lesions in patients presenting with fever.

INTRODUCTION: There is an awareness of the increased incidence of splenic abscess in Southeast Asia giving rise to unexplained fever. This study looks at the role of computed tomography (CT) in evaluating focal splenic lesions in patients presenting with fever. METHODS: 37 patients presenting with fever of unknown origin underwent CT and this study retrospectively analyses the findings in these patients. 13 patients also had associated abdominal pain. Patients with conditions at high risk for splenic infection include: diabetes mellitus in ten patients, leukaemia in seven patients, human immunodeficiency virus infection in five patients, intravenous drug abuse in six patients, and steroid therapy in two patients. No risk factors could be identified in seven patients. RESULTS: Splenic abscess was diagnosed in 28 patients. A range of infecting organisms was isolated but the most frequent were Staphylococcus aureus (eight), tuberculosis (four), Streptococcus (four), fungal (four) and melioidosis (four). No infecting organism could be identified in ten cases though in patients with leukaemia with multiple low attenuation areas, the cause was presumed to be fungal. Six patients were diagnosed to have splenic infarcts though differentiation from splenic abscess could be difficult; these patients were treated for an abscess and all had endocarditis. Three patients were subsequently diagnosed with lymphoma. Percutaneous abscess drainage was performed in five patients and splenectomy was carried out in six patients. CONCLUSION: CT proved to be very useful as it not only revealed the size and extent of any splenic abnormality but it assisted with guidance for percutaneous drainage, determined the site for biopsy, and provided follow-up after treatment.

Abscess↗
PubMed2001

Important unusual infections in Australia: a critical care perspective.

OBJECTIVE: To review a number of the important unusual infections in Australia that can lead to critical illness. DATA SOURCES: Articles, reports and published reviews on Japanese encephalitis, murine typhus, Australian spotted fever, Australian bat lyssavirus, leptospirosis, Capnocytophaga canimorsus, Chromobacterium violaceum, Edwardsiella tarda and Vibriosis. Emphasis was placed on articles, reports and published reviews published between 1990-2001. SUMMARY OF REVIEW: Japanese encephalitis has recently emerged in Australia, with reported outbreaks in the Torres Strait and north Queensland. Murine typhus needs to be included in the differential diagnosis of a patient with fever, headache and rash, especially if there has been possible exposure to rats and/or their droppings. If the symptoms follow exposure to ticks, or following a known tick bite, then Australian spotted fever needs to be considered. Australian bat lyssavirus can cause a fatal rabies-like disease in humans exposed to infection by bites or scratches from bats. Leptospirosis should be suspected in any patient with an appropriate history of exposure (especially occupational) and a history of myalgia, arthralgia, fever, malaise and/or chest X-ray shadowing. Capnocytophaga should be specifically sought in any patient with fever and/or septicaemia following a dog bite, especially if immunocompromised. Along with melioidosis, Chromobacteriosis should be considered in the differential diagnosis of a rapidly progressing septic illness with skin lesions and/or multiple visceral abscesses in a patient exposed to soil or muddy water. Edwardsiella ought to be considered as the causative agent of a soft tissue infection, septic arthritis or septicaemia in a recreational fisher or swimmer, especially if following a marine puncture wound. If the exposure is related to salty or brackish water, then Vibriosis needs to be considered. Vibriosis should also be suspected in a patient with septicaemia and a history of recent ingestion of raw or under-cooked seafood, especially oysters. CONCLUSIONS: Critical care physicians need to remain alert to unusual infectious agents as many can lead to significant morbidity and are associated with a high mortality rate.

Journal Article↗