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Verma G, Singh N, Mohanty A, Patro ARK, Pattnaik D. Coexistence of blaNDM and blaOXA-48 Genes in Carbapenem-Resistant Burkholderia pseudomallei Isolated From Pus: A Rare Phenomenon. Cureus 2023; 15:e50671. [PMID: 38229822 PMCID: PMC10790810 DOI: 10.7759/cureus.50671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Burkholderia pseudomallei causes melioidosis in both humans as well as animals and is classified as a tier 1 pathogen by the US CDC. Melioidosis is a disease that occurs predominantly in subtropical and tropical regions. It is endemic to northern Australia and parts of Southeast Asia, as well as the Indian subcontinent. Diagnosis can be made through history, clinical examination, imaging, and microbiological studies. We report a case where Burkholderia pseudomallei was isolated froma 41-year-old man who complained of pain in the left hip and the left shoulder and swelling in both lower limbs. Chest X-ray showed bilateral consolidation. USG of the left shoulder and bilateral hips showed a mass in the anterior region of the left upper arm and the lateral region of the left thigh. Pus aspirated from left shoulder grew Burkholderia pseudomallei on culture and was carbapenem-resistant. The isolate harbored two carbapenemase genes, blaNDM and blaOXA-48, which is a novel finding.
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Affiliation(s)
- Gaurav Verma
- Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Nipa Singh
- Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Ambika Mohanty
- Department of General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - A Raj Kumar Patro
- Department of Molecular Biology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Dipti Pattnaik
- Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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2
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Gupta AP, Halder R, Chakraborty M, Chakraborty PP. Isolated splenic abscess due to melioidosis in type 1 diabetes mellitus: laboratory diagnosis of Burkholderia pseudomallei in resource-restricted setting. BMJ Case Rep 2021; 14:14/2/e238985. [PMID: 33541991 PMCID: PMC7868293 DOI: 10.1136/bcr-2020-238985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus, type 1 in particular, is a well-recognised risk factor for melioidosis, a disease caused by Burkholderia pseudomallei Melioidosis is endemic in Southeast Asia and in northern Australia and has a variety of clinical presentation, isolated splenic abscess being one of them. B. pseudomallei, however, is an uncommon aetiology of splenic abscess. The diagnosis of melioidosis is often overlooked unless the clinician and the microbiologist are suspicious of the condition. Multiple splenic abscesses and perisplenic collection were noted in CT scan of the abdomen in a patient of type 1 diabetes, presenting with fever for preceding 4 weeks. B. pseudomallei was isolated from the splenic aspirate and the diagnosis was made based on gram stain and routine biochemical tests. He was successfully treated with antibiotics. We postulate that the likely route of infection was inoculation through skin, the integrity of which was compromised by multiple subcutaneous insulin injections.
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Affiliation(s)
| | - Ratan Halder
- Medicine, Midnapore Medical College and Hospital, Midnapore, West Bengal, India
| | - Mandira Chakraborty
- Microbiology, Medical College and Hospital Kolkata, Kolkata, West Bengal, India
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3
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Withatanung P, Kurian D, Tangjittipokin W, Plengvidhya N, Titball RW, Korbsrisate S, Stevens JM. Quantitative Proteomics Reveals Differences in the Response of Neutrophils Isolated from Healthy or Diabetic Subjects to Infection with Capsule-Variant Burkholderia thailandensis. J Proteome Res 2019; 18:2848-2858. [PMID: 31244210 DOI: 10.1021/acs.jproteome.9b00166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In Thailand, diabetes mellitus is the most significant risk factor for melioidosis, a severe disease caused by Burkholderia pseudomallei. In this study, neutrophils isolated from healthy or diabetic subjects were infected with B. thailandensis E555, a variant strain with a B. pseudomallei-like capsular polysaccharide used here as a surrogate micro-organism for B. pseudomallei. At 2 h post-infection, neutrophil proteins were subjected to 4-plex iTRAQ-based comparative proteomic analysis. A total of 341 proteins were identified in two or more samples, of which several proteins involved in oxidative stress and inflammation were enriched in infected diabetic neutrophils. We validated this finding by demonstrating that infected diabetic neutrophils generated significantly elevated levels of pro-inflammatory cytokines TNFα, IL-6, IL-1β, and IL-17 compared to healthy neutrophils. Our data also revealed that infected neutrophils from healthy or diabetic individuals undergo apoptotic cell death at distinctly different rates, with infected diabetic neutrophils showing a diminished ability to delay apoptosis and an increased likelihood of undergoing a lytic form of cell death, compared to infected neutrophils from healthy individuals. Increased expression of inflammatory proteins by infected neutrophils could contribute to the increased susceptibility to infection and inflammation in diabetic patients in melioidosis-endemic areas.
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Affiliation(s)
- Patoo Withatanung
- Department of Immunology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Dominic Kurian
- The Roslin Institute & Royal (Dick) School of Veterinary Studies , University of Edinburgh, Easter Bush , Midlothian EH25 9RG , United Kingdom
| | - Watip Tangjittipokin
- Department of Immunology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Nattachet Plengvidhya
- Department of Medicine, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Richard W Titball
- Department of Biosciences , University of Exeter , Exeter EX4 4QD , United Kingdom
| | - Sunee Korbsrisate
- Department of Immunology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok 10700 , Thailand
| | - Joanne M Stevens
- The Roslin Institute & Royal (Dick) School of Veterinary Studies , University of Edinburgh, Easter Bush , Midlothian EH25 9RG , United Kingdom
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San Martin PFM, Chua JC, Bautista RLP, Nailes JM, Panaligan MM, Dance DAB. Melioidosis in the Philippines. Trop Med Infect Dis 2018; 3:tropicalmed3030099. [PMID: 30274495 PMCID: PMC6161007 DOI: 10.3390/tropicalmed3030099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 09/02/2018] [Accepted: 09/03/2018] [Indexed: 11/16/2022] Open
Abstract
The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem.
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Affiliation(s)
- Peter Franz M San Martin
- Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Joseph C Chua
- Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Ralph Louie P Bautista
- Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Jennifer M Nailes
- Department of Preventive and Community Medicine, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - Mario M Panaligan
- Department of Medicine, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines.
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Old Road Campus, University of Oxford, Oxford OX3 7FZ, UK.
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
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Montúfar FE, Ochoa JE, Ortega H, Franco L, Montúfar MC, Monsalve A, Jaramillo C, Zapata M. "Melioidosis in Antioquia, Colombia: an emerging or endemic disease? A cases series". Int J Infect Dis 2015; 37:50-7. [PMID: 26051974 DOI: 10.1016/j.ijid.2015.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 05/27/2015] [Accepted: 05/30/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Melioidosis is endemic in Malaysia, the southwest of Thailand, and northern Australia. The incidence in Thailand is 4.4/1000000 inhabitants, where it causes 19% of community-acquired pneumonia (CAP) and 20% of bacteremic pneumonia, and the mortality is 50%. Sporadic cases have been described in Central and South America. The objective of this study was to describe the clinical and epidemiological features and ecological characteristics of melioidosis in Antioquia, Colombia. METHODS This is a case series description. RESULTS Seven cases were identified. Burkholderia pseudomallei was isolated from peripheral blood, pleural fluid, and urine and was identified by the automated system VITEK 2 (bioMérieux) and API 20NE biochemical kit. Five of the cases had a bacteremic form with shock and pulmonary compromise and two of these patients died. The non-bacteremic melioidosis cases had genitourinary, abdominal, and osteoarticular compromise. All patients had comorbidities and lived in rural hot and humid areas in the west central region of Colombia (Antioquia). Diabetes mellitus, renal insufficiency, and other chronic diseases are important risk factors for the development of severe forms. CONCLUSIONS The cases presented here are similar to those occurring in endemic areas regarding comorbidity, risk factors, clinical presentation, and environmental conditions. It is necessary to establish whether melioidosis is an endemic and under-diagnosed disease or an emerging disease in Colombia.
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Affiliation(s)
- F E Montúfar
- Infectious Diseases Section, Pablo Tobón Uribe Hospital, Medellín, Colombia; Pulmonology Unit, León XIII Clinic of Antioquia University, Medellín, Colombia; Research Group in Respiratory and Infectious Diseases (GIERI), Medellín, Colombia.
| | - J E Ochoa
- Epidemiology Group, National School of Public Health, Antioquia University, Medellín, Colombia
| | - H Ortega
- Internal Medicine and Pulmonology, Antioquia University, Medellín, Colombia
| | - L Franco
- Cardiovascular Clinic, Medellín, Colombia
| | - M C Montúfar
- Faculty of Medicine, Pontificia Bolivariana University, Medellín, Colombia; Research Group in Respiratory and Infectious Diseases (GIERI), Medellín, Colombia
| | - A Monsalve
- Faculty of Medicine, Pontificia Bolivariana University, Medellín, Colombia; Research Group in Respiratory and Infectious Diseases (GIERI), Medellín, Colombia
| | - C Jaramillo
- Faculty of Medicine, Pontificia Bolivariana University, Medellín, Colombia; Research Group in Respiratory and Infectious Diseases (GIERI), Medellín, Colombia
| | - M Zapata
- Faculty of Medicine, Pontificia Bolivariana University, Medellín, Colombia; Research Group in Respiratory and Infectious Diseases (GIERI), Medellín, Colombia
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Podnecky NL, Rhodes KA, Schweizer HP. Efflux pump-mediated drug resistance in Burkholderia. Front Microbiol 2015; 6:305. [PMID: 25926825 PMCID: PMC4396416 DOI: 10.3389/fmicb.2015.00305] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/27/2015] [Indexed: 12/17/2022] Open
Abstract
Several members of the genus Burkholderia are prominent pathogens. Infections caused by these bacteria are difficult to treat because of significant antibiotic resistance. Virtually all Burkholderia species are also resistant to polymyxin, prohibiting use of drugs like colistin that are available for treatment of infections caused by most other drug resistant Gram-negative bacteria. Despite clinical significance and antibiotic resistance of Burkholderia species, characterization of efflux pumps lags behind other non-enteric Gram-negative pathogens such as Acinetobacter baumannii and Pseudomonas aeruginosa. Although efflux pumps have been described in several Burkholderia species, they have been best studied in Burkholderia cenocepacia and B. pseudomallei. As in other non-enteric Gram-negatives, efflux pumps of the resistance nodulation cell division (RND) family are the clinically most significant efflux systems in these two species. Several efflux pumps were described in B. cenocepacia, which when expressed confer resistance to clinically significant antibiotics, including aminoglycosides, chloramphenicol, fluoroquinolones, and tetracyclines. Three RND pumps have been characterized in B. pseudomallei, two of which confer either intrinsic or acquired resistance to aminoglycosides, macrolides, chloramphenicol, fluoroquinolones, tetracyclines, trimethoprim, and in some instances trimethoprim+sulfamethoxazole. Several strains of the host-adapted B. mallei, a clone of B. pseudomallei, lack AmrAB-OprA, and are therefore aminoglycoside and macrolide susceptible. B. thailandensis is closely related to B. pseudomallei, but non-pathogenic to humans. Its pump repertoire and ensuing drug resistance profile parallels that of B. pseudomallei. An efflux pump in B. vietnamiensis plays a significant role in acquired aminoglycoside resistance. Summarily, efflux pumps are significant players in Burkholderia drug resistance.
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Affiliation(s)
- Nicole L Podnecky
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biological Sciences, Colorado State University Fort Collins, CO, USA
| | - Katherine A Rhodes
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biological Sciences, Colorado State University Fort Collins, CO, USA ; Department of Molecular Genetics and Microbiology, College of Medicine, Emerging Pathogens Institute, Institute for Therapeutic Innovation, University of Florida Gainesville, FL, USA
| | - Herbert P Schweizer
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biological Sciences, Colorado State University Fort Collins, CO, USA ; Department of Molecular Genetics and Microbiology, College of Medicine, Emerging Pathogens Institute, Institute for Therapeutic Innovation, University of Florida Gainesville, FL, USA
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7
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Abstract
Given the "inborn" nature of the innate immune system, it is surprising to find that innate immune function does in fact change with age. Similar patterns of distinct Toll-like-receptor-mediated immune responses come to light when one contrasts innate immune development at the beginning of life with that toward the end of life. Importantly, these developmental patterns of innate cytokine responses correlate with clinical patterns of susceptibility to disease: A heightened risk of suffering from excessive inflammation is often detected in prematurely born infants, disappears over the first few months of life, and reappears toward the end of life. In addition, risk periods for particular infections in early life reemerge in older adults. The near-mirror-image patterns that emerge in contrasts of early versus late innate immune ontogeny emphasize changes in host-environment interactions as the underlying molecular and teleologic drivers.
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Impaired early cytokine responses at the site of infection in a murine model of type 2 diabetes and melioidosis comorbidity. Infect Immun 2012. [PMID: 23208607 DOI: 10.1128/iai.00930-12] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Bacterial infections are a common and serious complication of type 2 diabetes (T2D). The prevalence of melioidosis, an emerging tropical infection caused by the Gram-negative bacterium Burkholderia pseudomallei, is increased in people with T2D. This is the first study to compare murine models of T2D and melioidosis. Susceptibility and disease progression following infection with B. pseudomallei were compared in our diet-induced polygenic mouse model and a leptin receptor-deficient monogenic model of T2D. The metabolic profile of mice with diet-induced diabetes, including body weight, blood glucose, cholesterol, triglycerides, insulin resistance, and baseline levels of inflammation, closely resembled that of clinical T2D. Following subcutaneous infection with B. pseudomallei, bacterial loads at 24 and 72 h postinfection in the blood, spleen, liver, lungs, and subcutaneous adipose tissue (SAT) at the site of infection were compared in parallel with the expression of inflammatory cytokines and tissue histology. As early as 24 h postinfection, the expression of inflammatory (interleukin-1β [IL-1β], tumor necrosis factor alpha [TNF-α], and IL-6) and T(H)1 (IL-12 and gamma interferon [IFN-γ]) cytokines was impaired in diabetic mice compared to nondiabetic littermates. Early differences in cytokine expression were associated with excessive infiltration of polymorphonuclear neutrophils (PMN) in diabetic mice compared to nondiabetic littermates. This was accompanied by bacteremia, hematogenous dissemination of bacteria to the lungs, and uncontrolled bacterial growth in the spleens of diabetic mice by 72 h postinfection. The findings from our novel model of T2D and melioidosis comorbidity support the role of impaired early immune pathways in the increased susceptibility of individuals with T2D to bacterial infections.
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9
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Neutrophil extracellular traps exhibit antibacterial activity against burkholderia pseudomallei and are influenced by bacterial and host factors. Infect Immun 2012; 80:3921-9. [PMID: 22927051 DOI: 10.1128/iai.00806-12] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Burkholderia pseudomallei is the causative pathogen of melioidosis, of which a major predisposing factor is diabetes mellitus. Polymorphonuclear neutrophils (PMNs) kill microbes extracellularly by the release of neutrophil extracellular traps (NETs). PMNs play a key role in the control of melioidosis, but the involvement of NETs in killing of B. pseudomallei remains obscure. Here, we showed that bactericidal NETs were released from human PMNs in response to B. pseudomallei in a dose- and time-dependent manner. B. pseudomallei-induced NET formation required NADPH oxidase activation but not phosphatidylinositol-3 kinase, mitogen-activated protein kinases, or Src family kinase signaling pathways. B. pseudomallei mutants defective in the virulence-associated Bsa type III protein secretion system (T3SS) or capsular polysaccharide I (CPS-I) induced elevated levels of NETs. NET induction by such mutants was associated with increased bacterial killing, phagocytosis, and oxidative burst by PMNs. Taken together the data imply that T3SS and the capsule may play a role in evading the induction of NETs. Importantly, PMNs from diabetic subjects released NETs at a lower level than PMNs from healthy subjects. Modulation of NET formation may therefore be associated with the pathogenesis and control of melioidosis.
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Tan KS, Lee KO, Low KC, Gamage AM, Liu Y, Tan GYG, Koh HQV, Alonso S, Gan YH. Glutathione deficiency in type 2 diabetes impairs cytokine responses and control of intracellular bacteria. J Clin Invest 2012; 122:2289-300. [PMID: 22546856 DOI: 10.1172/jci57817] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 03/07/2012] [Indexed: 11/17/2022] Open
Abstract
Individuals with type 2 diabetes are at increased risk of acquiring melioidosis, a disease caused by Burkholderia pseudomallei infection. Although up to half of melioidosis patients have underlying diabetes, the mechanisms involved in this increased susceptibility are unknown. We found that B. pseudomallei-infected PBMCs from diabetic patients were impaired in IL-12p70 production, which resulted in decreased IFN-γ induction and poor bacterial killing. The defect was specific to the IL-12-IFN-γ axis. Defective IL-12 production was also observed during Mycobacterium tuberculosis infection, in which diabetes is likewise known to be a strong risk factor. In contrast, IL-12 production in diabetic cells was not affected upon Salmonella enterica infection or in response to TLR2, -3, -4, and -5 ligands. Poor IL-12 production correlated with a deficiency in intracellular reduced glutathione (GSH) concentrations in diabetic patients. Addition of GSH or N-acetylcysteine to PBMCs selectively restored IL-12 and IFN-γ production and improved bacterial killing. Furthermore, the depletion of GSH in mice led to increased susceptibility to melioidosis, reduced production of IL-12p70, and poorer disease outcome. Our data thus establish a link between GSH deficiency in diabetes and increased susceptibility to melioidosis that may open up new therapeutic avenues to protect diabetic patients against some intracellular bacterial pathogens.
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Affiliation(s)
- Kai Soo Tan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chin CY, Monack DM, Nathan S. Delayed activation of host innate immune pathways in streptozotocin-induced diabetic hosts leads to more severe disease during infection with Burkholderia pseudomallei. Immunology 2012; 135:312-32. [PMID: 22136109 DOI: 10.1111/j.1365-2567.2011.03544.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a predisposing factor of melioidosis, contributing to higher mortality rates in diabetics infected with Burkholderia pseudomallei. To investigate how diabetes alters the inflammatory response, we established a streptozotocin (STZ) -induced diabetic murine acute-phase melioidosis model. Viable B. pseudomallei cells were consistently detected in the blood, liver and spleen during the 42-hr course of infection but the hyperglycaemic environment did not increase the bacterial burden. However, after 24 hr, granulocyte counts increased in response to infection, whereas blood glucose concentrations decreased over the course of infection. A genome-wide expression analysis of the STZ-diabetic murine acute melioidosis liver identified ~1000 genes whose expression was altered in the STZ-diabetic mice. The STZ-diabetic host transcriptional response was compared with the normoglycaemic host transcriptional response recently reported by our group. The microarray data suggest that the presence of elevated glucose levels impairs the host innate immune system by delaying the identification and recognition of B. pseudomallei surface structures. Consequently, the host is unable to activate the appropriate innate immune response over time, which may explain the increased susceptibility to melioidosis in the STZ-diabetic host. Nevertheless, a general 'alarm signal' of infection as well as defence programmes are still triggered by the STZ-diabetic host, although only 24 hr after infection. In summary, this study demonstrates that in the face of a B. pseudomallei acute infection, poor glycaemic control impaired innate responses during the early stages of B. pseudomallei infection, contributing to the increased susceptibility of STZ-induced diabetics to this fatal disease.
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Affiliation(s)
- Chui-Yoke Chin
- School of Biosciences and Biotechnology, Universiti Kebangsaan Malaysia, Selangor, Malaysia
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12
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Hodgson KA, Morris JL, Feterl ML, Govan BL, Ketheesan N. Altered macrophage function is associated with severe Burkholderia pseudomallei infection in a murine model of type 2 diabetes. Microbes Infect 2011; 13:1177-84. [PMID: 21835260 DOI: 10.1016/j.micinf.2011.07.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2010] [Revised: 07/13/2011] [Accepted: 07/21/2011] [Indexed: 12/19/2022]
Abstract
This study used a murine model of type 2 diabetes (BKS.Cg-Dock7(m) +/+Lepr(db)/J mice) to investigate the inflammatory and cellular mechanisms predisposing to Burkholderia pseudomallei infection and co-morbid diabetes. Homozygous db/db (diabetic) mice developed extreme obesity, dyslipidaemia and glucose intolerance leading to hyperglycaemia and overt type 2 diabetes. Compared to their heterozygous db/+ (non-diabetic) littermates, diabetic mice rapidly succumbed to subcutaneous B. pseudomallei infection, paralleled by severe hypoglycaemia and increased expression of the proinflammatory cytokines, tumour necrosis factor (TNF)-α and interleukin (IL)-1β, in the spleen, despite comparable bacterial loads in the spleen of non-diabetic mice. Neutrophil oxidative burst and dendritic cell uptake and killing of B. pseudomallei were similar between diabetic and non-diabetic mice. Compared to peritoneal macrophages from non-diabetic mice, macrophages from diabetic mice were unable to contain and kill B. pseudomallei. Functional differences between macrophages of diabetic and non-diabetic mice toward B. pseudomallei may contribute to rapid dissemination and more severe disease progression in hosts with co-morbid type 2 diabetes.
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Affiliation(s)
- Kelly A Hodgson
- Microbiology and Immunology, School of Veterinary and Biomedical Sciences, James Cook University, Townsville, Queensland 4811, Australia
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13
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Human polymorphonuclear neutrophil responses to Burkholderia pseudomallei in healthy and diabetic subjects. Infect Immun 2008; 77:456-63. [PMID: 18955471 DOI: 10.1128/iai.00503-08] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The major predisposing factor for melioidosis is diabetes mellitus, but no immunological mechanisms have been investigated to explain this. In this study, polymorphonuclear neutrophil (PMN) responses to Burkholderia pseudomallei, the causative agent of melioidosis, in healthy and diabetic Thai subjects were determined by flow cytometry. The results showed that B. pseudomallei displayed reduced uptake by PMNs compared to Salmonella enterica serovar Typhimurium and Escherichia coli. Additionally, intracellular survival of B. pseudomallei was detected throughout a 24-h period, indicating the intrinsic resistance of B. pseudomallei to killing by PMNs. Moreover, PMNs from diabetic subjects displayed impaired phagocytosis of B. pseudomallei, reduced migration in response to interleukin-8, and an inability to delay apoptosis. These data show that B. pseudomallei is intrinsically resistant to phagocytosis and killing by PMNs. These observations, together with the impaired migration and apoptosis in diabetes mellitus, may explain host susceptibility in melioidosis.
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Affiliation(s)
| | | | - Denis Malvy
- University Hospital Center, Bordeaux, France
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15
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Keluangkhot V, Pethsouvanh R, Strobel M. Mélioïdose. Med Mal Infect 2005; 35:469-75. [PMID: 16253457 DOI: 10.1016/j.medmal.2005.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 08/01/2005] [Indexed: 10/25/2022]
Abstract
Melioidosis is an emerging zoonosis, due to Burkholderia pseudomallei, which is a highly invasive, resistant, and resilient soil bacteria, transmitted by cutaneous or airborne route, and is a potential weapon for bioterrorism. Although the agent has been identified all over the world, the human disease is endemic only in SE Asia and Northern Australia, and gained recent interest after the December 2004 tsunami. Human infection can be a very severe systemic disease (mortality 20 to 80%), with protean expression, but the lung is the most affected organ (50%). Pathophysiology remains unclear. Diabetes mellitus is a major risk factor, and is present in half the Asian patients with melioidosis. Recommended antibiotic regimens are expensive, and in severe disease should be prolonged to 20 weeks to reduce the risk of relapse. Prospects for prevention are limited, and no vaccine is available yet.
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Affiliation(s)
- V Keluangkhot
- Institut de la francophonie pour la médecine tropicale, BP 9519, Vientiane, Laos
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16
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Abstract
Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease.
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Affiliation(s)
- Allen C Cheng
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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Abstract
PURPOSE OF REVIEW Burkholderia pseudomallei, the causative agent of melioidosis and a potential biological weapon, is still unfamiliar in some areas where sporadic cases are being reported among travelers. This review highlights findings in 2002-2003 and is an extension of a recent review by Dance. RECENT FINDINGS The allele profiles of B. pseudomallei are distinguishable from avirulent Burkholderia thailandensis, but Burkholderia mallei is a clone of B. pseudomallei. Capsule and a type III protein secretion apparatus enable B. pseudomallei to survive intracellular killing and facilitate intercellular spread. A strong antibody response to infection is useful for monitoring disease activity. A mutant that is auxotrophic in the branched chain amino acid biosynthetic pathway has been found to be attenuated and protective. A new selective media is useful for isolation from contaminated specimens and the environment. Molecular techniques have been developed to distinguish B. pseudomallei from B. thailandensis and B. mallei as well as for serological diagnosis. Classification of the clinical manifestation is proposed to facilitate global communication, and will be useful to compare the efficacies of new regimens and adjunctive immunomodulatory therapies, such as granulocyte colony-stimulating factor and activated protein C for septicemic melioidosis. SUMMARY Study of pathogenesis and intracellular survival of B. pseudomallei is advancing and may lead to better methods of therapy and vaccine production. New antimicrobial agents and immunomodulators are being studied to shorten the duration of treatment in the acute and maintenance phases, reduce the high mortality rate in septicemic melioidosis, and prevent relapses.
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Affiliation(s)
- Amorn Leelarasamee
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok 10700, Thailand
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