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Selvam K, Najib MA, Khalid MF, Yunus MH, Wahab HA, Harun A, Zainulabid UA, Fadzli Mustaffa KM, Aziah I. Isolation and characterization of ssDNA aptamers against BipD antigen of Burkholderia pseudomallei. Anal Biochem 2024; 695:115655. [PMID: 39214325 DOI: 10.1016/j.ab.2024.115655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/19/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Melioidosis is difficult to diagnose due to its wide range of clinical symptoms. The culture method is time-consuming and less sensitive, emphasizing the importance of rapid and accurate diagnostic tests for melioidosis. Burkholderia invasion protein D (BipD) of Burkholderia pseudomallei is a potential diagnostic biomarker. This study aimed to isolate and characterize single-stranded DNA aptamers that specifically target BipD. METHODS The recombinant BipD protein was produced, followed by isolation of BipD-specific aptamers using Systematic Evolution of Ligands by EXponential enrichment. The binding affinity and specificity of the selected aptamers were evaluated using Enzyme-Linked Oligonucleotide Assay. RESULTS The fifth SELEX cycle showed a notable enrichment of recombinant BipD protein-specific aptamers. Sequencing analysis identified two clusters with a total of seventeen distinct aptamers. AptBipD1, AptBipD13, and AptBipD50 were chosen based on their frequency. Among them, AptBipD1 exhibited the highest binding affinity with a Kd value of 1.0 μM for the recombinant BipD protein. Furthermore, AptBipD1 showed significant specificity for B. pseudomallei compared to other tested bacteria. CONCLUSION AptBipD1 is a promising candidate for further development of reliable, affordable, and efficient point-of-care diagnostic tests for melioidosis.
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Affiliation(s)
- Kasturi Selvam
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Mohamad Ahmad Najib
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Muhammad Fazli Khalid
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Muhammad Hafiznur Yunus
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Habibah A Wahab
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800, Pulau, Pinang, Malaysia
| | - Azian Harun
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Ummu Afeera Zainulabid
- Department of Internal Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, 25200, Pahang, Malaysia
| | - Khairul Mohd Fadzli Mustaffa
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Ismail Aziah
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
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Campbell S, Taylor B, Menouhos D, Hennessy J, Mayo M, Baird R, Currie BJ, Meumann EM. Performance of MALDI-TOF MS, real-time PCR, antigen detection, and automated biochemical testing for the identification of Burkholderia pseudomallei. J Clin Microbiol 2024; 62:e0096124. [PMID: 39235248 PMCID: PMC11481520 DOI: 10.1128/jcm.00961-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/17/2024] [Indexed: 09/06/2024] Open
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis, a disease highly endemic to Southeast Asia and northern Australia, though the area of endemicity is expanding. Cases may occur in returning travelers or, rarely, from imported contaminated products. Identification of B. pseudomallei is challenging for laboratories that do not see this organism frequently, and misidentifications by matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) and automated biochemical testing have been reported. The in vitro diagnostic database for use with the Vitek MS has recently been updated to include B. pseudomallei and we aimed to validate the performance for identification in comparison to automated biochemical testing with the Vitek 2 GN card, quantitative real-time polymerase chain reaction (qPCR) targeting the type III secretion system, and capsular polysaccharide antigen detection using a lateral flow immunoassay (LFA). We tested a "derivation" cohort including geographically diverse B. pseudomallei and a range of closely related Burkholderia species, and a prospective "validation" cohort of B. pseudomallei and B. cepacia complex clinical isolates. MALDI-TOF MS had a sensitivity of 1.0 and specificity of 1.0 for the identification and differentiation of B. pseudomallei from related Burkholderia species when a certainty cutoff of 99.9% was used. In contrast, automated biochemical testing for B. pseudomallei identification had a sensitivity of 0.83 and specificity of 0.88. Both qPCR and LFA correctly identified all B. pseudomallei isolates with no false positives. Due to the high level of accuracy, we have now incorporated MALDI-TOF MS into our laboratory's B. pseudomallei identification workflow.IMPORTANCEBurkholderia pseudomallei causes melioidosis, a disease associated with high morbidity and mortality that disproportionately affects rural areas in Southeast Asia and northern Australia. The known area of endemicity is expanding and now includes the continental United States. Laboratory identification can be challenging which may result in missed or delayed diagnoses and poor patient outcomes. In this study, we compared mass spectrometry using an updated spectral database with multiple other methods for B. pseudomallei identification and found mass spectrometry highly accurate. We have therefore incorporated this fast and cost-effective method into our laboratory's workflow for B. pseudomallei identification.
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Affiliation(s)
- Stuart Campbell
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Brooke Taylor
- Microbiology Department, Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Dimitrios Menouhos
- Microbiology Department, Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Jann Hennessy
- Microbiology Department, Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Robert Baird
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Microbiology Department, Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Bart J. Currie
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - Ella M. Meumann
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Microbiology Department, Territory Pathology, Royal Darwin Hospital, Darwin, Australia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Australia
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Madhurantakam S, Karnam JB, Dhamu VN, Seetaraman S, Gates-Hollingsworth MA, AuCoin DP, Clark DV, Schully KL, Muthukumar S, Prasad S. Electrochemical Immunoassay for Capturing Capsular Polysaccharide of Burkholderia pseudomallei: Early Onsite Detection of Melioidosis. ACS Infect Dis 2024; 10:2118-2126. [PMID: 38712884 DOI: 10.1021/acsinfecdis.4c00133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
This study presented the detection and quantification of capsular polysaccharide (CPS) as a biomarker for the diagnosis of melioidosis. After successfully screening four monoclonal antibodies (mAbs) previously determined to bind CPS molecules, the team developed a portable electrochemical immunosensor based on antibody-antigen interactions. The biosensor was able to detect CPS with a wide detection range from 0.1pg/mL to 1 μg/mL. The developed biosensor achieved high sensitivity for the detection of CPS spiked into both urine and serum. The developed assay platform was successfully programmed into a Windows app, and the sensor performance was evaluated with different spiked concentrations. The rapid electro-analytical device (READ) sensor showed great unprecedented sensitivity for the detection of CPS molecules in both serum and urine, and results were cross-validated with ELISA methods.
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Affiliation(s)
- Sasya Madhurantakam
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75083, United States
| | | | - Vikram Narayanan Dhamu
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75083, United States
| | | | | | - David P AuCoin
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada 89557, United States
| | - Danielle V Clark
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M. Jackson Foundation for the Advancement for Military Medicine, Inc., Bethesda, Maryland 20817, United States
| | - Kevin L Schully
- Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland 21702, United States
| | | | - Shalini Prasad
- Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75083, United States
- EnLiSense LLC, Allen, Texas 75013, United States
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Nualnoi T, Wongwitwichot P, Kaewmanee S, Chanchay P, Wongpanti N, Ueangsuwan T, Siangsanor R, Chotirouangnapa W, Saechin T, Thungtin S, Szekely J, Wattanachant C, Saechan V. Development of an Antigen Capture Lateral Flow Immunoassay for the Detection of Burkholderia pseudomallei. Diagnostics (Basel) 2024; 14:1033. [PMID: 38786331 PMCID: PMC11120185 DOI: 10.3390/diagnostics14101033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Early diagnosis is essential for the successful management of Burkholderia pseudomallei infection, but it cannot be achieved by the current gold standard culture technique. Therefore, this study aimed to develop a lateral flow immunoassay (LFIA) targeting B. pseudomallei capsular polysaccharide. The development was performed by varying nitrocellulose membrane reaction pads and chase buffers. The prototype LFIA is composed of Unisart CN95 and chase buffer containing tris-base, casein, and Surfactant 10G. The assay showed no cross-reactivity with E. coli, S. aureus, P. aeruginosa, and P. acne. The limit of detections (LODs) of the prototype LFIA was 107 and 106 CFU/mL B. pseudomallei in hemoculture medium and artificial urine, respectively. These LODs suggest that this prototype can detect melioidosis from positive hemoculture bottles but not straight from urine. Additionally, these LODs are still inferior compared to Active Melioidosis Detect (AMDTM). Overall, this prototype holds the potential to be used clinically with hemoculture bottles. However, further improvements should be considered, especially for use with urine samples.
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Affiliation(s)
- Teerapat Nualnoi
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
- Drug Delivery System Excellence Center (DDSEC), Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand;
| | - Paweena Wongwitwichot
- Drug Delivery System Excellence Center (DDSEC), Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand;
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand
| | - Siriluk Kaewmanee
- Faculty of Veterinary Science, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand;
| | | | - Nattapong Wongpanti
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
| | - Tossapol Ueangsuwan
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
| | - Rattikarn Siangsanor
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
| | - Wannittaya Chotirouangnapa
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
| | - Tanatchaporn Saechin
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
| | - Suwanna Thungtin
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand (T.U.)
| | - Jidapa Szekely
- Faculty of Medical Technology, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand;
| | - Chaiyawan Wattanachant
- Division of Animal Production Innovation & Management, Faculty of Natural Resources, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand;
| | - Vannarat Saechan
- Faculty of Veterinary Science, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand;
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Kain MJW, Reece NL, Parry CM, Rajahram GS, Paterson DL, Woolley SD. The Rapid Emergence of Hypervirulent Klebsiella Species and Burkholderia pseudomallei as Major Health Threats in Southeast Asia: The Urgent Need for Recognition as Neglected Tropical Diseases. Trop Med Infect Dis 2024; 9:80. [PMID: 38668541 PMCID: PMC11054678 DOI: 10.3390/tropicalmed9040080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/29/2024] [Accepted: 04/05/2024] [Indexed: 04/29/2024] Open
Abstract
The World Health Organization (WHO)'s list of neglected tropical diseases (NTDs) highlights conditions that are responsible for devastating health, social and economic consequences, and yet, they are overlooked and poorly resourced. The NTD list does not include conditions caused by Gram-negative bacilli (GNB). Infections due to GNB cause significant morbidity and mortality and are prevalent worldwide. Southeast Asia is a WHO region of low- and middle-income countries carrying the largest burden of NTDs. Two significant health threats in Southeast Asia are Burkholderia pseudomallei (causing melioidosis) and hypervirulent Klebsiella pneumoniae (HvKp). Both diseases have high mortality and increasing prevalence, yet both suffer from a lack of awareness, significant under-resourcing, incomplete epidemiological data, limited diagnostics, and a lack of evidence-based treatment. Emerging evidence shows that both melioidosis and HvKp are spreading globally, including in high-income countries, highlighting the potential future global threat they pose. In this article, we review both conditions, identifying current trends and challenges in Southeast Asia and areas for future research. We also argue that melioidosis and HvKp merit inclusion as NTDs, and that mandatory global surveillance and reporting systems should be established, and we make an urgent call for research to better understand, detect, and treat these neglected diseases.
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Affiliation(s)
| | | | - Christopher M. Parry
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX1 2JD, UK
| | - Giri Shan Rajahram
- Department of Medicine, Queen Elizabeth II Hospital, Kota Kinabalu 88300, Malaysia
- Infectious Diseases Society, Kota Kinabalu Sabah-Menzies School of Health Research, Clinical Research Unit, Kota Kinabalu 88994, Malaysia
| | - David L. Paterson
- ADVANCE-ID Network, Saw Swee Hock School of Public Health, National University of Singapore, Singapore 119077, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Stephen D. Woolley
- Institute of Naval Medicine, Alverstoke, Hampshire PO12 2DL, UK
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals Foundation NHS Trust, Liverpool L7 8YE, UK
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6
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Burtnick MN, Dance DAB, Vongsouvath M, Newton PN, Dittrich S, Sendouangphachanh A, Woods K, Davong V, Kenna DTD, Saiprom N, Sengyee S, Hantrakun V, Wuthiekanun V, Limmathurotsakul D, Chantratita N, Brett PJ. Identification of Burkholderia cepacia strains that express a Burkholderia pseudomallei-like capsular polysaccharide. Microbiol Spectr 2024; 12:e0332123. [PMID: 38299821 PMCID: PMC10913486 DOI: 10.1128/spectrum.03321-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/10/2023] [Indexed: 02/02/2024] Open
Abstract
Burkholderia pseudomallei and Burkholderia cepacia are Gram-negative, soil-dwelling bacteria that are found in a wide variety of environmental niches. While B. pseudomallei is the causative agent of melioidosis in humans and animals, members of the B. cepacia complex typically only cause disease in immunocompromised hosts. In this study, we report the identification of B. cepacia strains isolated from either patients or soil in Laos and Thailand that express a B. pseudomallei-like 6-deoxyheptan capsular polysaccharide (CPS). These B. cepacia strains were initially identified based on their positive reactivity in a latex agglutination assay that uses the CPS-specific monoclonal antibody (mAb) 4B11. Mass spectrometry and recA sequencing confirmed the identity of these isolates as B. cepacia (formerly genomovar I). Total carbohydrates extracted from B. cepacia cell pellets reacted with B. pseudomallei CPS-specific mAbs MCA147, 3C5, and 4C4, but did not react with the B. pseudomallei lipopolysaccharide-specific mAb Pp-PS-W. Whole genome sequencing of the B. cepacia isolates revealed the presence of genes demonstrating significant homology to those comprising the B. pseudomallei CPS biosynthetic gene cluster. Collectively, our results provide compelling evidence that B. cepacia strains expressing the same CPS as B. pseudomallei co-exist in the environment alongside B. pseudomallei. Since CPS is a target that is often used for presumptive identification of B. pseudomallei, it is possible that the occurrence of these unique B. cepacia strains may complicate the diagnosis of melioidosis.IMPORTANCEBurkholderia pseudomallei, the etiologic agent of melioidosis, is an important cause of morbidity and mortality in tropical and subtropical regions worldwide. The 6-deoxyheptan capsular polysaccharide (CPS) expressed by this bacterial pathogen is a promising target antigen that is useful for rapidly diagnosing melioidosis. Using assays incorporating CPS-specific monoclonal antibodies, we identified both clinical and environmental isolates of Burkholderia cepacia that express the same CPS antigen as B. pseudomallei. Because of this, it is important that staff working in melioidosis-endemic areas are aware that these strains co-exist in the same niches as B. pseudomallei and do not solely rely on CPS-based assays such as latex-agglutination, AMD Plus Rapid Tests, or immunofluorescence tests for the definitive identification of B. pseudomallei isolates.
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Affiliation(s)
- Mary N. Burtnick
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - David A. B. Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sabine Dittrich
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Deggendorf Institut of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| | - Amphone Sendouangphachanh
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Kate Woods
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
| | - Dervla T. D. Kenna
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health Microbiology Division, Specialised Microbiology & Laboratories Directorate, UK Health Security Agency, London, United Kingdom
| | - Natnaree Saiprom
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sineenart Sengyee
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Viriya Hantrakun
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Vanaporn Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Direk Limmathurotsakul
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narisara Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Paul J. Brett
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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DeMers HL, Nualnoi T, Thorkildson P, Hau D, Hannah EE, Green HR, Pandit SG, Gates-Hollingsworth MA, Boutthasavong L, Luangraj M, Woods KL, Dance D, AuCoin DP. Detection and Quantification of the Capsular Polysaccharide of Burkholderia pseudomallei in Serum and Urine Samples from Melioidosis Patients. Microbiol Spectr 2022; 10:e0076522. [PMID: 35924843 PMCID: PMC9430648 DOI: 10.1128/spectrum.00765-22] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/30/2022] [Indexed: 11/20/2022] Open
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis, a life-threatening disease common in Southeast Asia and northern Australia. Melioidosis often presents with nonspecific symptoms and has a fatality rate of upwards of 70% when left untreated. The gold standard for diagnosis is culturing B. pseudomallei from patient samples. Bacterial culture, however, can take up to 7 days, and its sensitivity is poor, at roughly 60%. The successful administration of appropriate antibiotics is reliant on rapid and accurate diagnosis. Hence, there is a genuine need for new diagnostics for this deadly pathogen. The Active Melioidosis Detect (AMD) lateral flow immunoassay (LFI) detects the capsular polysaccharide (CPS) of B. pseudomallei. The assay is designed for use on various clinical samples, including serum and urine; however, there are limited data to support which clinical matrices are the best candidates for detecting CPS. In this study, concentrations of CPS in paired serum and urine samples from melioidosis patients were determined using a quantitative antigen capture enzyme-linked immunosorbent assay. In parallel, samples were tested with the AMD LFI, and the results of the two immunoassays were compared. Additionally, centrifugal concentration was performed on a subset of urine samples to determine if this method may improve detection when CPS levels are initially low or undetectable. The results indicate that while CPS levels varied within the two matrices, there tended to be higher concentrations in urine. The AMD LFI detected CPS in 40.5% of urine samples, compared to 6.5% of serum samples, suggesting that urine is a preferable matrix for point-of-care diagnostic assays. IMPORTANCE Melioidosis is very challenging to diagnose. There is a clear need for a point-of-care assay for the detection of B. pseudomallei antigen directly from patient samples. The Active Melioidosis Detect lateral flow immunoassay detects the capsular polysaccharide (CPS) of B. pseudomallei and is designed for use on various clinical samples, including serum and urine. However, there are limited data regarding which clinical matrix is preferable for the detection of CPS. This study addresses this question by examining quantitative CPS levels in paired serum and urine samples and relating them to clinical parameters. Additionally, centrifugal concentration was performed on a subset of urine samples to determine whether this might enable the detection of CPS in samples in which it was initially present at low or undetectable levels. These results provide valuable insights into the detection of CPS in patients with melioidosis and suggest potential ways forward in the diagnosis and treatment of this challenging disease.
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Affiliation(s)
- Haley L. DeMers
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | - Teerapat Nualnoi
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | - Peter Thorkildson
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | - Derrick Hau
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | - Emily E. Hannah
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | - Heather R. Green
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | - Sujata G. Pandit
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
| | | | - Latsaniphone Boutthasavong
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Manophab Luangraj
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Kate L. Woods
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - David Dance
- Lao-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David P. AuCoin
- Department of Microbiology and Immunology, University of Nevada, Reno, School of Medicine, Reno, Nevada, USA
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8
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Wongpalee SP, Thananchai H, Chewapreecha C, Roslund HB, Chomkatekaew C, Tananupak W, Boonklang P, Pakdeerat S, Seng R, Chantratita N, Takarn P, Khamnoi P. Highly specific and sensitive detection of Burkholderia pseudomallei genomic DNA by CRISPR-Cas12a. PLoS Negl Trop Dis 2022; 16:e0010659. [PMID: 36037185 PMCID: PMC9423629 DOI: 10.1371/journal.pntd.0010659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Detection of Burkholderia pseudomallei, a causative bacterium for melioidosis, remains a challenging undertaking due to long assay time, laboratory requirements, and the lack of specificity and sensitivity of many current assays. In this study, we are presenting a novel method that circumvents those issues by utilizing CRISPR-Cas12a coupled with isothermal amplification to identify B. pseudomallei DNA from clinical isolates. Through in silico search for conserved CRISPR-Cas12a target sites, we engineered the CRISPR-Cas12a to contain a highly specific spacer to B. pseudomallei, named crBP34. The crBP34-based detection assay can detect as few as 40 copies of B. pseudomallei genomic DNA while discriminating against other tested common pathogens. When coupled with a lateral flow dipstick, the assay readout can be simply performed without the loss of sensitivity and does not require expensive equipment. This crBP34-based detection assay provides high sensitivity, specificity and simple detection method for B. pseudomallei DNA. Direct use of this assay on clinical samples may require further optimization as these samples are complexed with high level of human DNA. Melioidosis is a fatal infectious disease caused by a Gram-negative bacterium called Burkholderia pseudomallei. The bacteria can be found in many parts of the world, especially in the tropical and subtropical regions. Infection displays a variety of symptoms such as pneumonia, organ abscess and septicemia. The latter can lead to death within 24–48 hours if not properly diagnosed and treated. Rapid and accurate diagnosis, consequently, are essential for saving patients’ lives. Currently, culturing B. pseudomallei is a gold standard diagnostic method, but the assay turnaround time is 2–4 days, and the result could be of low sensitivity. Other detection methods such as real-time PCR and serological assays are limited by availability of equipment and by low specificity in endemic areas, respectively. For these reasons, in this study we developed a specific, sensitive and rapid detection assay for B. pseudomallei DNA, that is based on CRISPR-Cas12a system. The CRISPR-Cas12a is a protein-RNA complex that recognizes DNA. The RNA can be reprogramed to guide the detection of any DNA of interest, which in our case B. pseudomallei genomic DNA. Our data showed that this assay exhibited a 100% specificity to B. pseudomallei while discriminating against 10 other pathogens and human. The assay can detect B. pseudomallei DNA in less than one hour and does not require sophisticated equipment.
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Affiliation(s)
- Somsakul Pop Wongpalee
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- * E-mail:
| | - Hathairat Thananchai
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Claire Chewapreecha
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Henrik B. Roslund
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chalita Chomkatekaew
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Warunya Tananupak
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phumrapee Boonklang
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sukritpong Pakdeerat
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Rathanin Seng
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Narisara Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Piyawan Takarn
- Department of Microbiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phadungkiat Khamnoi
- Microbiology Unit, Diagnostic Laboratory, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand
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9
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Savelkoel J, Dance DAB, Currie BJ, Limmathurotsakul D, Wiersinga WJ. A call to action: time to recognise melioidosis as a neglected tropical disease. THE LANCET INFECTIOUS DISEASES 2022; 22:e176-e182. [DOI: 10.1016/s1473-3099(21)00394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/07/2021] [Accepted: 06/28/2021] [Indexed: 10/19/2022]
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10
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Currie BJ, Woerle C, Mayo M, Meumann EM, Baird RW. What is the role of lateral flow immunoassay for the diagnosis of melioidosis? Open Forum Infect Dis 2022; 9:ofac149. [PMID: 35493111 PMCID: PMC9043003 DOI: 10.1093/ofid/ofac149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Culture of Burkholderia pseudomallei remains the gold standard for diagnosis of melioidosis but is not possible in many resource-limited settings where melioidosis is endemic. Direct identification of B. pseudomallei antigen in clinical samples has been developed using a lateral flow immunoassay (LFA) targeting B. pseudomallei capsular polysaccharide.
Methods
We summarised the findings from the 8 studies to date of the Active Melioidosis Detect (AMD) LFA and compared these with our results from 232 patients with culture-confirmed melioidosis. We have also optimised the methodology for testing different clinical samples.
Results
Sensitivity and specificity for different samples was broadly similar in our study to those published from Thailand, India, Laos and Malaysia. 130/232 (56%) of our melioidosis patients were positive on one or more AMD tests: 27% for serum (rising to 39% in those with bacteremic melioidosis and 68% in those with septic shock); 63% for urine (72% in bacteremic melioidosis and 90% in septic shock); 85% in sputum that was culture positive; and 83% in pus that was culture positive. Heating sputum and pus samples increased sensitivity. Faint false positive urine bands seen on earlier AMD versions were not seen when re-tested using the most recent version, AMD-Plus.
Conclusions
While sensitivity of melioidosis LFA is low overall for blood samples, there is potential for use as a rapid diagnostic; testing serum and urine from those with severe sepsis who may have melioidosis and testing sputum and pus samples from clinically relevant scenarios. Prospective studies of patients with sepsis and other clinical presentations resembling melioidosis are required to ascertain if the specificity of AMD-PLUS is adequate to enable diagnosis of melioidosis with a high positive predictive value.
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Affiliation(s)
- Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Department of Infectious Diseases and Pathology and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Celeste Woerle
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Department of Infectious Diseases and Pathology and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Robert W Baird
- Department of Infectious Diseases and Pathology and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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11
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Evaluation of antigen-detecting and antibody-detecting diagnostic test combinations for diagnosing melioidosis. PLoS Negl Trop Dis 2021; 15:e0009840. [PMID: 34727111 PMCID: PMC8562799 DOI: 10.1371/journal.pntd.0009840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background Melioidosis, an infectious disease caused by Burkholderia pseudomallei, is endemic in many tropical developing countries and has a high mortality. Here we evaluated combinations of a lateral flow immunoassay (LFI) detecting B. pseudomallei capsular polysaccharide (CPS) and enzyme-linked immunosorbent assays (ELISA) detecting antibodies against hemolysin co-regulated protein (Hcp1) or O-polysaccharide (OPS) for diagnosing melioidosis. Methodology/Principal findings We conducted a cohort-based case-control study. Both cases and controls were derived from a prospective observational study of patients presenting with community-acquired infections and sepsis in northeast Thailand (Ubon-sepsis). Cases included 192 patients with a clinical specimen culture positive for B. pseudomallei. Controls included 502 patients who were blood culture positive for Staphylococcus aureus, Escherichia coli or Klebsiella pneumoniae or were polymerase chain reaction assay positive for malaria or dengue. Serum samples collected within 24 hours of admission were stored and tested using a CPS-LFI, Hcp1-ELISA and OPS-ELISA. When assessing diagnostic tests in combination, results were considered positive if either test was positive. We selected ELISA cut-offs corresponding to a specificity of 95%. Using a positive cut-off OD of 2.912 for Hcp1-ELISA, the combination of the CPS-LFI and Hcp1-ELISA had a sensitivity of 67.7% (130/192 case patients) and a specificity of 95.0% (477/502 control patients). The sensitivity of the combination (67.7%) was higher than that of the CPS-LFI alone (31.3%, p<0.001) and that of Hcp1-ELISA alone (53.6%, p<0.001). A similar phenomenon was also observed for the combination of CPS-LFI and OPS-ELISA. In case patients, positivity of the CPS-LFI was associated with a short duration of symptoms, high modified Sequential (sepsis-related) Organ Failure Assessment (SOFA) score, bacteraemia and mortality outcome, while positivity of Hcp1-ELISA was associated with a longer duration of symptoms, low modified SOFA score, non-bacteraemia and survival outcome. Conclusions/Significance A combination of antigen-antibody diagnostic tests increased the sensitivity of melioidosis diagnosis over individual tests while preserving high specificity. Point-of-care tests for melioidosis based on the use of combination assays should be further developed and evaluated. Melioidosis is an infection caused by the Gram-negative bacterium Burkholderia pseudomallei. There are currently no commercially available and reliable point-of-care diagnostic tests for melioidosis. We previously demonstrated that a prototype lateral flow immunoassay (LFI) developed to detect B. pseudomallei capsular polysaccharide (CPS) had limited sensitivity (31.3%) but high specificity (98.8%) for diagnosing melioidosis among patients presenting with community-acquired infection or sepsis in northeast Thailand. Here, we evaluated combinations of the CPS-LFI and enzyme-linked immunosorbent assays (ELISA) that detect antibodies against hemolysin co-regulated protein (Hcp1) or O-polysaccharide (OPS). When used in combination, results were considered positive if either test was positive. We selected ELISA cut-offs corresponding to a specificity of 95%. Our results demonstrated that a combination of antigen-detection (CPS-LFI) and antibody-detection (Hcp1-ELISA or OPS-ELISA) tests increased the sensitivity for diagnosis of melioidosis (68% or 63%, respectively) over any single test, while maintaining high specificity (95%). In case patients, positivity of the CPS-LFI was associated with a short duration of symptoms, severe infections (as measured by an organ failure assessment score), bacteraemia and mortality outcome, while positivity of Hcp1-ELISA was associated with a long duration of symptoms, non-bacteraemia and survival outcome. Based on our findings, we propose that point-of-care melioidosis diagnostic tests using combinations of antigen- and antibody-detection should be further developed and evaluated.
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12
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Radhakrishnan A, Behera B, Mishra B, Mohapatra PR, Kumar R, Singh AK. Clinico-microbiological description and evaluation of rapid lateral flow immunoassay and PCR for detection of Burkholderia pseudomallei from patients hospitalized with sepsis and pneumonia: A twenty-one months study from Odisha, India. Acta Trop 2021; 221:105994. [PMID: 34118206 DOI: 10.1016/j.actatropica.2021.105994] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 05/18/2021] [Accepted: 05/31/2021] [Indexed: 12/26/2022]
Abstract
Establishing a diagnosis of melioidosis based on clinical grounds is difficult in hospitalized patients with sepsis or community acquired pneumonia (CAP). We aimed to ascertain the prevalence, clinico-epidemiological and laboratory profile of melioidosis in hospitalized patients with sepsis or CAP, and to evaluate the diagnostic utility of rapid lateral flow immunoassay (LFI) and PCR in comparison with culture. In all patients with sepsis or CAP, blood, sputum/throat swab, and urine sample were subjected to culture along with other samples based on clinical presentation. In addition, PCR assay targeting the type III secretion system 1 (TTS1) and LFI was performed. Thirty-three (33/196, 17%) out of the total 196 cases were diagnosed as melioidosis by culture. The prevalence of melioidosis in patients who had only sepsis without CAP, had both sepsis and CAP, had CAP without sepsis was 31% (26/84), 22 % (4/18) and 3%(3/94) respectively. All the LFI or PCR positive cases were culture positive from at least one or more samples (blood/sputum/urine/pus). The sensitivity, specificity, positive predictive value and negative predictive value of TTS1 PCR was 78% (18/23 melioidosis patients), 100% (34/34 non-melioidosis patients), 100% (18/18 melioidosis patients) and 87% (34/39 non-melioidosis patients). The sensitivity, specificity, positive predictive value and negative predictive value of Rapid LFI was 91% (21/23 melioidosis patients), 100% (22/22 non-melioidosis patients), 100% (21/21 melioidosis patients) and 91% (22/24 non-melioidosis patients). On sample wise stratification of LFI and TTS1 with respect to culture, plasma/serum samples showed the highest discordance by PCR (9/55, 16.3%) and LFI (11/35, 31.4%). The lowest discordance was noted in respiratory tract samples (2/32, 6.2%) by PCR and pus/body fluids samples (2/14, 14.2%) by LFI and these findings are in line with previous published literature. The clinical utility of PCR and LFI needs to be further validated in a large scale study for early diagnosis of septicaemic melioidosis.
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Affiliation(s)
| | - Bijayini Behera
- Department of Microbiology, AIIMS, Bhubaneswar, Odisha, India.
| | | | | | - Rajesh Kumar
- Department of General Medicine, AIIMS, Bhubaneswar Odisha, India.
| | - Arvind Kumar Singh
- Department of Community and Family Medicine, AIIMS, Bhubaneswar, Odisha, India.
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13
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Warrell CE, Phyo AP, Win MM, McLean ARD, Watthanaworawit W, Swe MMM, Soe K, Lin HN, Aung YY, Ko CK, Waing CZ, Linn KS, Aung YPW, Aung NM, Tun NN, Dance DAB, Smithuis FM, Ashley EA. Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes. Trans R Soc Trop Med Hyg 2021; 115:914-921. [PMID: 33681986 PMCID: PMC8326957 DOI: 10.1093/trstmh/trab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 01/22/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. METHODS A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. RESULTS Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. CONCLUSIONS TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.
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Affiliation(s)
- Clare E Warrell
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | | | - Mo Mo Win
- Department of Medical Research, Myanmar
| | - Alistair R D McLean
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Wanitda Watthanaworawit
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Kyaw Soe
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Htet Naing Lin
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | | | | | | | | | | | - Ne Myo Aung
- Department of Medicine, Insein General Hospital, Min Gyi Road, Insein Township, Yangon, Myanmar.,Department of Medicine, University of Medicine 2, Khaymar Thi Road, North Okkalapa Township, Yangon, Myanmar
| | - Ni Ni Tun
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | - David A B Dance
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Frank M Smithuis
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Medical Action Myanmar, Yangon, Myanmar
| | - Elizabeth A Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar.,Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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14
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Mardhiah K, Wan-Arfah N, Naing NN, Hassan MRA, Chan HK. The Cox model of predicting mortality among melioidosis patients in Northern Malaysia: A retrospective study. Medicine (Baltimore) 2021; 100:e26160. [PMID: 34160382 PMCID: PMC8238369 DOI: 10.1097/md.0000000000026160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/15/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT Melioidosis is an infectious disease that is initiated by a bacteria recognized as Burkholderia pseudomallei. Despite the high fatality rate from melioidosis, there is a minimal published study about the disease in Malaysia.This study aimed to identify the prognostic factors of mortality among melioidosis patients in northern Malaysia.All inpatient patients who were admitted to Hospital Sultanah Bahiyah, Kedah and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis during the period 2014 to 2017 were included in the study. The study retrospectively collected 510 melioidosis patients from the Melioidosis Registry. Hazard ratio (HR) used in advanced multiple Cox regression was used to obtain the final model of prognostic factors of melioidosis. The analysis was performed using STATA/SE 14.0 for Windows software.From the results, among the admitted patients, 50.1% died at the hospital. The mean age for those who died was 55 years old, and they were mostly male. The most common underlying disease was diabetes mellitus (69.8%), followed by hypertension (32.7%). The majority of cases (86.8%) were bacteremic. The final Cox model identified 5 prognostic factors of mortality among melioidosis patients. The factors were diabetes mellitus, type of melioidosis, platelet count, white blood cell count, and urea value. The results showed that bacteremic melioidosis increased the risk of dying by 3.47 (HR: 3.47, 95% confidence intervals [CI]: 1.67-7.23, P = .001) compared to non-bacteremic melioidosis. Based on the blood investigations, the adjusted HRs from the final model showed that all 3 blood investigations were included as the prognostic factors for the disease (low platelet: HR = 1.76, 95% CI: 1.22-2.54, P = .003; high white blood cell: HR = 1.49, 95% CI 1.06-2.11, P = .023; high urea: HR = 2.92, 95% CI: 1.76-4.85, P < .001; and low level of urea: HR = 2.69, 95% CI: 1.69-4.29, P < .001). By contrast, melioidosis patients with diabetic had 30.0% lower risk of dying from melioidosis compared to those with non-diabetic (HR = 0.70, 95% CI: 0.52-0.94, P = .016).Identifying the prognostic factors of mortality in patients with melioidosis allows a guideline of early management in these patients, which may improve patient's survival.
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Affiliation(s)
- Kamaruddin Mardhiah
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Huan-Keat Chan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
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15
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Muangsombut V, Withatanung P, Chantratita N, Chareonsudjai S, Lim J, Galyov EE, Ottiwet O, Sengyee S, Janesomboon S, Loessner MJ, Dunne M, Korbsrisate S. Rapid Clinical Screening of Burkholderia pseudomallei Colonies by a Bacteriophage Tail Fiber-Based Latex Agglutination Assay. Appl Environ Microbiol 2021; 87:e0301920. [PMID: 33811022 PMCID: PMC8174754 DOI: 10.1128/aem.03019-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/15/2021] [Indexed: 01/21/2023] Open
Abstract
Melioidosis is a life-threatening disease in humans caused by the Gram-negative bacterium Burkholderia pseudomallei. As severe septicemic melioidosis can lead to death within 24 to 48 h, a rapid diagnosis of melioidosis is critical for ensuring that an optimal antibiotic course is prescribed to patients. Here, we report the development and evaluation of a bacteriophage tail fiber-based latex agglutination assay for rapid detection of B. pseudomallei infection. Burkholderia phage E094 was isolated from rice paddy fields in northeast Thailand, and the whole genome was sequenced to identify its tail fiber (94TF). The 94TF complex was structurally characterized, which involved identification of a tail assembly protein that forms an essential component of the mature fiber. Recombinant 94TF was conjugated to latex beads and developed into an agglutination-based assay (94TF-LAA). 94TF-LAA was initially tested against a large library of Burkholderia and other bacterial strains before a field evaluation was performed during routine clinical testing. The sensitivity and specificity of the 94TF-LAA were assessed alongside standard biochemical analyses on 300 patient specimens collected from an area of melioidosis endemicity over 11 months. The 94TF-LAA took less than 5 min to produce positive agglutination, demonstrating 98% (95% confidence interval [CI] of 94.2% to 99.59%) sensitivity and 83% (95% CI of 75.64% to 88.35%) specificity compared to biochemical-based detection. Overall, we show how a Burkholderia-specific phage tail fiber can be exploited for rapid detection of B. pseudomallei. The 94TF-LAA has the potential for further development as a supplementary diagnostic to assist in clinical identification of this life-threatening pathogen. IMPORTANCE Rapid diagnosis of melioidosis is essential for ensuring that optimal antibiotic courses are prescribed to patients and thus warrants the development of cost-effective and easy-to-use tests for implementation in underresourced areas such as northeastern Thailand and other tropical regions. Phage tail fibers are an interesting alternative to antibodies for use in various diagnostic assays for different pathogenic bacteria. As exposed appendages of phages, tail fibers are physically robust and easy to manufacture, with many tail fibers (such as 94TF investigated here) capable of targeting a given bacterial species with remarkable specificity. Here, we demonstrate the effectiveness of a latex agglutination assay using a Burkholderia-specific tail fiber 94TF against biochemical-based detection methods that are the standard diagnostic in many areas where melioidosis is endemic.
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Affiliation(s)
- Veerachat Muangsombut
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patoo Withatanung
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narisara Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sorujsiri Chareonsudjai
- Department of Microbiology and Melioidosis Research Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Jiali Lim
- DSO National Laboratories, Singapore
| | - Edouard E. Galyov
- Department of Genetics and Genome Biology, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Orawan Ottiwet
- Department of Medical Technology and Clinical Pathology, Mukdahan Hospital, Mukdahan, Thailand
| | - Sineenart Sengyee
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sujintana Janesomboon
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Matthew Dunne
- Institute of Food Nutrition and Health, ETH Zurich, Zurich, Switzerland
| | - Sunee Korbsrisate
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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16
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Swe MMM, Win MM, Cohen J, Phyo AP, Lin HN, Soe K, Amorncha P, Wah TT, Win KKN, Ling C, Parker DM, Dance DAB, Ashley EA, Smithuis F. Geographical distribution of Burkholderia pseudomallei in soil in Myanmar. PLoS Negl Trop Dis 2021; 15:e0009372. [PMID: 34029325 PMCID: PMC8143414 DOI: 10.1371/journal.pntd.0009372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/07/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. METHODOLOGY/PRINCIPAL FINDINGS We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70-7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19-2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21-6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant. CONCLUSION/SIGNIFICANCE This study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar.
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Affiliation(s)
- Myo Maung Maung Swe
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Mo Mo Win
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Joshua Cohen
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | | | | | - Kyaw Soe
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - Premjit Amorncha
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Bangkok, Thailand
| | - Thin Thin Wah
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Kyi Kyi Nyein Win
- Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar
| | - Clare Ling
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Shoklo Malaria Research Unit (SMRU), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Daniel M. Parker
- Department of Population Health and Disease Prevention Program in Public Health, University of California, Irvine, CA, United States of America
| | - David A. B. Dance
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth A. Ashley
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People’s Democratic Republic
| | - Frank Smithuis
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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17
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BipD of Burkholderia pseudomallei: Structure, Functions, and Detection Methods. Microorganisms 2021; 9:microorganisms9040711. [PMID: 33808203 PMCID: PMC8067316 DOI: 10.3390/microorganisms9040711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 01/13/2023] Open
Abstract
Melioidosis is a severe disease caused by Burkholderia pseudomallei (B. pseudomallei), a Gram-negative environmental bacterium. It is endemic in Southeast Asia and Northern Australia, but it is underreported in many other countries. The principal routes of entry for B. pseudomallei are skin penetration, inhalation, and ingestion. It mainly affects immunocompromised populations, especially patients with type 2 diabetes mellitus. The laboratory diagnosis of melioidosis is challenging due to its non-specific clinical manifestations, which mimic other severe infections. The culture method is considered an imperfect gold standard for the diagnosis of melioidosis due to its low sensitivity. Antibody detection has low sensitivity and specificity due to the high seropositivity among healthy people in endemic regions. Antigen detection using various proteins has been tested for the rapid determination of B. pseudomallei; however, it presents certain limitations in terms of its sensitivity and specificity. Therefore, this review aims to frame the present knowledge of a potential target known as the Burkholderia invasion protein D (BipD), including future directions for its detection using an aptamer-based sensor (aptasensor).
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18
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Mardhiah K, Wan-Arfah N, Naing NN, Abu Hassan MR, Chan HK, Hasan H. The Trend of Direct Medical Cost of Meliodiosis Patients in Kedah: A Retrospective Study from 2014 to 2017. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:155-162. [PMID: 33732004 PMCID: PMC7959198 DOI: 10.2147/ceor.s286283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study was conducted to determine the direct medical cost of treating melioidosis patients. The calculation was made according to the variables extracted from medical records. MATERIALS AND METHODS Data collection was performed retrospectively on a total of 293 cases from Hospital Sultanah Bahiyah, Kedah, Malaysia. The data consisted of personal information, treatment history, and investigation findings, including blood results, USG abdomen results, and CT scan results. The site of culture and sensitivity were also obtained. The total direct medical cost was based on the antibiotics/treatments received by the patients, diagnostic test and investigations performed. The trend analysis used to see the pattern of costs from 2014 to 2017. All the costs were compared based on patients' status and duration of stay at the hospital using the independent t-test. RESULTS The overall mean of direct medical cost for melioidosis amounted to US $233.61 (RM931.33). Overall, the finding confirms a huge reduction (44.7%) of direct medical cost from 2014 to 2017 (P = 0.001). From 2015 to 2016, there was a 19.1% reduction of direct medical cost (P>0.95), followed by a 38.8% reduction in costs from 2016 to 2017 (P = 0.019). In the case of the duration of stay, the mean of total direct medical cost among patients with ≥14 duration of stay was higher compared to those with <14 duration of stay (p < 0.001). There was no significant mean difference of direct medical cost between patients who were cured and died. CONCLUSION Despite the higher mortality of melioidosis cases compared to other infectious diseases, there is a limitation in the amount of published data on the management cost of melioidosis. The importance of cost in managing this disease should be underlined to perform a fully prepared management toward the disease.
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Affiliation(s)
- Kamaruddin Mardhiah
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Muhammad Radzi Abu Hassan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Huan-Keat Chan
- Clinical Research Center, Hospital Sultanah Bahiyah, Ministry of Health Malaysia, Alor Setar, Kedah, Malaysia
| | - Hazriah Hasan
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
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19
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Schully KL, Young CC, Mayo M, Connolly AL, Rigas V, Spall A, Chan AA, Salvador MG, Lawler JV, Opdyke JA, Clark DV, Currie BJ. Next-generation Diagnostics for Melioidosis: Evaluation of a Prototype i-STAT Cartridge to Detect Burkholderia pseudomallei Biomarkers. Clin Infect Dis 2020; 69:421-427. [PMID: 30403768 DOI: 10.1093/cid/ciy929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 10/29/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Infection with the gram-negative bacterium Burkholderia pseudomallei can result in melioidosis, a life-threatening disease that can be difficult to diagnose. Culture remains the gold standard for diagnosis but requires laboratory resources not available in many endemic regions. A lateral flow immunoassay has shown promise for POC diagnostics but suffers from low sensitivity when used on blood samples. PCR also has low sensitivity on blood, attributed to the low bacterial numbers in blood observed in melioidosis patients, even when bacteraemic. METHODS A prototype i-STAT cartridge was developed to utilize the monoclonal antibody specific for the capsule of pathogenic Burkholderia species employed on the LFI. The resulting POC assay was evaluated on 414 clinical specimens from Darwin, Australia and Cambodia. RESULTS The i-STAT assay accurately distinguished Australian blood culture positive melioidosis patients from Australian patients hospitalized with other infections (AUC = 0.91, 95% CI 0.817 - 1.0). We derived an assay cutoff with 76% sensitivity and 94% specificity that correctly classified 88% (n = 74) of the Australian patients. Interestingly, only 46% (6/13) of the culture-positive melioidosis patients in Cambodia were classified correctly. Of great importance however, the assay detected capsule from blood samples for 32% of blood culture negative melioidosis patients in both cohorts and previously undiagnosed melioidosis patients in Cambodia. In addition the assay showed high sensitivity and specificity for urine, pus and sputum. CONCLUSIONS Diagnostic tools that are not dependent upon the growth kinetics or the levels of bacteremia of B. pseudomallei represent the next-generation of diagnostics and must be pursued further.
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Affiliation(s)
- Kevin L Schully
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick
| | - Charles C Young
- Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - Amy L Connolly
- Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland
| | - Vanessa Rigas
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - Ammarah Spall
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick
| | - Alyssa A Chan
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick
| | - Mark G Salvador
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick
| | - James V Lawler
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick
| | - Jason A Opdyke
- Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense, Medical Countermeasure Systems, Ft. Detrick, Maryland
| | - Danielle V Clark
- Austere Environments Consortium for Enhanced Sepsis Outcomes, Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Department of Infectious Diseases and Northern Territory Medical Program, Royal Darwin Hospital, Australia
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20
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Wagner GE, Föderl-Höbenreich E, Assig K, Lipp M, Berner A, Kohler C, Lichtenegger S, Stiehler J, Karoonboonyanan W, Thanapattarapairoj N, Promkong C, Koosakulnirand S, Chaichana P, Ehricht R, Gad AM, Söffing HH, Dunachie SJ, Chantratita N, Steinmetz I. Melioidosis DS rapid test: A standardized serological dipstick assay with increased sensitivity and reliability due to multiplex detection. PLoS Negl Trop Dis 2020; 14:e0008452. [PMID: 32658917 PMCID: PMC7416965 DOI: 10.1371/journal.pntd.0008452] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/10/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Melioidosis, caused by Burkholderia pseudomallei, is a severe infectious disease with high mortality rates, but is under-recognized worldwide. In endemic areas, there is a great need for simple, low-cost and rapid diagnostic tools. In a previous study we showed, that a protein multiplex array with 20 B. pseudomallei-specific antigens detects antibodies in melioidosis patients with high sensitivity and specificity. In a subsequent study the high potential of anti-B. pseudomallei antibody detection was confirmed using a rapid Hcp1 single protein-based assay. Our protein array also showed that the antibody profile varies between patients, possibly due to a combination of host factors but also antigen variations in the infecting B. pseudomallei strains. The aim of this study was to develop a rapid test, combining Hcp1 and the best performing antigens BPSL2096, BPSL2697 and BPSS0477 from our previous study, to take advantage of simultaneous antibody detection. METHODS AND PRINCIPAL FINDINGS The 4-plex dipstick was validated with sera from 75 patients on admission plus control groups, achieving 92% sensitivity and 97-100% specificity. We then re-evaluated melioidosis sera with the 4-plex assay that were previously misclassified by the monoplex Hcp1 rapid test. 12 out of 55 (21.8%) false-negative samples were positive in our new dipstick assay. Among those, 4 sera (7.3%) were Hcp1 positive, whereas 8 (14.5%) sera remained Hcp1 negative but gave a positive reaction with our additional antigens. CONCLUSIONS Our dipstick rapid test represents an inexpensive, standardized and simple diagnostic tool with an improved serodiagnostic performance due to multiplex detection. Each additional band on the test strip makes a false-positive result more unlikely, contributing to its reliability. Future prospective studies will seek to validate the gain in sensitivity and specificity of our multiplex rapid test approach in different melioidosis patient cohorts.
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Affiliation(s)
- Gabriel E. Wagner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Esther Föderl-Höbenreich
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Karoline Assig
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Michaela Lipp
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Andreas Berner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Christian Kohler
- Friedrich Loeffler Institute for Medical Microbiology, Greifswald, Germany
| | - Sabine Lichtenegger
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Julia Stiehler
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | | | | | - Chidchanok Promkong
- Department of Medical Laboratory, Nakhon Phanom Hospital, Nakhon Phanom, Thailand
| | - Sirikamon Koosakulnirand
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Panjaporn Chaichana
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ralf Ehricht
- Leibniz Institute of Photonic Technology (IPHT), Jena, Germany
- InfectoGnostics Research Campus, Jena, Germany
- Institute of Physical Chemistry, Friedrich Schiller University Jena, Jena, Germany
| | - Anne-Marie Gad
- Senova Gesellschaft für Biowissenschaft und Technik mbH, Weimar, Germany
| | - Hans H. Söffing
- Senova Gesellschaft für Biowissenschaft und Technik mbH, Weimar, Germany
| | - Susanna J. Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Narisara Chantratita
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ivo Steinmetz
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
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21
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Adapting Microarray Gene Expression Signatures for Early Melioidosis Diagnosis. J Clin Microbiol 2020; 58:JCM.01906-19. [PMID: 32350042 DOI: 10.1128/jcm.01906-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/17/2020] [Indexed: 12/24/2022] Open
Abstract
Melioidosis is caused by Burkholderia pseudomallei and is predominantly seen in tropical regions. The clinical signs and symptoms of the disease are nonspecific and often result in misdiagnosis, failure of treatment, and poor clinical outcome. Septicemia with septic shock is the most common cause of death, with mortality rates above 40%. Bacterial culture is the gold standard for diagnosis, but it has low sensitivity and takes days to produce definitive results. Early laboratory diagnosis can help guide physicians to provide treatment specific to B. pseudomallei In our study, we adapted host gene expression signatures obtained from microarray data of B. pseudomallei-infected cases to develop a real-time PCR diagnostic test using two differentially expressed genes, AIM2 (absent in melanoma 2) and FAM26F (family with sequence similarity 26, member F). We tested blood from 33 patients with B. pseudomallei infections and 29 patients with other bacterial infections to validate the test and determine cutoff values for use in a cascading diagnostic algorithm. Differentiation of septicemic melioidosis from other sepsis cases had a sensitivity of 82%, specificity of 93%, and negative and positive predictive values (NPV and PPV) of 82% and 93%, respectively. Separation of cases likely to be melioidosis from those unlikely to be melioidosis in nonbacteremic situations showed a sensitivity of 40%, specificity of 54%, and NPV and PPV of 44% and 50%, respectively. We suggest that our AIM2 and FAM26F expression combination algorithm could be beneficial for early melioidosis diagnosis, offering a result within 24 h of admission.
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22
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Choi JY, Hii KC, Bailey ES, Chuang JY, Tang WY, Yuen Wong EK, Ti T, Pau KS, Berita A, Saihidi I, Ting J, Chua TT, Toh TH, AuCoin DP, DeShazer D, Gray GC. Burkholderia pseudomallei Detection among Hospitalized Patients, Sarawak. Am J Trop Med Hyg 2020; 102:388-391. [PMID: 31769397 DOI: 10.4269/ajtmh.19-0625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Burkholderia pseudomallei infections are prevalent in Southeast Asia and northern Australia and often misdiagnosed. Diagnostics are often neither sensitive nor rapid, contributing up to 50% mortality rate. In this 2018 pilot study, we enrolled 100 patients aged 6 months-79 years from Kapit Hospital in Sarawak, Malaysia, with symptoms of B. pseudomallei infection. We used three different methods for the detection of B. pseudomallei: a real-time polymerase chain reaction (PCR) assay, a rapid lateral flow immunoassay, and the standard-of-care bacterial culture-the gold standard. Among the 100 participants, 24 (24%) were positive for B. pseudomallei by one or more of the detection methods. Comparing the two individual diagnostic methods against the gold standard-bacterial culture-of any positive test, there was low sensitivity for each test (25-44%) but high specificity (93-98%). It seems clear that more sensitive diagnostics or a sensitive screening diagnostic followed by specific confirmatory diagnostic is needed for this disease.
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Affiliation(s)
- Jessica Y Choi
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - King Ching Hii
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Emily S Bailey
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Jia Yun Chuang
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Wei Yieng Tang
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | | | - Tiana Ti
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Kat Siong Pau
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Antoinette Berita
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Izreena Saihidi
- Kapit Hospital, Ministry of Health Malaysia, Kapit, Sarawak, Malaysia
| | - Jakie Ting
- Faculty of Medicine, SEGi University, Kota Damansara, Malaysia.,Clinical Research Center, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - Tiing-Tiing Chua
- Clinical Research Center, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - Teck-Hock Toh
- Faculty of Medicine, SEGi University, Kota Damansara, Malaysia.,Clinical Research Center, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | | | - David DeShazer
- US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Gregory C Gray
- Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Global Health Research Center, Duke-Kunshan University, Kunshan, China.,Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
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23
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Larson DT, Schully KL, Spall A, Lawler JV, Maves RC. Indirect Detection of Burkholderia pseudomallei Infection in a US Marine After Training in Australia. Open Forum Infect Dis 2020; 7:ofaa103. [PMID: 32391401 PMCID: PMC7200084 DOI: 10.1093/ofid/ofaa103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 11/14/2022] Open
Abstract
In 2012, the United States Marine Corps began annual deployments around Australia, including highly endemic areas for Burkholderia pseudomallei. B. pseudomallei infection, or melioidosis, is difficult to diagnose, and culture remains the gold standard. Accurate and timely diagnosis is essential, however, to ensuring appropriate therapy. Ten days after returning from Australia, a Marine presented to a community hospital with massive cervical lymphadenopathy, fever, and cough. Computed tomography demonstrated scattered pulmonary infiltrates with small cavitations; lymphadenopathy involving the cervical, supraclavicular, and mediastinal nodes; and splenomegaly. Sputum and blood cultures were negative. Empiric antimicrobial therapy with ceftazidime was initiated for suspected melioidosis. Retrospectively, a prototype iSTAT cartridge modified to detect B. pseudomallei capsular polysaccharide antigen was used to test a specimen of the patient's blood and was determined to be positive. Over the course of therapy, B. pseudomallei capsular antigen levels in blood declined as the patient improved. The leveraging of an existing point-of-care (POC) analyzer to create a rapid diagnostic assay for melioidosis provides a template for rapid POC diagnostics that could significantly improve the ability of clinicians to deliver timely and appropriate therapy for serious infections.
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Affiliation(s)
- Derek T Larson
- Infectious Diseases Service, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, USA
| | - Kevin L Schully
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, USA
| | - Ammarah Spall
- Austere Environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Ft. Detrick, Maryland, USA
| | - James V Lawler
- Global Center for Health Security and Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ryan C Maves
- Division of Infectious Diseases, Naval Medical Center, San Diego, California, USA
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24
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Shi L, Chen J, Yi G. Burkholderia pseudomallei was Identified in a Melioidosis Aneurysm using Polymerase Chain Reaction Targeting 23S rRNA. Ann Vasc Surg 2020; 68:569.e13-569.e20. [PMID: 32339680 DOI: 10.1016/j.avsg.2020.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/28/2020] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
Melioidosis abdominal aortic aneurysm and splenic abscesses lead to poor prognosis and high mortality rate as high as 50% due to delayed/missed diagnosis. We describe an attempt to identify Burkholderia pseudomallei immediately, which was confirmed by polymerase chain reaction (PCR) and gene sequence analysis of 23S rRNA gene. PCR is not only an unambiguous identification of B. pseudomallei but also a rapid detection because B. pseudomallei may not be readily isolated. For patients of melioidosis abdominal aortic aneurysm with spleen abscess, prolonged antibiotic therapy, splenectomy and artificial vessel replacement provided an excellent result in our study. The progression, roentgenographic findings and histopathology character of melioidosis are similar to those of tuberculosis disease. PCR is useful to differentiate B. pseudomallei from Mycobacterium tuberculosis.
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Affiliation(s)
- Li Shi
- The Infective Disease Department and Tropical Medicine Research Unit, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan Province, People's Republic of China.
| | - Jie Chen
- Acupuncture and Massage Institute, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, People's Republic of China
| | - Gao Yi
- The Infective Disease Department and Tropical Medicine Research Unit, Affiliated Hainan Hospital of Hainan Medical University, Haikou, Hainan Province, People's Republic of China
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25
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Abstract
The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.
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Affiliation(s)
- I Gassiep
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - M Armstrong
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
| | - R Norton
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Rizzi MC, Rattanavong S, Bouthasavong L, Seubsanith A, Vongsouvath M, Davong V, De Silvestri A, Manciulli T, Newton PN, Dance DAB. Evaluation of the Active Melioidosis Detect™ test as a point-of-care tool for the early diagnosis of melioidosis: a comparison with culture in Laos. Trans R Soc Trop Med Hyg 2019; 113:757-763. [PMID: 31638152 PMCID: PMC6907004 DOI: 10.1093/trstmh/trz092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Melioidosis is difficult to diagnose clinically and culture of Burkholderia pseudomallei is the current, imperfect gold standard. However, a reliable point-of-care test (POCT) could enable earlier treatment and improve outcomes. METHODS We evaluated the sensitivity and specificity of the Active Melioidosis Detect™ (AMD) rapid test as a POCT and determined how much it reduced the time to diagnosis compared with culture. RESULTS We tested 106 whole blood, plasma and buffy coat samples, 96 urine, 28 sputum and 20 pus samples from 112 patients, of whom 26 (23.2%) were culture-positive for B. pseudomallei. AMD sensitivity and specificity were 65.4 and 87.2%, respectively, the latter related to 10 weak positive reactions on urine samples, considered likely false positives. The positive predictive value was 60.7%, negative predictive value was 89.3% and concordance rate between operators reading the test was 95.7%; time to diagnosis decreased by a median of 23 h. CONCLUSIONS Our findings confirm that a strongly positive AMD result can reduce the time to diagnosis of melioidosis. However, the AMD currently has a disappointing overall sensitivity, especially with blood fractions, and specificity problems when testing urine samples.
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Affiliation(s)
- Maria Chiara Rizzi
- University of Pavia, Pavia, Italy
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Sayaphet Rattanavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Latsaniphone Bouthasavong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Amphayvanh Seubsanith
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Viengmon Davong
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | | | | | - Paul N Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7FZ, UK
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine and Global Health, 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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Peeters M, Ombelet S, Chung P, Tsoumanis A, Lim K, Long L, De Smet B, Kham C, Teav S, Vlieghe E, Phe T, Jacobs J. Slow growth of Burkholderia pseudomallei compared to other pathogens in an adapted blood culture system in Phnom Penh, Cambodia. J Med Microbiol 2019; 68:1159-1166. [PMID: 31188093 DOI: 10.1099/jmm.0.001011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Burkholderia pseudomallei is a key pathogen causing bloodstream infections at Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia. Here, visual instead of automated detection of growth of commercial blood culture bottles is done. The present study assessed the performance of this system. METHODOLOGY Blood culture sets, consisting of paired adult aerobic and anaerobic bottles (bioMérieux, FA FAN 259791 and FN FAN 252793) were incubated in a standard incubator for 7 days after reception. Each day, the bottle growth indicator was visually inspected for colour change indicating growth. Blind subculture was performed from the aerobic bottle at day 3. RESULTS From 2010 to 2015, 11 671 sets representing 10 389 suspected bloodstream infection episodes were documented. In 1058 (10.2 %) episodes, pathogens grew; they comprised Escherichia coli (31.7 %), Salmonella Paratyphi A (13.9 %), B. pseudomallei (8.5 %), Staphylococcus aureus (7.8 %) and Klebsiella pneumoniae (7.0 %). Blind subculture yielded 72 (4.1 %) pathogens, mostly (55/72, 76.4 %) B. pseudomallei. Cumulative proportions of growth at day 2 were as follows: E. coli: 85.0 %, Salmonella Paratyphi A: 85.0 %, K. pneumoniae: 76.3 % and S. aureus: 52.2 %; for B. pseudomallei, this was only 4.0 %, which increased to 70.1 % (70/99) at day 4 mainly by detection on blind subculture (55/99). Compared to the anaerobic bottles, aerobic bottles had a higher yield and a shorter time-to-detection, particularly for B. pseudomallei. CONCLUSIONS Visual inspection for growth of commercial blood culture bottles in a low-resource setting provided satisfactory yield and time-to-detection. However, B. pseudomallei grew slowly and was mainly detected by blind subculture. The aerobic bottle outperformed the anaerobic bottle.
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Affiliation(s)
- Marjan Peeters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Sien Ombelet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Panha Chung
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kruy Lim
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Leng Long
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Birgit De Smet
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chun Kham
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Syna Teav
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Erika Vlieghe
- Unit of Internal Medicine and Infectious Diseases, University Hospital Antwerp, Antwerp, Belgium
| | - Thong Phe
- Sihanouk Hospital Centre of HOPE, Phnom Penh, Cambodia
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
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Melioidosis in Colombia, description of a clinical case and epidemiological considerations. ACTA ACUST UNITED AC 2019; 39:10-18. [PMID: 31529845 DOI: 10.7705/biomedica.v39i3.4534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 01/28/2023]
Abstract
Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected.
There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases.
We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.
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29
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Identification of Burkholderia pseudomallei by Use of the Vitek Mass Spectrometer. J Clin Microbiol 2019; 57:JCM.00081-19. [PMID: 30842230 DOI: 10.1128/jcm.00081-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/27/2019] [Indexed: 02/07/2023] Open
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis. This condition most often presents as pneumonia and bacteremia, with mortality rates of 9% to 70%. Therefore, early identification of this organism may aid in directing appropriate management. This study aimed to use the Vitek matrix-assisted laser desorption ionization-time of flight mass spectrometer to create a spectrum for the rapid identification of B. pseudomallei Spectra from 85 isolate cultures were acquired using the Vitek mass spectrometer research mode. A SuperSpectrum was created using peak matching and subsequently activated for analysis of organism identification. All 85 isolates were correctly identified as B. pseudomallei A total of 899 spectra were analyzed and demonstrated a specificity of 99.8%. Eighty-one clinical isolates were used, of which 10 were neuromelioidosis, and no discernible spectrum difference was appreciated. Spectrum acquisition from a single spot was only successful in 374/899 (41%) of isolates. This increased to 100% when 3 spots of the same extract were analyzed. The Vitek mass spectrometer can be used for the rapid identification of B. pseudomallei with a high level of specificity.
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Yi J, Simpanya MF, Settles EW, Shannon AB, Hernandez K, Pristo L, Keener ME, Hornstra H, Busch JD, Soffler C, Brett PJ, Currie BJ, Bowen RA, Tuanyok A, Keim P. Caprine humoral response to Burkholderia pseudomallei antigens during acute melioidosis from aerosol exposure. PLoS Negl Trop Dis 2019; 13:e0006851. [PMID: 30811382 PMCID: PMC6411198 DOI: 10.1371/journal.pntd.0006851] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/11/2019] [Accepted: 01/09/2019] [Indexed: 11/29/2022] Open
Abstract
Burkholderia pseudomallei causes melioidosis, a common source of pneumonia and sepsis in Southeast Asia and Northern Australia that results in high mortality rates. A caprine melioidosis model of aerosol infection that leads to a systemic infection has the potential to characterize the humoral immune response. This could help identify immunogenic proteins for new diagnostics and vaccine candidates. Outbred goats may more accurately mimic human infection, in contrast to the inbred mouse models used to date. B. pseudomallei infection was delivered as an intratracheal aerosol. Antigenic protein profiling was generated from the infecting strain MSHR511. Humoral immune responses were analyzed by ELISA and western blot, and the antigenic proteins were identified by mass spectrometry. Throughout the course of the infection the assay results demonstrated a much greater humoral response with IgG antibodies, in both breadth and quantity, compared to IgM antibodies. Pre-infection sera showed multiple immunogenic proteins already reactive for IgG (7-20) and IgM (0-12) in most of the goats despite no previous exposure to B. pseudomallei. After infection, the number of IgG reactive proteins showed a marked increase as the disease progressed. Early stage infection (day 7) showed immune reaction to chaperone proteins (GroEL, EF-Tu, and DnaK). These three proteins were detected in all serum samples after infection, with GroEL immunogenically dominant. Seven common reactive antigens were selected for further analysis using ELISA. The heat shock protein GroEL1 elicited the strongest goat antibody immune response compared to the other six antigens. Most of the six antigens showed the peak IgM reactivity at day 14, whereas the IgG reactivity increased further as the disease progressed. An overall MSHR511 proteomic comparison between the goat model and human sera showed that many immune reactive proteins are common between humans and goats with melioidosis.
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Affiliation(s)
- Jinhee Yi
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Mukoma F. Simpanya
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Erik W. Settles
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Austin B. Shannon
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Karen Hernandez
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Lauren Pristo
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Mitchell E. Keener
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Heidie Hornstra
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Joseph D. Busch
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
| | - Carl Soffler
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Paul J. Brett
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, United States of America
| | - Bart J. Currie
- Menzies School of Health Research and Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Richard A. Bowen
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, United States of America
| | - Apichai Tuanyok
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Paul Keim
- The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, United States of America
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Chaichana P, Jenjaroen K, Amornchai P, Chumseng S, Langla S, Rongkard P, Sumonwiriya M, Jeeyapant A, Chantratita N, Teparrukkul P, Limmathurotsakul D, Day NPJ, Wuthiekanun V, Dunachie SJ. Antibodies in Melioidosis: The Role of the Indirect Hemagglutination Assay in Evaluating Patients and Exposed Populations. Am J Trop Med Hyg 2018; 99:1378-1385. [PMID: 30298810 PMCID: PMC6283516 DOI: 10.4269/ajtmh.17-0998] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 08/22/2018] [Indexed: 12/19/2022] Open
Abstract
Melioidosis is a major neglected tropical disease with high mortality, caused by the Gram-negative bacterium Burkholderia pseudomallei (Bp). Microbiological culture remains the gold standard for diagnosis, but a simpler and more readily available test such as an antibody assay is highly desirable. In this study, we conducted a serological survey of blood donors (n = 1,060) and adult melioidosis patients (n = 200) in northeast Thailand to measure the antibody response to Bp using the indirect hemagglutination assay (IHA). We found that 38% of healthy adults (aged 17-59 years) have seropositivity (IHA titer ≥ 1:80). The seropositivity in healthy blood donors was associated with having a declared occupation of rice farmer and with residence in a nonurban area, but not with gender or age. In the melioidosis cohort, the seropositivity rate was higher in adult patients aged between 18 and 45 years (90%, 37/41) compared with those aged ≥ 45 years (68%, 108/159, P = 0.004). The seropositivity rate was significantly higher in people with diabetes (P = 0.008). Seropositivity was associated with decreased mortality on univariable analysis (P = 0.005), but not on multivariable analysis when adjusted for age, diabetes status, preexisting renal disease, and neutrophil count. This study confirms the presence of high background antibodies in an endemic region and demonstrates the limitations of using IHA during acute melioidosis in this population.
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Affiliation(s)
- Panjaporn Chaichana
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Kemajittra Jenjaroen
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Premjit Amornchai
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Suchintana Chumseng
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Sayan Langla
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Patpong Rongkard
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | | | - Atthanee Jeeyapant
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Narisara Chantratita
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Prapit Teparrukkul
- Medical Department, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nicholas P. J. Day
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Vanaporn Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Susanna J. Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, United Kingdom
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