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An Investigation of Burkholderia pseudomallei Seroprevalence in Market Pigs Slaughtered at Selected Pig Abattoirs in Uganda. Pathogens 2022; 11:pathogens11111363. [DOI: 10.3390/pathogens11111363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
Burkholderia pseudomallei is a Gram-negative bacterium that causes melioidosis, a disease of humans and animals. It is primarily transmitted through direct contact with contaminated soil and surface water. The epidemiology of this pathogen in Africa, including Uganda, is largely unknown. The objectives of this study were to estimate the seroprevalence of B. pseudomallei in pigs slaughtered in central Uganda and to identify potential hotspots for this pathogen in the country. A total of 1035 pig sera were analyzed for serological responses to B. pseudomallei with type A and type B LPS using OPS type A and OPS type B ELISAs. Of the 1035 samples, 75 (7.25%, 95% CI: 5.8–9%) were seropositive to the OPS-A ELISA using a two standard deviations (SD) cutoff and 19 (1.84%, 95% CI: 1.2–2.9%) at 3 SD. For the OPS-B ELISA, 93/1035 (8.99%, 95% CI: 7.4–10.9%) were seropositive at the 2 SD cutoff, and 28/1035 (2.71%, 95% CI: 1.9–3.9%) at the 3 SD cutoff. Pigs slaughtered in central Uganda were exposed to B. pseudomallei, and there is a higher seroprevalence in the rainy months. Public health awareness campaigns about melioidosis may be needed.
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Maze MJ, Elrod MG, Biggs HM, Bonnewell J, Carugati M, Hoffmaster AR, Lwezaula BF, Madut DB, Maro VP, Mmbaga BT, Morrissey AB, Saganda W, Sakasaka P, Rubach MP, Crump JA. Investigation of Melioidosis Using Blood Culture and Indirect Hemagglutination Assay Serology among Patients with Fever, Northern Tanzania. Am J Trop Med Hyg 2020; 103:2510-2514. [PMID: 32996455 PMCID: PMC7695086 DOI: 10.4269/ajtmh.20-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prediction models indicate that melioidosis may be common in parts of East Africa, but there are few empiric data. We evaluated the prevalence of melioidosis among patients presenting with fever to hospitals in Tanzania. Patients with fever were enrolled at two referral hospitals in Moshi, Tanzania, during 2007–2008, 2012–2014, and 2016–2019. Blood was collected from participants for aerobic culture. Bloodstream isolates were identified by conventional biochemical methods. Non–glucose-fermenting Gram-negative bacilli were further tested using a Burkholderia pseudomallei latex agglutination assay. Also, we performed B. pseudomallei indirect hemagglutination assay (IHA) serology on serum samples from participants enrolled from 2012 to 2014 and considered at high epidemiologic risk of melioidosis on the basis of admission within 30 days of rainfall. We defined confirmed melioidosis as isolation of B. pseudomallei from blood culture, probable melioidosis as a ≥ 4-fold rise in antibody titers between acute and convalescent sera, and seropositivity as a single antibody titer ≥ 40. We enrolled 3,716 participants and isolated non-enteric Gram-negative bacilli in five (2.5%) of 200 with bacteremia. As none of these five isolates was B. pseudomallei, there were no confirmed melioidosis cases. Of 323 participants tested by IHA, 142 (44.0%) were male, and the median (range) age was 27 (0–70) years. We identified two (0.6%) cases of probable melioidosis, and 57 (17.7%) were seropositive. The absence of confirmed melioidosis from 9 years of fever surveillance indicates melioidosis was not a major cause of illness.
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Affiliation(s)
- Michael J Maze
- Centre for International Health, University of Otago, Dunedin, New Zealand.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Mindy Glass Elrod
- Bacterial Special Pathogens Branch, US Centers for Disease Control, Atlanta, Georgia
| | - Holly M Biggs
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - John Bonnewell
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Manuela Carugati
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina
| | - Alex R Hoffmaster
- Bacterial Special Pathogens Branch, US Centers for Disease Control, Atlanta, Georgia
| | | | - Deng B Madut
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania
| | - Anne B Morrissey
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | | | | | - Matthew P Rubach
- Programme in Emerging Infectious Diseases, Duke-National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - John A Crump
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Health System, Durham, North Carolina.,Mawenzi Regional Referral Hospital, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Tumaini University, Moshi, Tanzania.,Duke Global Health Institute, Duke University, Durham, North Carolina.,Centre for International Health, University of Otago, Dunedin, New Zealand
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Steinmetz I, Wagner GE, Kanyala E, Sawadogo M, Soumeya H, Teferi M, Andargie E, Yeshitela B, Yaba Atsé-Achi L, Sanogo M, Bonfoh B, Rakotozandrindrainy R, Pongombo Shongo C, Shongoya Pongombo M, Kasamba Ilunga E, Lichtenegger S, Assig K, May J, Bertherat E, Owusu M, Owusu-Dabo E, Adu-Sarkodie Y. Melioidosis in Africa: Time to Uncover the True Disease Load. Trop Med Infect Dis 2018; 3:E62. [PMID: 30274458 PMCID: PMC6073667 DOI: 10.3390/tropicalmed3020062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/31/2018] [Accepted: 06/01/2018] [Indexed: 02/05/2023] Open
Abstract
Melioidosis is an often fatal infectious disease with a protean clinical spectrum, caused by the environmental bacterial pathogen Burkholderia pseudomallei. Although the disease has been reported from some African countries in the past, the present epidemiology of melioidosis in Africa is almost entirely unknown. Therefore, the common view that melioidosis is rare in Africa is not evidence-based. A recent study concludes that large parts of Africa are environmentally suitable for B. pseudomallei. Twenty-four African countries and three countries in the Middle East were predicted to be endemic, but no cases of melioidosis have been reported yet. In this study, we summarize the present fragmentary knowledge on human and animal melioidosis and environmental B. pseudomallei in Africa and the Middle East. We propose that systematic serological studies in man and animals together with environmental investigations on potential B. pseudomallei habitats are needed to identify risk areas for melioidosis. This information can subsequently be used to target raising clinical awareness and the implementation of simple laboratory algorithms for the isolation of B. pseudomallei from clinical specimens. B. pseudomallei was most likely transferred from Asia to the Americas via Africa, which is shown by phylogenetic analyses. More data on the virulence and genomic characteristics of African B. pseudomallei isolates will contribute to a better understanding of the global evolution of the pathogen and will also help to assess potential differences in disease prevalence and outcome.
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Affiliation(s)
- Ivo Steinmetz
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria.
- Friedrich Loeffler Institute of Medical Microbiology, University Medicine of Greifswald, KöR, 17475 Greifswald, Germany.
| | - Gabriel E Wagner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Estelle Kanyala
- Departement UFR/Science de la Santé, Université d'Ouagadougou, BP 7021, Ouagadougou, Burkina Faso.
| | - Mamadou Sawadogo
- Departement UFR/Science de la Santé, Université d'Ouagadougou, BP 7021, Ouagadougou, Burkina Faso.
| | - Hema Soumeya
- Centre Muraz, 01 BP 390 Bobo Dioulasso, Burkina Faso.
| | - Mekonnen Teferi
- Armauer Hansen Research Institute, Jimma Road, ALERT Compound, P.O. Box 1005 Addis Ababa, Ethiopia.
| | - Emawayish Andargie
- Armauer Hansen Research Institute, Jimma Road, ALERT Compound, P.O. Box 1005 Addis Ababa, Ethiopia.
| | - Biruk Yeshitela
- Armauer Hansen Research Institute, Jimma Road, ALERT Compound, P.O. Box 1005 Addis Ababa, Ethiopia.
| | - Louise Yaba Atsé-Achi
- Laboratoire Central Vétérinaire de Bingerville, LANADA, P.O. Box 206 Bingerville, Cote D'Ivoire.
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), 01 BP 1303 Abidjan, Cote D'Ivoire.
| | - Moussa Sanogo
- Laboratoire Central Vétérinaire de Bingerville, LANADA, P.O. Box 206 Bingerville, Cote D'Ivoire.
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), 01 BP 1303 Abidjan, Cote D'Ivoire.
| | | | - Célestin Pongombo Shongo
- Democratic Republic of the Congo, Université de Lubumbashi, 1825 Lubumbashi, Republic of the Congo.
| | - Mick Shongoya Pongombo
- Democratic Republic of the Congo, Université de Lubumbashi, 1825 Lubumbashi, Republic of the Congo.
| | - Eric Kasamba Ilunga
- Democratic Republic of the Congo, Université de Lubumbashi, 1825 Lubumbashi, Republic of the Congo.
| | - Sabine Lichtenegger
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria.
| | - Karoline Assig
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8036 Graz, Austria.
- Friedrich Loeffler Institute of Medical Microbiology, University Medicine of Greifswald, KöR, 17475 Greifswald, Germany.
| | - Jürgen May
- Bernhard Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany.
| | - Eric Bertherat
- Department of Infectious Hazard Management, World Health Organization, Geneva 27, Switzerland.
| | - Michael Owusu
- College of Health Sciences, Kwame Nkrumah University of Science and Technology, 00233 Kumasi, Ghana.
| | - Ellis Owusu-Dabo
- College of Health Sciences, Kwame Nkrumah University of Science and Technology, 00233 Kumasi, Ghana.
- Kumasi Centre for Collaborative Research, 00233 Kumasi, Ghana.
| | - Yaw Adu-Sarkodie
- College of Health Sciences, Kwame Nkrumah University of Science and Technology, 00233 Kumasi, Ghana.
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Perumal Samy R, Stiles BG, Sethi G, Lim LHK. Melioidosis: Clinical impact and public health threat in the tropics. PLoS Negl Trop Dis 2017; 11:e0004738. [PMID: 28493905 PMCID: PMC5426594 DOI: 10.1371/journal.pntd.0004738] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
This review briefly summarizes the geographical distribution and clinical impact of melioidosis, especially in the tropics. Burkholderia pseudomallei (a gram-negative bacterium) is the major causative agent for melioidosis, which is prevalent in Singapore, Malaysia, Thailand, Vietnam, and Northern Australia. Melioidosis patients are increasingly being recognized in other parts of the world. The bacteria are intrinsically resistant to many antimicrobial agents, but prolonged treatment, especially with combinations of antibiotics, may be effective. Despite therapy, the overall case fatality rate of septicemia in melioidosis remains significantly high. Intracellular survival of the bacteria within macrophages may progress to chronic infections, and about 10% of patients suffer relapses. In the coming decades, melioidosis will increasingly afflict travelers throughout many global regions. Clinicians managing travelers returning from the subtropics or tropics with severe pneumonia or septicemia should consider acute melioidosis as a differential diagnosis. Patients with open skin wounds, diabetes, or chronic renal disease are at higher risk for melioidosis and should avoid direct contact with soil and standing water in endemic regions. Furthermore, there are fears that B. pseudomallei may be used as a biological weapon. Technological advancements in molecular diagnostics and antibiotic therapy are improving the disease outcomes in endemic areas throughout Asia. Research and development efforts on vaccine candidates against melioidosis are ongoing.
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Affiliation(s)
- Ramar Perumal Samy
- Department of Physiology, NUS Immunology Programme, Centre for Life Sciences, Yong Loo Lin School of Medicine, National University Health System (NUHS), National University of Singapore, Singapore
| | - Bradley G. Stiles
- Integrated Toxicology Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, NUHS, National University of Singapore, Singapore
| | - Lina H. K. Lim
- Department of Physiology, NUS Immunology Programme, Centre for Life Sciences, Yong Loo Lin School of Medicine, National University Health System (NUHS), National University of Singapore, Singapore
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Birnie E, Wiersinga WJ, Limmathurotsakul D, Grobusch MP. Melioidosis in Africa: should we be looking more closely? Future Microbiol 2015; 10:273-81. [PMID: 25689538 DOI: 10.2217/fmb.14.113] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Melioidosis is a life-threatening infection caused by the Gram-negative bacterium Burkholderia pseudomallei, mainly found in Southeast Asia. Recently, African foci have been identified, although reports remain mostly anecdotal. In Africa, multiple febrile diseases have been erroneously attributed to malaria in the past, and many cases of fever remain mis- or undiagnosed. Vigilance for previously under-recognized pathogens may enhance our understanding of disease epidemiology and facilitate improvement of patient care. Melioidosis may be such a condition. We summarize data on melioidosis in Africa and discuss the future directions for epidemiological, clinical and bacteriological studies. We conclude that searching for old bugs in new places is no academic treasure hunt but a clinically relevant activity to pursue.
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Affiliation(s)
- Emma Birnie
- Center of Tropical Medicine & Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Salam AP, Khan N, Malnick H, Kenna DTD, Dance DAB, Klein JL. Melioidosis acquired by traveler to Nigeria. Emerg Infect Dis 2012. [PMID: 21762592 PMCID: PMC3381395 DOI: 10.3201/eid1707.110502] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe melioidosis associated with travel to Nigeria in a woman with diabetes, a major predisposing factor for this infection. With the prevalence of diabetes projected to increase dramatically in many developing countries, the global reach of melioidosis may expand.
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Affiliation(s)
- Alex P Salam
- Guy's and St. Thomas' National Health Service Trust, London, UK
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Batchelor BI, Paul J, Trakulsomboon S, Mgongo M, Dance DA. Melioidosis survey in Kenya. Trans R Soc Trop Med Hyg 1994; 88:181. [PMID: 7518617 DOI: 10.1016/0035-9203(94)90286-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Abstract
For nearly 80 years clinical melioidosis has been considered a rare disease. This bacterial infection is caused by Pseudomonas pseudomallei, a saprophyte found in soil and surface water of endemic areas. Consequently, those who have most contact with soil, the rural poor, are likely to be at greatest risk of infection. Since the diversity of clinical manifestations necessitates the isolation and identification of the causative organism for a definitive diagnosis of melioidosis and the population at greatest risk within endemic areas rarely have access to an appropriate level of health care, the disease has probably been underrecognized. Melioidosis is now known to be an important cause of human morbidity and mortality in Thailand, and this may be true throughout Southeast Asia, which is usually regarded as the main endemic area for the disease. In Australia, melioidosis causes a smaller number of human infections, while disease among livestock has important economic and possible public health implications. Sporadic reports of the infection indicate its presence in several other tropical regions: in the Indian subcontinent, Africa, and Central and South America. Clinical melioidosis may be highly prevalent in these areas, but underdiagnosed as a result of a lack of awareness of the clinical and microbiological features of the disease, or simply because of a lack of health care facilities. Furthermore, during the last two decades the importation and transmission of melioidosis within nontropical zones have been documented. The causative organism is not difficult to grow, and modern antibiotics have improved disease prognosis. Further studies are needed to determine the true worldwide distribution and prevalence of melioidosis so that improved therapeutic and preventive measures can be developed and applied.
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Affiliation(s)
- D A Dance
- Bangkok Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand
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