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Poh MM, Liu JS, De PP, Chan M, Leo YS, Vasoo S. Predictors of mortality in culture-proven Burkholderia pseudomallei infections in a Singapore Tertiary Hospital. Diagn Microbiol Infect Dis 2024; 110:116494. [PMID: 39173566 DOI: 10.1016/j.diagmicrobio.2024.116494] [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: 06/01/2024] [Revised: 07/26/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
Burkholderia pseudomallei is a pathogen expanding in geographic range. We performed a retrospective study analyzing the clinical, microbiologic features of culture-proven melioidosis, and predictors of mortality based on data from a Singapore tertiary hospital between 2006- 2016. We found ICU admission, bacteremia, and mechanical ventilation to be associated with mortality.
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Affiliation(s)
- Mark Ms Poh
- National Healthcare Group Internal Medicine Residency, Tan Tock Seng Hospital, Singapore
| | - Justin S Liu
- National Healthcare Group Internal Medicine Residency, Tan Tock Seng Hospital, Singapore
| | - Partha P De
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
| | - Monica Chan
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Yee Sin Leo
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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2
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Nisarg S, Tirlangi PK, Ravindra P, Bhat R, Sujir SN, Alli SD, Chowdhury S, Earny VA, Gupta N, Mukhopadhyay C. Predictors of 28-day mortality in melioidosis patients presenting to an emergency department: a retrospective cohort study from South India. Trans R Soc Trop Med Hyg 2024; 118:652-658. [PMID: 38554065 DOI: 10.1093/trstmh/trae017] [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: 11/07/2023] [Revised: 01/02/2024] [Accepted: 03/08/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Septic melioidosis is associated with high mortality in resource-limited settings. The current study aims to find 28-d all-cause mortality predictors within 24 h of admission in melioidosis patients presenting to an emergency department. METHODS This retrospective cohort study (2018-2022) included melioidosis patients divided into two groups based on their primary outcomes (28-d mortality). All the clinically relevant factors significant in univariate analysis were selected for binary logistic regression analysis. Those factors significant in logistic regression analysis were considered independent predictors of mortality. RESULTS Of the 53 patients with melioidosis, the 28-d mortality of melioidosis patients admitted to the emergency department was 51% (n=27). Respiratory involvement, renal dysfunction, haemodynamic instability, elevated aspartate transaminase, elevated activated partial thromboplastin time, elevated CRP, elevated procalcitonin, decreased albumin, decreased absolute neutrophil count, decreased absolute lymphocyte count and use of piperacillin-tazobactam or azithromycin were significant predictors of mortality on univariate analysis. Vasopressor requirement (p=0.03) and low serum albumin level (0.041) at presentation were independent predictors of mortality. CONCLUSION Vasopressor requirement and low albumin levels at presentation in the emergency department are independent predictors of mortality. There is a need to create awareness among primary care physicians to enable early diagnosis and prompt initiation of treatment.
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Affiliation(s)
- S Nisarg
- De part ment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Praveen Kumar Tirlangi
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Prithvishree Ravindra
- De part ment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rachana Bhat
- De part ment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sachin Nayak Sujir
- De part ment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sai Deepak Alli
- De part ment of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Soumi Chowdhury
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Venkat Abhiram Earny
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
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Kumari S, Banu M, Ramanatha K, Barani R, Sridharan KS. Are Burkholderia Emerging Pathogens in patients with underlying morbidity: A case series. Heliyon 2024; 10:e33283. [PMID: 39021926 PMCID: PMC11253054 DOI: 10.1016/j.heliyon.2024.e33283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Burkholderia is a genus consisting of several species including the Burkholderia pseudomallei group, Burkholderia cepacia complex and other phytopathogens. Burkholderia species is a gram-negative bacillus with protean presentation that can be acquired from various sources, including water, soil, plant surfaces, and hospital environments. The organism on Gram staining is seen as gram-negative rod and on culture, the colonies are non-lactose fermenting. As it can mimic other diseases, it is frequently misdiagnosed and there is lack of awareness about the clinical spectrum of disease and diagnosis. This study aims to investigate varied clinical manifestations, identify potential risk factors and transmission modes and contribute to enhancing the clinical management of diseases. The increasing prevalence of Burkholderia infection implies its potential emergence as a significant public health concern, compounded by the growing incidence of diabetes, which has the potential to escalate the overall disease burden. The principal finding of the case series highlighted a spectrum of clinical presentations, emphasizing the need for comprehensive diagnostic strategies and tailored therapeutic interventions. These strategies will address the diverse manifestations and challenges posed by Burkholderia infections. This underscores the importance of heightened awareness among clinicians and microbiologists, given the need for extended treatment to achieve a complete cure and prevent potential relapses.
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Affiliation(s)
- Swati Kumari
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 600116
| | - Marleena Banu
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 600116
| | - Krishnapriya Ramanatha
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 600116
| | - Ramya Barani
- Department of Microbiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 600116
| | - Kopula Sathyamurthy Sridharan
- Department of Laboratory Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India, 600116
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Qian Y, Shen Y. Si Miao San relieves hyperuricemia by regulating intestinal flora. Biomed Chromatogr 2024; 38:e5807. [PMID: 38118432 DOI: 10.1002/bmc.5807] [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: 09/19/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023]
Abstract
This study seeks to investigate the therapeutic effects of Si Miao San (SMS) on hyperuricemia and its underlying mechanisms, particularly focusing on the role of intestinal flora. The key components of SMS were identified using high-performance liquid chromatography (HPLC). To establish a rat model of hyperuricemia, an intraperitoneal injection of potassium oxonate was performed, followed by oral administration of various concentrations of SMS. The study evaluated the status of hyperuricemia, renal pathology, xanthine oxidase (XO) activity, and intestinal flora. Utilizing HPLC, we identified five active components of SMS. Following SMS intervention, there was a significant reduction in serum levels of uric acid (UA), blood urea nitrogen, and creatinine, accompanied by an increase in urine UA levels in rats with hyperuricemia. Distinct pathological injuries were evident in the renal tissues of hyperuricemic rats, and these were partially alleviated following SMS intervention. Moreover, SMS exhibited a dose-dependent reduction in XO activity both in the serum and hepatic tissues. Notably, SMS contributed to an enhancement in the diversity of intestinal flora in hyperuricemic rats. The intervention of SMS resulted in a reduction in the abundance of certain bacterial species, including Parabacteroides johnsonii, Corynebacterium urealyticum, and Burkholderiales bacterium. This suggests that SMS may exert anti-hyperuricemia effects, potentially by modulating the composition of intestinal flora.
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Affiliation(s)
- Yue Qian
- Rehabilitation Center, Hangzhou Wuyunshan Hospital (Hangzhou Institute of Health Promotion), Hangzhou, Zhejiang Province, China
| | - Yan Shen
- Department of Nursing, Hangzhou Wuyunshan Hospital (Hangzhou Institute of Health Promotion), Hangzhou, Zhejiang Province, China
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Schwartzman G, Reddy SA, Berg SH, Currie BJ, Saavedra AP. Cutaneous melioidosis: An updated review and primer for the dermatologist. J Am Acad Dermatol 2023; 89:1201-1208. [PMID: 37582471 DOI: 10.1016/j.jaad.2023.07.1032] [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: 05/04/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023]
Abstract
Melioidosis is an emerging infection with increasing endemic foci and global distribution. It is underrecognized and underdiagnosed because of factors including limited awareness of the disease, nonspecific clinical presentation, lack of diagnostic facilities in some locations, misidentification in laboratories inexperienced with culture, and identification of Burkholderia pseudomallei. Cutaneous findings are reported in approximately 10% to 20% of melioidosis cases and dermatologists may play a significant role in its recognition and management. The most dynamic situation of melioidosis recognition and/or expansion currently is in the United States. Global modeling had predicted that B. pseudomallei were potentially endemic in the southern United States and endemicity with local cases of melioidosis was confirmed in 2022. With the distribution and prevalence of melioidosis increasing globally and with this recent recognition that melioidosis is now endemic in the southern United States, it is important for dermatologists to maintain high clinical suspicion in appropriate patients and be familiar with its diagnosis and treatment. Here we review the available literature on cutaneous melioidosis to evaluate its epidemiology, etiology, pathophysiology and clinical presentation and provide guidance for diagnosis and management in dermatology practice.
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Affiliation(s)
| | - Soumya A Reddy
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Scott H Berg
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Arturo P Saavedra
- Department of Dermatology, University of Virginia, Charlottesville, Virginia
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Velôso DS, da Silva SP, de Coelho CMS, Parente JML, Veloso TAE, Lima MM, Sampaio CT, de Freitas MFAB, Rolim DB, de Lemos ERS, Horta MAP. Emergence of melioidosis in Brazil: a case series. J Med Case Rep 2023; 17:362. [PMID: 37608318 PMCID: PMC10463497 DOI: 10.1186/s13256-023-04093-8] [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: 06/23/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Melioidosis is a serious disease caused by the bacterium Burkholderia pseudomallei which affects humans and animals. It results in a wide spectrum of clinical manifestations, mainly in the respiratory tract, progressing to septic shock and death. CASE PRESENTATION Herein, we present a series of seven patients (median age: 41 years) with confirmed melioidosis, treated at a public hospital in Piauí State, Brazil between 2019 and 2021. The most common clinical presentations were fever, cough, pneumonia, and abdominal pain. The mean duration of antibacterial therapy with 1 g of meropenem was 28.6 ± 1.1 days. Six patients recovered and one died. The mean hospitalization time was 51.0 ± 39.2 days. CONCLUSIONS Melioidosis is an emerging infectious disease in Brazil. Health professionals in endemic areas need to be aware of the clinical presentation and appropriate clinical management of the disease because early diagnosis and early initiation of antibiotic therapy can be life-saving.
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Affiliation(s)
- Dilbert Silva Velôso
- University Hospital/Federal University of Piaui, Teresina, Brazil
- Laboratório de Hantaviroses e Rickettsioses/Instituto Oswaldo Cruz/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | | | | | | | | | | | | | - Elba Regina Sampaio de Lemos
- Laboratório de Hantaviroses e Rickettsioses/Instituto Oswaldo Cruz/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Marco Aurélio Pereira Horta
- Laboratório de Hantaviroses e Rickettsioses/Instituto Oswaldo Cruz/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Melioidosis and Burkholderia pseudomallei : progress in epidemiology, diagnosis, treatment and vaccination. Curr Opin Infect Dis 2022; 35:517-523. [PMID: 35942848 DOI: 10.1097/qco.0000000000000869] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Melioidosis and its causative bacterium Burkholderia pseudomallei are being found in unexpected locations and bacterial genotyping is providing new insights into global spread and where and how individuals are being infected. This review summarizes recent studies covering the epidemiology, diagnosis, treatment, and prevention of melioidosis. RECENT FINDINGS Whole-genome sequencing of B. pseudomallei from patients and environmental sampling is informing the phylogeography of B. pseudomallei at regional, continental, and global levels, while also defining the epidemiology for individual cases. The situation in Africa remains the most unresolved, while the evolving story of B. pseudomallei in the Americas may establish that B. pseudomallei is endemic in parts of southern USA. Guidelines for diagnosis and treatment of melioidosis are well established, and published mortality has decreased from 50% or higher to 10% or lower in some countries but access to laboratory and therapeutic resources are not available or are extremely limited in many melioidosis-endemic regions. SUMMARY The enormous clinical diversity of melioidosis and the complexities of laboratory diagnosis and of treatment make it a sentinel disease for highlighting the continuing global disparities in access to and provision of healthcare.
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Gupta A, Siddiqui F, Purwar S, Joshi R, Mukhopadhyay C. Is it always COVID-19 in acute febrile illness in the tropics during the pandemic? PLoS Negl Trop Dis 2022; 16:e0010891. [PMID: 36322563 PMCID: PMC9629600 DOI: 10.1371/journal.pntd.0010891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
- * E-mail:
| | - Farha Siddiqui
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rajnish Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Center for Emerging and Tropical Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Mohapatra PR, Mishra B. Prevention of melioidosis. J Family Med Prim Care 2022; 11:4981-4986. [PMID: 36505663 PMCID: PMC9731021 DOI: 10.4103/jfmpc.jfmpc_1_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 11/07/2022] Open
Abstract
Melioidosis is a complex tropical disease linked with many complications. It is increasingly diagnosed in India. The clinical mimicry of this disease with several other common causes of pneumonia has kept the clinicians in ignorance. Usually, the diagnosis and appropriate management get delayed. The organism closely resembles the common contaminant Pseudomonas and is easily misidentified in microbiology laboratories. The diagnosis is often missed because of poor diagnostic sensitivity of blood culture, the gold standard of the diagnosis. All this contributes to increased morbidity and mortality. The rampant use of high-end broad-spectrum antibiotics like ceftazidime and meropenem at suboptimal dose and duration suppresses the diagnosis without eradicating the disease, leaving the chance of recurrence from its latency even after years. As an infectious disease, the cure and prevention depend on early diagnosis and treatment. An awareness of its peculiar presentations and history can differentiate clinically and suspect the condition much easily from other mimickers of tuberculosis to sepsis. Ultimately, the prevention of melioidosis remains the critical strategy. Increasing the number of cases and intricated management of this fatal but potentially curable disease had prompted us to take up the mission of preventing the disease by spreading knowledge and awareness.
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Affiliation(s)
- Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Prasanta Raghab Mohapatra, Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha - 751 019, India. E-mail:
| | - Baijayantimala Mishra
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Singh A, Talyan A, Chandra R, Srivastav A, Upadhya V, Mukhopadhyay C, Shreedhar S, Sudhakaran D, Nair S, Papanna M, Yadav R, Singh SK, Dikid T. Risk factors for melioidosis in Udupi District, Karnataka, India, January 2017-July 2018. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000865. [PMID: 36962866 PMCID: PMC10021467 DOI: 10.1371/journal.pgph.0000865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/13/2022] [Indexed: 12/15/2022]
Abstract
We initiated an epidemiological investigation following the death of a previously healthy 17 year-old boy with neuro-melioidosis. A case was defined as a culture-confirmed melioidosis patient from Udupi district admitted to hospital A from January 2013-July 2018. For the case control study, we enrolled a subset of cases admitted to hospital A from January 2017- July 2018. A control was resident of Udupi district admitted to hospital A in July 2018 with a non-infectious condition. Using a matched case-control design, we compared each case to 3 controls using age and sex groups. We assessed for risk factors related to water storage, activities of daily living, injuries and environmental exposures (three months prior to hospitalization), using conditional regression analysis. We identified 50 cases with case fatality rate 16%. Uncontrolled diabetes mellitus was present in 84% cases and 66% of cases occurred between May and October (rainy season). Percutaneous inoculation through exposure to stagnant water and injury leading to breakage in the skin were identified as an important mode of transmission. We used these findings to develop a surveillance case definition and initiated training of the district laboratory for melioidosis diagnosis.
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Affiliation(s)
- Akhileshwar Singh
- Epidemic Intelligence Service Programme, National Centre for Disease Control, Delhi, India
| | - Ashok Talyan
- Epidemic Intelligence Service Programme, National Centre for Disease Control, Delhi, India
| | - Ramesh Chandra
- Epidemic Intelligence Service Programme, National Centre for Disease Control, Delhi, India
| | - Anubhav Srivastav
- Epidemic Intelligence Service Programme, National Centre for Disease Control, Delhi, India
| | | | - Chiranjay Mukhopadhyay
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Center for Emerging and Tropical Diseases, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shyamsundar Shreedhar
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Deepak Sudhakaran
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Suma Nair
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mohan Papanna
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, United States of America
- Huck Institute of Life Sciences, The Pennsylvania State University, PA, United States of America
| | - Rajesh Yadav
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Sujeet Kumar Singh
- Epidemic Intelligence Service Programme, National Centre for Disease Control, Delhi, India
| | - Tanzin Dikid
- Epidemic Intelligence Service Programme, National Centre for Disease Control, Delhi, India
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Md-Lasim A, Mohd-Taib FS, Abdul-Halim M, Mohd-Ngesom AM, Nathan S, Md-Nor S. Leptospirosis and Coinfection: Should We Be Concerned? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179411. [PMID: 34502012 PMCID: PMC8431591 DOI: 10.3390/ijerph18179411] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/05/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
Pathogenic Leptospira is the causative agent of leptospirosis, an emerging zoonotic disease affecting animals and humans worldwide. The risk of host infection following interaction with environmental sources depends on the ability of Leptospira to persist, survive, and infect the new host to continue the transmission chain. Leptospira may coexist with other pathogens, thus providing a suitable condition for the development of other pathogens, resulting in multi-pathogen infection in humans. Therefore, it is important to better understand the dynamics of transmission by these pathogens. We conducted Boolean searches of several databases, including Google Scholar, PubMed, SciELO, and ScienceDirect, to identify relevant published data on Leptospira and coinfection with other pathogenic bacteria. We review the role of the host-microbiota in determining the synanthropic interaction of Leptospira sp. with other bacteria, thus creating a suitable condition for the leptospira to survive and persist successfully. We also discuss the biotic and abiotic factors that amplify the viability of Leptospira in the environment. The coinfection of leptospira with pathogenic bacteria has rarely been reported, potentially contributing to a lack of awareness. Therefore, the occurrence of leptospirosis coinfection may complicate diagnosis, long-lasting examination, and mistreatment that could lead to mortality. Identifying the presence of leptospirosis with other bacteria through metagenomic analysis could reveal possible coinfection. In conclusion, the occurrence of leptospirosis with other diseases should be of concern and may depend on the success of the transmission and severity of individual infections. Medical practitioners may misdiagnose the presence of multiple infections and should be made aware of and receive adequate training on appropriate treatment for leptospirosis patients. Physicians could undertake a more targeted approach for leptospirosis diagnosis by considering other symptoms caused by the coinfected bacteria; thus, more specific treatment could be given.
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Affiliation(s)
- Asmalia Md-Lasim
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM, Bangi 43600, Selangor, Malaysia; (A.M.-L.); (S.N.); (S.M.-N.)
- Herbal Medicine Research Centre (HMRC), Institute for Medical Research (IMR), National Institue of Health (NIH), Ministry of Health, Shah Alam 40170, Selangor, Malaysia
| | - Farah Shafawati Mohd-Taib
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM, Bangi 43600, Selangor, Malaysia; (A.M.-L.); (S.N.); (S.M.-N.)
- Correspondence: ; Tel.: +60-12-3807701
| | - Mardani Abdul-Halim
- Biotechnology Research Institute, Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu 88400, Sabah, Malaysia;
| | - Ahmad Mohiddin Mohd-Ngesom
- Center for Toxicology and Health Risk, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Federal Territory of Kuala Lumpur, Malaysia;
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM, Bangi 43600, Selangor, Malaysia; (A.M.-L.); (S.N.); (S.M.-N.)
| | - Shukor Md-Nor
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, UKM, Bangi 43600, Selangor, Malaysia; (A.M.-L.); (S.N.); (S.M.-N.)
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