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Tran QTL, Nguyen HV, Pham HT, Mai TV, Nguyen QHM, Le DV, Bui LNH, Hoang LTH, Hoang TQ, Trinh TT. Clinical Utility of Combined Whole-cell Antigen and Recombinant Hemolysis Co-regulated Protein 1-Enzyme-linked Immunosorbent Assays Reveals Underdiagnosed Cases of Melioidosis in Vietnam. Am J Trop Med Hyg 2022; 107:tpmd211143. [PMID: 35895334 PMCID: PMC9490659 DOI: 10.4269/ajtmh.21-1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/16/2022] [Indexed: 11/07/2022] Open
Abstract
Melioidosis is a fatal infectious disease in the tropics and subtropics. Currently, bacterial culture is the gold standard for diagnosis of the disease, but its sensitivity is relatively low. In this study, we evaluated four ELISAs using sera collected from culture-confirmed cases of melioidosis (n = 63), cases with other bacterial infections (n = 62), and healthy donors (n = 60). Antigens used for ELISAs were the whole-cell (WC) antigens and recombinant proteins of hemolysis co-regulated protein 1 (Hcp1), GroEL1, and alkyl hydroperoxide reductase subunit C (AhpC). Using the cutoff values for optical density at 490 nm defined at a specificity of > 95%, the sensitivity of the WC, Hcp1, GroEL1, and AhpC ELISAs was 93.7%, 87.3%, 61.9%, and 57.1%, respectively. The combined WC/Hcp1 ELISA showed the greatest sensitivity and specificity of 98.4% and 95.1%, respectively. Of 511 and 500 sera collected from clinically suspected febrile patients admitted to the General Hospital of Ha Tinh Province and the Hue Central Hospital, respectively, combined WC/Hcp1 ELISAs showed 52 (10.2%) and 41 (8.2%) patients positive for melioidosis, respectively. The assay detected 14 of 14 (100%) and 21 of 23 (91.3%) culture-confirmed cases of melioidosis at Ha Tinh and Hue, respectively. A follow-up study of 38 patients positive for melioidosis by combined WC/Hcp1 ELISAs but negative for Burkholderia pseudomallei by culture method or not assigned to examine for bacterial culture resulted in 2 (5.3%) culture-reconfirmed patients with melioidosis, 9 (23.7%) deaths, 17 (44.7%) unhealthy patients, and 10 (26.3%) healthy persons. Combined WC/Hcp1 ELISA was a reliable serological method to detect underdiagnosed cases of melioidosis. Further investigations are needed to estimate the true sensitivity and specificity of the assay and the true number of cases of melioidosis.
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Affiliation(s)
- Quyen T. L. Tran
- VNU-Institute of Microbiology and Biotechnology, Vietnam National University, Hanoi, Vietnam
| | - Ha V. Nguyen
- VNU-Institute of Microbiology and Biotechnology, Vietnam National University, Hanoi, Vietnam
| | - Huyen T. Pham
- General Hospital of Ha Tinh Province, Ha Tinh, Vietnam
| | | | - Quyen H. M. Nguyen
- VNU-Institute of Microbiology and Biotechnology, Vietnam National University, Hanoi, Vietnam
| | - Dzung V. Le
- General Hospital of Ha Tinh Province, Ha Tinh, Vietnam
| | - Linh N. H. Bui
- VNU-Institute of Microbiology and Biotechnology, Vietnam National University, Hanoi, Vietnam
| | | | | | - Trung T. Trinh
- VNU-Institute of Microbiology and Biotechnology, Vietnam National University, Hanoi, Vietnam
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2
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Raj S, Sistla S, Melepurakkal Sadanandan D, Kadhiravan T, Chinnakali P. Estimation of seroprevalence of melioidosis among adult high risk groups in Southeastern India by indirect Hemagglutination assay. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000431. [PMID: 36962223 PMCID: PMC10021966 DOI: 10.1371/journal.pgph.0000431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/06/2022] [Indexed: 11/18/2022]
Abstract
Burkholderia pseudomallei is an environmental saprophyte known to cause melioidosis, a disease endemic in northern Australia and Southeast Asia. With the increasing number of melioidosis cases, there is a lack of data on seroprevalence rates and extent of exposure in high risk population of melioidosis from different endemic regions in India. The present cross sectional study was undertaken to estimate the seroprevalence of melioidosis in high risk populations in and around Puducherry, a coastal town in Southeastern India. Blood samples were collected from 275 diabetic individuals attending a tertiary care centre in Southern India and 275 farmers residing under the rural field practice area of our hospital. The antibody levels were estimated using an Indirect Hemagglutination Assay. The overall seropositivity was found to be 19.8% with a titer ≥1:20. Farmers were 2.8 times more likely to be seropositive than non-farmers. Rates of seroprevalence among diabetic subjects were less compared to the non-diabetic individuals. The seropositivity rates in non-diabetic farmers were higher (56/203, 27.6%) compared to diabetic farmers (34/164, 20.7%). The lowest seropositivity was seen among diabetic non-farmers at 10.4%. Multivariable logistic regression analysis revealed domicile (adjusted odds ratio-aOR: 2.32, 95% Confidence interval-CI: 1.05, 5.13) and contact with animals (aOR: 1.89, 95% CI:1.04, 3.44) as significant predictors of seropositivity. None of the other socio-demographic factors including gender and age were significantly associated with seropositivity. This study demonstrates widespread exposure to B. pseudomallei among adults residing in and around Puducherry, including those engaged in non-farming occupations.
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Affiliation(s)
- Sruthi Raj
- Department of Microbiology, JIPMER, Puducherry, India
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3
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Heacock-Kang Y, McMillan IA, Norris MH, Sun Z, Zarzycki-Siek J, Bluhm AP, Cabanas D, Norton RE, Ketheesan N, Miller JF, Schweizer HP, Hoang TT. The Burkholderia pseudomallei intracellular 'TRANSITome'. Nat Commun 2021; 12:1907. [PMID: 33772012 PMCID: PMC7998038 DOI: 10.1038/s41467-021-22169-1] [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: 08/10/2020] [Accepted: 02/26/2021] [Indexed: 01/01/2023] Open
Abstract
Prokaryotic cell transcriptomics has been limited to mixed or sub-population dynamics and individual cells within heterogeneous populations, which has hampered further understanding of spatiotemporal and stage-specific processes of prokaryotic cells within complex environments. Here we develop a 'TRANSITomic' approach to profile transcriptomes of single Burkholderia pseudomallei cells as they transit through host cell infection at defined stages, yielding pathophysiological insights. We find that B. pseudomallei transits through host cells during infection in three observable stages: vacuole entry; cytoplasmic escape and replication; and membrane protrusion, promoting cell-to-cell spread. The B. pseudomallei 'TRANSITome' reveals dynamic gene-expression flux during transit in host cells and identifies genes that are required for pathogenesis. We find several hypothetical proteins and assign them to virulence mechanisms, including attachment, cytoskeletal modulation, and autophagy evasion. The B. pseudomallei 'TRANSITome' provides prokaryotic single-cell transcriptomics information enabling high-resolution understanding of host-pathogen interactions.
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Affiliation(s)
- Yun Heacock-Kang
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Ian A McMillan
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Michael H Norris
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Geography and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Zhenxin Sun
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Jan Zarzycki-Siek
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Andrew P Bluhm
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
- Department of Geography and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Darlene Cabanas
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Robert E Norton
- Townsville Hospital, Townsville, QLD, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Natkunam Ketheesan
- Science and Technology, University of New England, New South Wales, Australia
| | - Jeff F Miller
- Department of Microbiology, Immunology, and Molecular Genetics, and the California NanoSystems Institute, University of California, Los Angeles, CA, USA
| | - Herbert P Schweizer
- Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Tung T Hoang
- School of Life Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA.
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4
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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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5
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Pumpuang A, Phunpang R, Ekchariyawat P, Dulsuk A, Loupha S, Kwawong K, Charoensawat Y, Thiansukhon E, Day NPJ, Burtnick MN, Brett PJ, West TE, Chantratita N. Distinct classes and subclasses of antibodies to hemolysin co-regulated protein 1 and O-polysaccharide and correlation with clinical characteristics of melioidosis patients. Sci Rep 2019; 9:13972. [PMID: 31562344 PMCID: PMC6764960 DOI: 10.1038/s41598-019-48828-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/01/2019] [Indexed: 12/28/2022] Open
Abstract
Melioidosis is a tropical infectious disease caused by Burkholderia pseudomallei that results in high mortality. Hemolysin co-regulated protein 1 (Hcp1) and O-polysaccharide (OPS) are vaccine candidates and potential diagnostic antigens. The correlation of classes/subclasses of antibodies against these antigens with clinical characteristics of melioidosis patients is unknown. Antibodies in plasma samples from melioidosis patients and healthy donors were quantified by ELISA and compared with clinical features. In melioidosis patients, Hcp1 induced high IgG levels. OPS induced high IgG and IgA levels. The area under receiver operating characteristic curve (AUROCC) to discriminate melioidosis cases from healthy donors was highest for anti-Hcp1 IgG (0.92) compared to anti-Hcp1 IgA or IgM. In contrast, AUROCC for anti-OPS for IgG (0.91) and IgA (0.92) were comparable. Anti-Hcp1 IgG1 and anti-OPS IgG2 had the greatest AUROCCs (0.87 and 0.95, respectively) compared to other IgG subclasses for each antigen. Survivors had significantly higher anti-Hcp1 IgG3 levels than non-survivors. Male melioidosis patients with diabetes had higher anti-OPS IgA levels than males without diabetes. Thus, diverse and specific antibody responses are associated with distinct clinical characteristics in melioidosis, confirming the diagnostic utility of these responses and providing new insights into immune mechanisms.
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Affiliation(s)
- Apinya Pumpuang
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Department of Clinical Pathology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Rungnapa Phunpang
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Peeraya Ekchariyawat
- Department of Microbiology, Faculty of Public health, Mahidol University, Bangkok, Thailand
| | - Adul Dulsuk
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Siriorn Loupha
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kochnipa Kwawong
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Yaowaree Charoensawat
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Nicholas P J Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Mary N Burtnick
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Paul J Brett
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - T Eoin West
- Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, and International Respiratory and Severe Illness Center, University of Washington, Seattle, WA, USA
| | - 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.
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6
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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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7
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Weppelmann TA, Norris MH, von Fricken ME, Rahman Khan MS, Okech BA, Cannella AP, Schweizer HP, Sanford DC, Tuanyok A. Seroepidemiology of Burkholderia pseudomallei, Etiologic Agent of Melioidosis, in the Ouest and Sud-Est Departments of Haiti. Am J Trop Med Hyg 2018; 99:1222-1228. [PMID: 30226137 PMCID: PMC6221251 DOI: 10.4269/ajtmh.18-0352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022] Open
Abstract
Burkholderia pseudomallei, the etiological agent of melioidosis, has been hypothesized to be endemic throughout the Caribbean, including the impoverished nation of Haiti. However, because of the protean clinical manifestations, presence of asymptomatic infections, and limited medical diagnostic capacity, the identification of active melioidosis cases remains challenging. A seroepidemiological study was conducted using a novel enzyme-linked immunosorbent assay (ELISA) to detect antibodies toward B. pseudomallei in the native population. The performance of an indirect ELISA with purified lipopolysaccharide (LPS) from B. pseudomallei was evaluated using serum collected from rhesus macaques exposed to aerosolized B. pseudomallei. After optimization, serum collected from asymptomatic population members (n = 756) was screened for polyvalent (immunoglobulin M [IgM]/ immunoglobulin G [IgG]/ immunoglobulin A) and monoclonal (IgG or IgM) immunoglobulins against B. pseudomallei LPS. The population seroprevalence was 11.5% (95% confidence interval [CI]: 9.2, 13.8) for polyvalent immunoglobulins, 9.8% (95% CI: 7.7, 11.9) for IgG, and 1.7% (95% CI: 0.8, 2.6%) for IgM. The seroprevalence was not significantly different by gender (P = 0.16), but increased significantly (P < 0.001) with age, yielding an estimated annual seroconversion rate of 1.05% (95% CI: 0.81, 1.3). The detection of both recent (IgM+) and previous (IgG+) exposure to B. pseudomallei provides serological evidence that melioidosis is endemic in Haiti.
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Affiliation(s)
- Thomas A. Weppelmann
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Michael H. Norris
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | | | - Md. Siddiqur Rahman Khan
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Bernard A. Okech
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Anthony P. Cannella
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Herbert P. Schweizer
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Molecular Genetics and Microbiology, College of Medicine, University of Florida, Gainesville, Florida
| | | | - Apichai Tuanyok
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, Florida
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8
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Bory S, Daily F, Khim G, Letchford J, Sok S, Kol H, Seang Lak M, Tuseo L, Vibol C, Oeng S, Turner P. A Report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 2017. Trop Med Infect Dis 2018; 3:tropicalmed3010023. [PMID: 30274421 PMCID: PMC6136626 DOI: 10.3390/tropicalmed3010023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/16/2018] [Accepted: 02/17/2018] [Indexed: 11/16/2022] Open
Abstract
Melioidosis is an endemic infection in Cambodia, a lower middle income SE Asian country. Despite more laboratories isolating and identifying Burkholderia pseudomallei in recent years, the infection remains under-recognised and under-diagnosed, particularly in the adult population. Lack of knowledge about the disease and lack of utilization of microbiology laboratories contributes to this, along with laboratory capacity issues. Treatment costs often hamper optimal management. In response to these issues, a national one-health training event was held in October 2017 to raise awareness of the disease amongst clinical, laboratory, and public health professionals. The meeting format, findings, and outcomes are described here.
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Affiliation(s)
- Sotharith Bory
- Infectious Diseases Unit, Calmette Hospital, Phnom Penh 12201, Cambodia.
| | - Frances Daily
- Diagnostic Microbiology Development Program, Phnom Penh 12302, Cambodia.
| | - Gaetan Khim
- Diagnostic Microbiology Development Program, Phnom Penh 12302, Cambodia.
| | - Joanne Letchford
- Diagnostic Microbiology Development Program, Phnom Penh 12302, Cambodia.
| | - Srun Sok
- Hospital Services Department, Ministry of Health, Phnom Penh 12152, Cambodia.
| | - Hero Kol
- Preventive Medicine Department, Ministry of Health, Phnom Penh 12152, Cambodia.
| | - Muy Seang Lak
- Preventive Medicine Department, Ministry of Health, Phnom Penh 12152, Cambodia.
| | - Luciano Tuseo
- World Health Organization, Phnom Penh 12302, Cambodia.
| | - Chan Vibol
- World Health Organization, Phnom Penh 12302, Cambodia.
| | - Sopheap Oeng
- Diagnostic Microbiology Development Program, Phnom Penh 12302, Cambodia.
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap 17252, Cambodia.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK.
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9
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Suttisunhakul V, Hip P, Ouch P, Ly P, Supaprom C, Rachmat A, Prouty M, Vaughn A, Eltayeb A, Kheng S, Clark DV, Lawler JV, Chantratita N, Burtnick MN, Brett PJ, Schully KL. Retrospective Analysis of Fever and Sepsis Patients from Cambodia Reveals Serological Evidence of Melioidosis. Am J Trop Med Hyg 2018; 98:1039-1045. [PMID: 29436341 DOI: 10.4269/ajtmh.17-0885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Burkholderia pseudomallei, the etiologic agent of melioidosis, is predicted to be ubiquitous in tropical regions of the world with areas of highest endemicity throughout Southeast Asia (SEA). Nevertheless, the distribution of B. pseudomallei and the burden of melioidosis in many SEA countries remain unclear. In Cambodia, only two human endemic cases of melioidosis were reported through 2008 and since then only a few hundred cases have been described in the literature. This is in sharp contrast to the annual burden of thousands of cases in surrounding areas. To further investigate the prevalence of melioidosis in Cambodia, we used a recently developed O-polysaccharide-based rapid enzyme-linked immunosorbent assay to detect B. pseudomallei-specific antibodies in serum samples obtained from 1,316 febrile illness or sepsis patients from 10 different provinces. Based on a cutoff value derived through culture-confirmed melioidosis cases, the proportion of positive samples in our cohort was approximately 12%. Regression analysis indicated that the odds of obtaining a positive result were 2.2 times higher for males than females controlling for age and province (95% confidence interval: 1.6-3.2, P < 0.001). Consistent with this, 9.2% of females were positive versus 18.2% of males (P < 0.001). Notably, 22.5% of grain or rice farmers were positive versus 10.1% of subjects with occupations not involving regular contact with soil. Positive results varied significantly by province. Collectively, the results of this study suggest that the true burden of melioidosis in Cambodia is greater than has previously been reported.
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Affiliation(s)
- Vichaya Suttisunhakul
- Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Phireak Hip
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Pidor Ouch
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Piseth Ly
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Chonthida Supaprom
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Agus Rachmat
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Michael Prouty
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Andrew Vaughn
- U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia
| | - Ahreej Eltayeb
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland.,Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland
| | - Sim Kheng
- Cambodian Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Danielle V Clark
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland.,Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland
| | - James V Lawler
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland.,Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland
| | - Narisara Chantratita
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Mary N Burtnick
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Paul J Brett
- Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada
| | - Kevin L Schully
- The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland.,Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland
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Nair AV, Menon V, Kumaran CK, Khan PS, Kochukunju BV, Kurian N. Arthroscopic Management of a Rare Case of Melioidotic Septic Arthritis of the Ankle in a New Endemic Area on the Southwest Coast of India: A Case Report. JBJS Case Connect 2017; 7:e45. [PMID: 29252875 DOI: 10.2106/jbjs.cc.16.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of melioidotic septic arthritis of the ankle and secondary osteomyelitis of the talus in a 64-year-old farmer with diabetes mellitus. Arthroscopic drainage and debridement, followed by 6 months of appropriate antibiotic therapy, resulted in a good short-term outcome. CONCLUSION Melioidotic septic arthritis of the ankle is extremely rare. This case report highlights the possibility of this disease occurring on the Indian subcontinent.
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Affiliation(s)
| | - Vidya Menon
- Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Chandrababu K Kumaran
- Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Prince Shanavas Khan
- Department of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Schully KL, Berjohn CM, Prouty AM, Fitkariwala A, Som T, Sieng D, Gregory MJ, Vaughn A, Kheng S, Te V, Duplessis CA, Lawler JV, Clark DV. Melioidosis in lower provincial Cambodia: A case series from a prospective study of sepsis in Takeo Province. PLoS Negl Trop Dis 2017; 11:e0005923. [PMID: 28902844 PMCID: PMC5612750 DOI: 10.1371/journal.pntd.0005923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/25/2017] [Accepted: 09/01/2017] [Indexed: 12/31/2022] Open
Abstract
Melioidosis is a severe infectious disease caused by the gram-negative soil bacterium Burkholderia pseudomallei. Melioidosis is well known to be a major cause of morbidity and mortality in Southeast Asia, particularly in Thailand. However, melioidosis remains underreported in surrounding areas such as Cambodia. We report a case series of melioidosis in seven patients from Takeo Province, Cambodia. The patients, aged 24-65 years, were enrolled from May 2014 to May 2015 during a one year prospective study of sepsis at Takeo Provincial Hospital. They presented with fever, rigors, dyspnea, fatigue, diaphoresis, productive cough, and skin abscesses. Six of the seven patients were also hyponatremic. B. pseudomallei was cultured from the blood of six patients and the sputum of one patient. In this manuscript, we provide a detailed description of the clinical presentation, case management and laboratory confirmation of B. pseudomallei, as well as discuss the difficulties of identifying and treating melioidosis in low resource settings.
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Affiliation(s)
- Kevin L. Schully
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | | | | | | | - Tin Som
- Naval Medical Research Unit-2, Phnom Penh, Cambodia
| | - Darith Sieng
- Naval Medical Research Unit-2, Phnom Penh, Cambodia
| | - Michael J. Gregory
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | | | - Sim Kheng
- Cambodian Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia
| | - Vantha Te
- Takeo Provincial Referral Hospital, Takeo, Cambodia
| | - Christopher A. Duplessis
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | - James V. Lawler
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
| | - Danielle V. Clark
- Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland, United States of America
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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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13
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Wiersinga WJ, Birnie E, Weehuizen TA, Alabi AS, Huson MA, in ’t Veld RAGH, Mabala HK, Adzoda GK, Raczynski-Henk Y, Esen M, Lell B, Kremsner PG, Visser CE, Wuthiekanun V, Peacock SJ, van der Ende A, Limmathurotsakul D, Grobusch MP. Clinical, environmental, and serologic surveillance studies of melioidosis in Gabon, 2012-2013. Emerg Infect Dis 2015; 21:40-7. [PMID: 25530077 PMCID: PMC4285261 DOI: 10.3201/eid2101.140762] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Burkholderia pseudomallei and B. thailandensis are
in the soil; a novel B. pseudomallei sequence type causes lethal
septic shock. Burkholderia pseudomallei, an environmental gram-negative bacillus,
is the causative agent of melioidosis and a bio-threat agent. Reports of B.
pseudomallei isolation from soil and animals in East and West Africa
suggest that melioidosis might be more widely distributed than previously thought.
Because it has been found in equatorial areas with tropical climates, we hypothesized
that B. pseudomallei could exist in Gabon. During 2012–2013,
we conducted a seroprevalance study in which we set up microbiology facilities at a
large clinical referral center and prospectively screened all febrile patients by
conducting blood cultures and testing for B. pseudomallei and
related species; we also determined whether B. pseudomallei could be
isolated from soil. We discovered a novel B. pseudomallei sequence
type that caused lethal septic shock and identified B. pseudomallei
and B. thailandensis in the environment. Our data suggest that
melioidosis is emerging in Central Africa but is unrecognized because of the lack of
diagnostic microbiology facilities.
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Saïdani N, Griffiths K, Million M, Gautret P, Dubourg G, Parola P, Brouqui P, Lagier JC. Melioidosis as a travel-associated infection: Case report and review of the literature. Travel Med Infect Dis 2015; 13:367-81. [DOI: 10.1016/j.tmaid.2015.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/05/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022]
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Reynolds C, Goudet A, Jenjaroen K, Sumonwiriya M, Rinchai D, Musson J, Overbeek S, Makinde J, Quigley K, Manji J, Spink N, Yos P, Wuthiekanun V, Bancroft G, Robinson J, Lertmemongkolchai G, Dunachie S, Maillere B, Holden M, Altmann D, Boyton R. T Cell Immunity to the Alkyl Hydroperoxide Reductase of Burkholderia pseudomallei: A Correlate of Disease Outcome in Acute Melioidosis. THE JOURNAL OF IMMUNOLOGY 2015; 194:4814-24. [PMID: 25862821 PMCID: PMC4416739 DOI: 10.4049/jimmunol.1402862] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/02/2015] [Indexed: 01/09/2023]
Abstract
There is an urgent need for a better understanding of adaptive immunity to Burkholderia pseudomallei, the causative agent of melioidosis that is frequently associated with sepsis or death in patients in Southeast Asia and Northern Australia. The imperative to identify vaccine targets is driven both by the public health agenda in these regions and biological threat concerns. In several intracellular bacterial pathogens, alkyl hydroperoxidase reductases are upregulated as part of the response to host oxidative stress, and they can stimulate strong adaptive immunity. We show that alkyl hydroperoxidase reductase (AhpC) of B. pseudomallei is strongly immunogenic for T cells of ‘humanized’ HLA transgenic mice and seropositive human donors. Some T cell epitopes, such as p6, are able to bind diverse HLA class II heterodimers and stimulate strong T cell immunity in mice and humans. Importantly, patients with acute melioidosis who survive infection show stronger T cell responses to AhpC relative to those who do not. Although the sequence of AhpC is virtually invariant among global B. pseudomallei clinical isolates, a Cambodian isolate varies only in C-terminal truncation of the p6 T cell epitope, raising the possibility of selection by host immunity. This variant peptide is virtually unable to stimulate T cell immunity. For an infection in which there has been debate about centrality of T cell immunity in defense, these observations support a role for T cell immunity to AhpC in disease protection.
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Affiliation(s)
- Catherine Reynolds
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom
| | - Amélie Goudet
- CEA, Institut de Biologie et de Technologies de Saclay, Labex Laboratoire de Recherche sur le Médicament et l'Innovation Thérapeutique and Institut de Recherche Vaccinale, Service d'Ingénierie Moléculaire des Protéines, 91191 Gif sur Yvette, France
| | - Kemajittra Jenjaroen
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Manutsanun Sumonwiriya
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Darawan Rinchai
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40000, Thailand
| | - Julie Musson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Saskia Overbeek
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom
| | - Julia Makinde
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom
| | - Kathryn Quigley
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom
| | - Jiten Manji
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom
| | - Natasha Spink
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - Pagnarith Yos
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Vanaporn Wuthiekanun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Gregory Bancroft
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, United Kingdom
| | - John Robinson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Ganjana Lertmemongkolchai
- Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40000, Thailand
| | - Susanna Dunachie
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand; Centre for Tropical Medicine, University of Oxford, Oxford OX3 7FZ, United Kingdom; and
| | - Bernard Maillere
- CEA, Institut de Biologie et de Technologies de Saclay, Labex Laboratoire de Recherche sur le Médicament et l'Innovation Thérapeutique and Institut de Recherche Vaccinale, Service d'Ingénierie Moléculaire des Protéines, 91191 Gif sur Yvette, France
| | - Matthew Holden
- School of Medicine, University of St Andrews, St Andrews KY16 9TF, United Kingdom
| | - Daniel Altmann
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom
| | - Rosemary Boyton
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Department of Medicine, Imperial College London, London W12 ONN, United Kingdom;
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Kogilavaani J, Shatriah I, Regunath K, Helmy AKA. Bilateral orbital abscesses with subdural empyema and cavernous sinus thrombosis due to melioidosis in a child. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60744-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Systematic review and consensus guidelines for environmental sampling of Burkholderia pseudomallei. PLoS Negl Trop Dis 2013; 7:e2105. [PMID: 23556010 PMCID: PMC3605150 DOI: 10.1371/journal.pntd.0002105] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 01/28/2013] [Indexed: 02/06/2023] Open
Abstract
Background Burkholderia pseudomallei, a Tier 1 Select Agent and the cause of melioidosis, is a Gram-negative bacillus present in the environment in many tropical countries. Defining the global pattern of B. pseudomallei distribution underpins efforts to prevent infection, and is dependent upon robust environmental sampling methodology. Our objective was to review the literature on the detection of environmental B. pseudomallei, update the risk map for melioidosis, and propose international consensus guidelines for soil sampling. Methods/Principal Findings An international working party (Detection of Environmental Burkholderia pseudomallei Working Party (DEBWorP)) was formed during the VIth World Melioidosis Congress in 2010. PubMed (January 1912 to December 2011) was searched using the following MeSH terms: pseudomallei or melioidosis. Bibliographies were hand-searched for secondary references. The reported geographical distribution of B. pseudomallei in the environment was mapped and categorized as definite, probable, or possible. The methodology used for detecting environmental B. pseudomallei was extracted and collated. We found that global coverage was patchy, with a lack of studies in many areas where melioidosis is suspected to occur. The sampling strategies and bacterial identification methods used were highly variable, and not all were robust. We developed consensus guidelines with the goals of reducing the probability of false-negative results, and the provision of affordable and ‘low-tech’ methodology that is applicable in both developed and developing countries. Conclusions/Significance The proposed consensus guidelines provide the basis for the development of an accurate and comprehensive global map of environmental B. pseudomallei. Melioidosis is a serious infectious disease caused by the Tier 1 selected agent and Gram-negative environmental saprophyte, Burkholderia pseudomallei. The organism is commonly found in soil and water in melioidosis endemic areas. Infection in humans occurs following bacterial inoculation, inhalation or ingestion. There is a striking lack of accurate information on the global risk of melioidosis, something that could be determined from the global distribution of environmental B. pseudomallei. Soil sampling to detect the presence of B. pseudomallei has been ad hoc, poorly standardized, and the available information poorly collated. Negative studies are almost never reported, and there is no published review on this topic. We responded to this problem during the VIth World Melioidosis Congress held in Townsville, Australia in December 2010 by forming the ‘Detection of Environmental Burkholderia pseudomallei Working Party (DEBWorP)’. We have since worked together to undertake a systematic review, map the available information, and reach a consensus on low cost methods for the detection of environmental B. pseudomallei. Our goal is to promote the use of these consensus methods and encourage people worldwide to participate in an effort to produce a comprehensive global map of environmental B. pseudomallei.
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Vong S, Guillard B, Borand L, Rammaert B, Goyet S, Te V, Lorn Try P, Hem S, Rith S, Ly S, Cavailler P, Mayaud C, Buchy P. Acute lower respiratory infections in ≥ 5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology. BMC Infect Dis 2013; 13:97. [PMID: 23432906 PMCID: PMC3606325 DOI: 10.1186/1471-2334-13-97] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 02/14/2013] [Indexed: 11/13/2022] Open
Abstract
Background Few data exist on viral and bacterial etiology of acute lower respiratory infections (ALRI) in ≥5 year –old persons in the tropics. Methods We conducted active surveillance of community-acquired ALRI in two hospitals in Cambodia, a low-income tropical country. Patients were tested for acid-fast bacilli (AFB) by direct sputum examination, other bacteria by blood and/or sputum cultures, and respiratory viruses using molecular techniques on nasopharyngeal/throat swabs. Pulmonologists reviewed clinical/laboratory data and interpreted chest X-rays (CXR) to confirm ALRI. Results Between April 2007 - December 2009, 1,904 patients aged ≥5 years were admitted with acute pneumonia (50.4%), lung sequelae-associated ALRI (24.3%), isolated pleural effusions (8.9%) or normal CXR-related ALRI (17.1%); 61 (3.2%) died during hospitalization. The two former diagnoses were predominantly due to bacterial etiologies while viral detection was more frequent in the two latter diagnoses. AFB-positive accounted for 25.6% of acute pneumonia. Of the positive cultures (16.8%), abscess-prone Gram-negative bacteria (39.6%) and Haemophilus influenzae (38.0%) were most frequent, followed by Streptococcus pneumoniae (17.7%). Of the identified viruses, the three most common viruses included rhinoviruses (49.5%), respiratory syncytial virus (17.7%) and influenza viruses (12.1%) regardless of the diagnostic groups. Wheezing was associated with viral identification (31.9% vs. 13.8%, p < 0.001) independent of age and time-to-admission. Conclusions High frequency of H. influenzae and S. pneumoniae infections support the need for introduction of the respective vaccines in the national immunization program. Tuberculosis was frequent in patients with acute pneumonia, requiring further investigation. The relationship between respiratory viruses and wheezing merits further studies.
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Affiliation(s)
- Sirenda Vong
- Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh, Cambodia.
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Choh LC, Ong GH, Vellasamy KM, Kalaiselvam K, Kang WT, Al-Maleki AR, Mariappan V, Vadivelu J. Burkholderia vaccines: are we moving forward? Front Cell Infect Microbiol 2013; 3:5. [PMID: 23386999 PMCID: PMC3564208 DOI: 10.3389/fcimb.2013.00005] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 01/20/2013] [Indexed: 11/29/2022] Open
Abstract
The genus Burkholderia consists of diverse species which includes both "friends" and "foes." Some of the "friendly" Burkholderia spp. are extensively used in the biotechnological and agricultural industry for bioremediation and biocontrol. However, several members of the genus including B. pseudomallei, B. mallei, and B. cepacia, are known to cause fatal disease in both humans and animals. B. pseudomallei and B. mallei are the causative agents of melioidosis and glanders, respectively, while B. cepacia infection is lethal to cystic fibrosis (CF) patients. Due to the high rate of infectivity and intrinsic resistance to many commonly used antibiotics, together with high mortality rate, B. mallei and B. pseudomallei are considered to be potential biological warfare agents. Treatments of the infections caused by these bacteria are often unsuccessful with frequent relapse of the infection. Thus, we are at a crucial stage of the need for Burkholderia vaccines. Although the search for a prophylactic therapy candidate continues, to date development of vaccines has not advanced beyond research to human clinical trials. In this article, we review the current research on development of safe vaccines with high efficacy against B. pseudomallei, B. mallei, and B. cepacia. It can be concluded that further research will enable elucidation of the potential benefits and risks of Burkholderia vaccines.
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Affiliation(s)
| | | | | | | | | | | | | | - Jamuna Vadivelu
- Department of Medical Microbiology, Faculty of Medicine, University of MalayaKuala Lumpur, Malaysia
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20
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Rammaert B, Beauté J, Borand L, Hem S, Buchy P, Goyet S, Overtoom R, Angebault C, Te V, Try PL, Mayaud C, Vong S, Guillard B. Pulmonary melioidosis in Cambodia: a prospective study. BMC Infect Dis 2011; 11:126. [PMID: 21569563 PMCID: PMC3117704 DOI: 10.1186/1471-2334-11-126] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 05/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melioidosis is a disease caused by Burkholderia pseudomallei and considered endemic in South-East Asia but remains poorly documented in Cambodia. We report the first series of hospitalized pulmonary melioidosis cases identified in Cambodia describing clinical characteristics and outcomes. METHODS We characterized cases of acute lower respiratory infections (ALRI) that were identified through surveillance in two provincial hospitals. Severity was defined by systolic blood pressure, cardiac frequency, respiratory rate, oxygen saturation and body temperature. B. pseudomallei was detected in sputum or blood cultures and confirmed by API20NE gallery. We followed up these cases between 6 months and 2 years after hospital discharge to assess the cost-of-illness and long-term outcome. RESULTS During April 2007 - January 2010, 39 ALRI cases had melioidosis, of which three aged ≤2 years; the median age was 46 years and 56.4% were males. A close contact with soil and water was identified in 30 patients (76.9%). Pneumonia was the main radiological feature (82.3%). Eleven patients were severe cases. Twenty-four (61.5%) patients died including 13 who died within 61 days after discharge. Of the deceased, 23 did not receive any antibiotics effective against B. pseudomallei. Effective drugs that were available did not include ceftazidime. Mean total illness-related costs was of US$65 (range $25-$5000). Almost two-thirds (61.5%) incurred debt and 28.2% sold land or other belongings to pay illness-related costs. CONCLUSIONS The observed high fatality rate is likely explained by the lack or limited access to efficient antibiotics and under-recognition of the disease among clinicians, which led to inappropriate therapy.
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Rolim DB, Vilar DCFL, de Góes Cavalcanti LP, Freitas LBN, Inglis TJJ, Nobre Rodrigues JL, Nagao-Dias AT. Burkholderia pseudomallei antibodies in individuals living in endemic regions in Northeastern Brazil. Am J Trop Med Hyg 2011; 84:302-5. [PMID: 21292903 DOI: 10.4269/ajtmh.2011.10-0220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A seroepidemiological investigation was conducted among the population of two municipalities in Northeastern Brazil. Immunoglobulin M (IgM) and IgG antibodies to Burkholderia pseudomallei were positive in 51.27% (161 in 317 samples) and 58.49% (186), respectively. IgM titers were higher in children than in adults. On the contrary, IgG increased progressively with age. We observed a significant association between agricultural occupation and raised IgM titers (P < 0.005) and IgG titers (P < 0.001), and between construction workers and raised IgG titers (P = 0.005). Antibody IgG avidities did not correlate with age. The highest titers of antibodies (1/800) showed the highest antibody avidity indexes (P < 0.01). Most of the serum samples recognized 45-kDa and 200-kDa bands by IgG1 and IgG2 subclasses. Our study showed a high seropositivity among individuals living in endemic regions of the state of Ceará, and highlights the need for further surveillance close to water courses such as dams and rivers in Northeastern Brazil.
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22
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Randomized soil survey of the distribution of Burkholderia pseudomallei in rice fields in Laos. Appl Environ Microbiol 2010; 77:532-6. [PMID: 21075883 DOI: 10.1128/aem.01822-10] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Melioidosis is a major cause of morbidity and mortality in Southeast Asia, where the causative organism (Burkholderia pseudomallei) is present in the soil. In the Lao People's Democratic Republic (Laos), B. pseudomallei is a significant cause of sepsis around the capital, Vientiane, and has been isolated in soil near the city, adjacent to the Mekong River. We explored whether B. pseudomallei occurs in Lao soil distant from the Mekong River, drawing three axes across northwest, northeast, and southern Laos to create nine sampling areas in six provinces. Within each sampling area, a random rice field site containing a grid of 100 sampling points each 5 m apart was selected. Soil was obtained from a depth of 30 cm and cultured for B. pseudomallei. Four of nine sites (44%) were positive for B. pseudomallei, including all three sites in Saravane Province, southern Laos. The highest isolation frequency was in east Saravane, where 94% of soil samples were B. pseudomallei positive with a geometric mean concentration of 464 CFU/g soil (95% confidence interval, 372 to 579 CFU/g soil; range, 25 to 10,850 CFU/g soil). At one site in northwest Laos (Luangnamtha), only one sample (1%) was positive for B. pseudomallei, at a concentration of 80 CFU/g soil. Therefore, B. pseudomallei occurs in Lao soils beyond the immediate vicinity of the Mekong River, alerting physicians to the likelihood of melioidosis in these areas. Further studies are needed to investigate potential climatic, soil, and biological determinants of this heterogeneity.
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Badran S, Pedersen TI, Roed C, Lunding S, Birk N, Vestergaard H, Røder B, Lillelund HK, Kurtzhals JAL, Kemp M, Christensen JJ. Imported melioidosis in Danish travellers: a diagnostic challenge. ACTA ACUST UNITED AC 2010; 42:445-9. [PMID: 20297927 DOI: 10.3109/00365540903582467] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infections with Burkholderia pseudomallei (melioidosis) are rare events in Scandinavian countries, but the bacterium may be contracted during travel to endemic areas, i.e. Southeast Asia (especially Thailand) and northern Australia. Here, 5 travel-related cases occurring within the last 3 y in Denmark are reported, with particular emphasis on diagnostic and therapeutic challenges posed to health staff with little experience in the management of melioidosis. A newly developed B. pseudomallei-specific polymerase chain reaction test was applied and was able to correctly identify all isolates.
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Affiliation(s)
- Shadia Badran
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institut, Copenhagen, Denmark
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Pagnarith Y, Kumar V, Thaipadungpanit J, Wuthiekanun V, Amornchai P, Sin L, Day NP, Peacock SJ. Emergence of pediatric melioidosis in Siem Reap, Cambodia. Am J Trop Med Hyg 2010; 82:1106-12. [PMID: 20519608 PMCID: PMC2877419 DOI: 10.4269/ajtmh.2010.10-0030] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the first cases of pediatric melioidosis in Cambodia. Thirty-nine cases were diagnosed at the Angkor Hospital for Children, Siem Reap, between October 2005 and December 2008 after the introduction of microbiology capabilities. Median age was 7.8 years (range = 1.6–16.2 years), 15 cases were male (38%), and 4 cases had pre-existing conditions that may have pre-disposed the patient to melioidosis. Infection was localized in 27 cases (69%) and disseminated in 12 cases (31%). Eleven cases (28%) were treated as outpatients, and 28 (72%) cases were admitted. Eight children (21%) died a median of 2 days after admission; seven deaths were attributable to melioidosis, all of which occurred in children receiving suboptimal antimicrobial therapy and before bacteriological culture results were available. Our findings indicate the need for heightened awareness of melioidosis in Cambodia, and they have led us to review microbiology procedures and antimicrobial prescribing of suspected and confirmed cases.
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Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, Chaowagul W, Day NPJ, Peacock SJ. Increasing incidence of human melioidosis in Northeast Thailand. Am J Trop Med Hyg 2010; 82:1113-7. [PMID: 20519609 PMCID: PMC2877420 DOI: 10.4269/ajtmh.2010.10-0038] [Citation(s) in RCA: 311] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative environmental bacterium Burkholderia pseudomallei. A prospective cohort study identified 2,243 patients admitted to Sappasithiprasong Hospital in northeast Thailand with culture-confirmed melioidosis between 1997 and 2006. These data were used to calculate an average incidence rate for the province of 12.7 cases of melioidosis per 100,000 people per year. Incidence increased incrementally from 8.0 (95% confidence interval [CI] = 7.2–10.0) in 2000 to 21.3 (95% CI = 19.2–23.6) in 2006 (P < 0.001; χ2 test for trend). Male sex, age ≥ 45 years, and either known or undiagnosed diabetes were independent risk factors for melioidosis. The average mortality rate from melioidosis over the study period was 42.6%. The minimum estimated population mortality rate from melioidosis in 2006 was 8.63 per 100,000 people (95% CI = 7.33–10.11), the third most common cause of death from infectious diseases in northeast Thailand after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis.
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Affiliation(s)
- Direk Limmathurotsakul
- Department of Tropical Hygiene and Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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Norris MH, Kang Y, Lu D, Wilcox BA, Hoang TT. Glyphosate resistance as a novel select-agent-compliant, non-antibiotic-selectable marker in chromosomal mutagenesis of the essential genes asd and dapB of Burkholderia pseudomallei. Appl Environ Microbiol 2009; 75:6062-75. [PMID: 19648360 PMCID: PMC2753064 DOI: 10.1128/aem.00820-09] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Accepted: 07/26/2009] [Indexed: 11/20/2022] Open
Abstract
Genetic manipulation of the category B select agents Burkholderia pseudomallei and Burkholderia mallei has been stifled due to the lack of compliant selectable markers. Hence, there is a need for additional select-agent-compliant selectable markers. We engineered a selectable marker based on the gat gene (encoding glyphosate acetyltransferase), which confers resistance to the common herbicide glyphosate (GS). To show the ability of GS to inhibit bacterial growth, we determined the effective concentrations of GS against Escherichia coli and several Burkholderia species. Plasmids based on gat, flanked by unique flip recombination target (FRT) sequences, were constructed for allelic-replacement. Both allelic-replacement approaches, one using the counterselectable marker pheS and the gat-FRT cassette and one using the DNA incubation method with the gat-FRT cassette, were successfully utilized to create deletions in the asd and dapB genes of wild-type B. pseudomallei strains. The asd and dapB genes encode an aspartate-semialdehyde dehydrogenase (BPSS1704, chromosome 2) and dihydrodipicolinate reductase (BPSL2941, chromosome 1), respectively. Mutants unable to grow on media without diaminopimelate (DAP) and other amino acids of this pathway were PCR verified. These mutants displayed cellular morphologies consistent with the inability to cross-link peptidoglycan in the absence of DAP. The B. pseudomallei 1026b Deltaasd::gat-FRT mutant was complemented with the B. pseudomallei asd gene on a site-specific transposon, mini-Tn7-bar, by selecting for the bar gene (encoding bialaphos/PPT resistance) with PPT. We conclude that the gat gene is one of very few appropriate, effective, and beneficial compliant markers available for Burkholderia select-agent species. Together with the bar gene, the gat cassette will facilitate various genetic manipulations of Burkholderia select-agent species.
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Affiliation(s)
- Michael H Norris
- Department of Microbiology, University of Hawaii at Manoa, Honolulu, Hawaii 96822, USA
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Duplessis C, Maguire JD. Melioidosis masquerading as community-acquired pneumonia: a case report demonstrating efficacy of intrapleural fibrinolytic therapy. J Travel Med 2009; 16:74-7. [PMID: 19192137 DOI: 10.1111/j.1708-8305.2008.00277.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Burkholderia pseudomallei, a soil saprophyte typically associated with the highly fatal disease melioidosis in Southeast Asia, is an increasing global concern as worldwide travel proliferates in our increasingly cosmopolitan society. Emergence of this disease in locations where it was not previously described underscores the importance of understanding the basic microbiology, pathogenesis, and epidemiology of infectious diseases on a global scale rather than the myopic view of the usual microbiological culprits of community-acquired pneumonia (CAP) in developed nations. We report a case of melioidosis originally diagnosed as CAP complicated by empyema successfully cured with combination of antibiotics and intrapleural fibrinolytic therapy, averting operative intervention.
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Barrett AR, Kang Y, Inamasu KS, Son MS, Vukovich JM, Hoang TT. Genetic tools for allelic replacement in Burkholderia species. Appl Environ Microbiol 2008; 74:4498-508. [PMID: 18502918 PMCID: PMC2493169 DOI: 10.1128/aem.00531-08] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 05/13/2008] [Indexed: 11/20/2022] Open
Abstract
Allelic replacement in the Burkholderia genus has been problematic due to the lack of appropriate counter-selectable and selectable markers. The counter-selectable marker sacB, commonly used in gram-negative bacteria, is nonselective on sucrose in many Burkholderia species. In addition, the use of antibiotic resistance markers of clinical importance for the selection of desirable genetic traits is prohibited in the United States for two potential bioterrorism agents, Burkholderia mallei and Burkholderia pseudomallei. Here, we engineered a mutated counter-selectable marker based on the B. pseudomallei PheS (the alpha-subunit of phenylalanyl tRNA synthase) protein and tested its effectiveness in three different Burkholderia species. The mutant PheS protein effectively killed 100% of the bacteria in the presence of 0.1% p-chlorophenylalanine. We assembled the mutant pheS on several allelic replacement vectors, in addition to constructing selectable markers based on tellurite (Tel(r)) and trimethoprim (Tp(r)) resistance that are excisable by flanking unique FLP recombination target (FRT) sequences. As a proof of concept, we utilized one of these gene replacement vectors (pBAKA) and the Tel(r)-FRT cassette to produce a chromosomal mutation in the Burkholderia thailandensis betBA operon, which codes for betaine aldehyde dehydrogenase and choline dehydrogenase. Chromosomal resistance markers could be excised by the introduction of pFLP-AB5 (Tp(r)), which is one of two constructed flp-containing plasmids, pFLP-AB4 (Tel(r)) and pFLP-AB5 (Tp(r)). These flp-containing plasmids harbor the mutant pheS gene and allow self curing on media that contain p-chlorophenylalanine after Flp-FRT excision. The characterization of the Delta betBA::Tel(r)-FRT and Delta betBA::FRT mutants indicated a defect in growth with choline as a sole carbon source, while these mutants grew as well as the wild type with succinate and glucose as alternative carbon sources.
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Affiliation(s)
- Ashley R Barrett
- Department of Microbiology, College of Natural Sciences, University of Hawaii at Manoa, Honolulu, HI 96822, USA
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