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Badrick TC, Meumann EM, Shirley K, Simos P, May ML, Quagliotto G, Bursle EC, Leonard N, McDougall RJ, Robson JM. Paracoccidioidomycosis: an Australian case. Med J Aust 2024. [PMID: 38741384 DOI: 10.5694/mja2.52300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/20/2024] [Indexed: 05/16/2024]
Affiliation(s)
| | - Ella M Meumann
- Sullivan Nicolaides Pathology Central Laboratory, Brisbane, QLD
| | - Kathryn Shirley
- Sullivan Nicolaides Pathology Central Laboratory, Brisbane, QLD
| | - Peter Simos
- Gold Coast University Hospital, Gold Coast, QLD
| | - Mertya L May
- Sullivan Nicolaides Pathology Central Laboratory, Brisbane, QLD
| | - Gary Quagliotto
- Sullivan Nicolaides Pathology Central Laboratory, Brisbane, QLD
| | - Evan C Bursle
- Sullivan Nicolaides Pathology Central Laboratory, Brisbane, QLD
| | - Nici Leonard
- General Practice Market Street Medical Practice, Brisbane, QLD
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2
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Abstract
Burkholderia pseudomallei, the causative agent of melioidosis, is found in soil and water of tropical and subtropical regions globally. Modelled estimates of the global burden predict that melioidosis remains vastly under-reported, and a call has been made for it to be recognized as a neglected tropical disease by the World Health Organization. Severe weather events and environmental disturbance are associated with increased case numbers, and it is anticipated that, in some regions, cases will increase in association with climate change. Genomic epidemiological investigations have confirmed B. pseudomallei endemicity in newly recognized regions, including the southern United States. Melioidosis follows environmental exposure to B. pseudomallei and is associated with comorbidities that affect the immune response, such as diabetes, and with socioeconomic disadvantage. Several vaccine candidates are ready for phase I clinical trials. In this Review, we explore the global burden, epidemiology and pathophysiology of B. pseudomallei as well as current diagnostics, treatment recommendations and preventive measures, highlighting research needs and priorities.
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Affiliation(s)
- Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- NDM Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Susanna J Dunachie
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
- NDM Centre for Global Health Research, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Willem J Wiersinga
- Division of Infectious Diseases, Center for Experimental Molecular Medicine, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Smith S, Marquardt T, Jennison AV, D'Addona A, Stewart J, Yarwood T, Ho J, Binotto E, Harris J, Fahmy M, Esmonde J, Richardson M, Graham RMA, Gair R, Ariotti L, Preston-Thomas A, Rubenach S, O'Sullivan S, Allen D, Ragh T, Grayson S, Manoy S, Warner JM, Meumann EM, Robson JM, Hanson J. Clinical Manifestations and Genomic Evaluation of Melioidosis Outbreak among Children after Sporting Event, Australia. Emerg Infect Dis 2023; 29:2218-2228. [PMID: 37877500 PMCID: PMC10617349 DOI: 10.3201/eid2911.230951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Melioidosis, caused by the environmental gram-negative bacterium Burkholderia pseudomallei, usually develops in adults with predisposing conditions and in Australia more commonly occurs during the monsoonal wet season. We report an outbreak of 7 cases of melioidosis in immunocompetent children in Australia. All the children had participated in a single-day sporting event during the dry season in a tropical region of Australia, and all had limited cutaneous disease. All case-patients had an adverse reaction to oral trimethoprim/sulfamethoxazole treatment, necessitating its discontinuation. We describe the clinical features, environmental sampling, genomic epidemiologic investigation, and public health response to the outbreak. Management of this outbreak shows the potential benefits of making melioidosis a notifiable disease. The approach used could also be used as a framework for similar outbreaks in the future.
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Gramp PE, Dooley J, O'Brien B, Jones A, Tan L, Robson J, Robertson T, Simos P, Fuller R, Gramp DV, Meumann EM. Fatal granulomatous amebic encephalitis initially presenting with a cutaneous lesion. Australas J Dermatol 2023; 64:e256-e261. [PMID: 37154242 DOI: 10.1111/ajd.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/23/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
We present a case of a 66-year-old man with a cutaneous Balamuthia mandrillaris lesion that progressed to fatal granulomatous amoebic encephalitis. We provide a summary of Australian cases and describe the clinical features and approach to diagnosing this rare but devastating condition, including the importance of PCR for diagnosis.
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Affiliation(s)
- Prudence E Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - John Dooley
- NH Diagnostics, Gold Coast, Queensland, Australia
| | - Blake O'Brien
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Andrew Jones
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Leong Tan
- Neurosurgery Department, Pindara Hospital, Queensland, Gold Coast, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
| | - Thomas Robertson
- Royal Brisbane and Women's Hospital, Queensland, Brisbane, Australia
| | - Peter Simos
- Infectious Disease Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Robert Fuller
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dallas V Gramp
- Dermatology Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Ella M Meumann
- Sullivan Nicolaides Pathology, Queensland, Brisbane, Australia
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Currie BJ, Meumann EM, Kaestli M. The Expanding Global Footprint of Burkholderia pseudomallei and Melioidosis. Am J Trop Med Hyg 2023; 108:1081-1083. [PMID: 37160279 PMCID: PMC10540122 DOI: 10.4269/ajtmh.23-0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Affiliation(s)
- Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Program, Darwin, Northern Territory, Australia
| | - Ella M. Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Program, Darwin, Northern Territory, Australia
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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6
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Abstract
Nucleic acid amplification tests (NAATs), including polymerase chain reaction (PCR) assays, are more sensitive for the detection of SARS-CoV-2 than rapid antigen tests (RATS), and are the gold standard for diagnosis of acute COVID-19. However NAATs can remain positive for weeks following infection due to low-level shedding of non-viable viral fragments. RATs (in particular self-testing) are the mainstay of COVID-19 diagnosis due to their convenience, speed and high specificity. The sensitivity of RATs is highest within seven days of symptom onset. A negative RAT result may warrant a NAAT or repeat RAT for confirmation. The presence of spike antibodies is consistent with either vaccination or infection. Nucleocapsid antibodies suggest a previous infection. Serological tests measuring neutralising antibodies that infer immunity are not readily available.
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Donnan EJ, Marais BJ, Coulter C, Waring J, Bastian I, Williamson DA, Sherry NL, Bond K, Sintchenko V, Meumann EM, Horan K, Cooley L, Denholm JT. The use of whole genome sequencing for tuberculosis public health activities in Australia: a joint statement of the National Tuberculosis Advisory Committee and Communicable Diseases Genomics Network. Commun Dis Intell (2018) 2023; 47. [PMID: 36850064 DOI: 10.33321/cdi.2023.47.8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- Ellen J Donnan
- New South Wales Tuberculosis Program, Health Protection New South Wales, Sydney, Australia
| | - Ben J Marais
- The Children's Hospital at Westmead, Sydney Childrens Hospital Network, Sydney, Australia.,Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, Australia
| | - Chris Coulter
- Communicable Diseases Branch, Queensland Department of Health, Brisbane, Australia.,Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Queensland Health, Brisbane, Australia
| | - Justin Waring
- Western Australia Tuberculosis Control Program, North Metropolitan Health Service, Public Health Services, Perth, Western Australia
| | | | - Deborah A Williamson
- Victorian Infectious Diseases Reference Laboratory (VIDRL), at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,Department of Infectious Diseases, Doherty Institute, University of Melbourne, Melbourne, Australia
| | - Norelle L Sherry
- Microbiological Diagnostic Unti Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia.,Department of Infectious Diseases, Austin Health, Melbourne, Australia
| | - Katherine Bond
- Victorian Infectious Diseases Reference Laboratory (VIDRL), at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Vitali Sintchenko
- Sydney Infectious Diseases Institute (Sydney ID), The University of Sydney, Sydney, Australia.,Institute of Clinical Pathology and Medical Research - NSW Health Pathology, Sydney, Australia
| | - Ella M Meumann
- Royal Darwin Hospital, Darwin, Australia.,Menzies School of Health Research, Darwin, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unti Public Health Laboratory, Department of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne, Australia
| | - Louise Cooley
- Department of Microbiology and Infectious Diseases, Royal Hobart Hospital, Hobart, Australia.,University of Tasmania, Hobart, Australia
| | - Justin T Denholm
- Department of Infectious Diseases, Doherty Institute, University of Melbourne, Melbourne, Australia.,Victorian Tuberculosis Program, Melbourne Health, Melbourne, Australia
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Meumann EM, Krause VL, Baird R, Currie BJ. Using Genomics to Understand the Epidemiology of Infectious Diseases in the Northern Territory of Australia. Trop Med Infect Dis 2022; 7:tropicalmed7080181. [PMID: 36006273 PMCID: PMC9413455 DOI: 10.3390/tropicalmed7080181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
The Northern Territory (NT) is a geographically remote region of northern and central Australia. Approximately a third of the population are First Nations Australians, many of whom live in remote regions. Due to the physical environment and climate, and scale of social inequity, the rates of many infectious diseases are the highest nationally. Molecular typing and genomic sequencing in research and public health have provided considerable new knowledge on the epidemiology of infectious diseases in the NT. We review the applications of genomic sequencing technology for molecular typing, identification of transmission clusters, phylogenomics, antimicrobial resistance prediction, and pathogen detection. We provide examples where these methodologies have been applied to infectious diseases in the NT and discuss the next steps in public health implementation of this technology.
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Affiliation(s)
- Ella M. Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin 0810, Australia
- Correspondence:
| | - Vicki L. Krause
- Northern Territory Centre for Disease Control, Northern Territory Government, Darwin 0810, Australia
| | - Robert Baird
- Territory Pathology, Royal Darwin Hospital, Darwin 0810, Australia
| | - Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin 0810, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin 0810, Australia
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Hogarth F, Coffey P, Goddard L, Lewis S, Labib S, Wilmot M, Andersson P, Sherry N, Seemann T, Howden BP, Freeman K, Baird R, Hosegood I, McDermott K, Walsh N, Polkinghorne B, Marshall C, Davies J, Krause V, Meumann EM. Genomic Evidence of In-Flight SARS-CoV-2 Transmission, India to Australia, April 2021. Emerg Infect Dis 2022; 28:1527-1530. [PMID: 35483111 PMCID: PMC9239893 DOI: 10.3201/eid2807.212466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Epidemiologic and genomic investigation of SARS-CoV-2 infections associated with 2 repatriation flights from India to Australia in April 2021 indicated that 4 passengers transmitted SARS-CoV-2 to >11 other passengers. Results suggest transmission despite mandatory mask use and predeparture testing. For subsequent flights, predeparture quarantine and expanded predeparture testing were implemented.
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Hodgetts K, Kleinecke M, Woerle C, Kaestli M, Budd R, Webb JR, Ward L, Mayo M, Currie BJ, Meumann EM. Melioidosis in the remote Katherine region of northern Australia. PLoS Negl Trop Dis 2022; 16:e0010486. [PMID: 35696415 PMCID: PMC9232150 DOI: 10.1371/journal.pntd.0010486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/24/2022] [Accepted: 05/10/2022] [Indexed: 11/19/2022] Open
Abstract
Melioidosis is endemic in the remote Katherine region of northern Australia. In a population with high rates of chronic disease, social inequities, and extreme remoteness, the impact of melioidosis is exacerbated by severe weather events and disproportionately affects First Nations Australians. All culture-confirmed melioidosis cases in the Katherine region of the Australian Top End between 1989–2021 were included in the study, and the clinical features and epidemiology were described. The diversity of Burkholderia pseudomallei strains in the region was investigated using genomic sequencing. From 1989–2021 there were 128 patients with melioidosis in the Katherine region. 96/128 (75%) patients were First Nations Australians, 72/128 (56%) were from a very remote region, 68/128 (53%) had diabetes, 57/128 (44%) had a history of hazardous alcohol consumption, and 11/128 (9%) died from melioidosis. There were 9 melioidosis cases attributable to the flooding of the Katherine River in January 1998; 7/9 flood-associated cases had cutaneous melioidosis, five of whom recalled an inoculating event injury sustained wading through flood waters or cleaning up after the flood. The 126 first-episode clinical B. pseudomallei isolates that underwent genomic sequencing belonged to 107 different sequence types and were highly diverse, reflecting the vast geographic area of the study region. In conclusion, melioidosis in the Katherine region disproportionately affects First Nations Australians with risk factors and is exacerbated by severe weather events. Diabetes management, public health intervention for hazardous alcohol consumption, provision of housing to address homelessness, and patient education on melioidosis prevention in First Nations languages should be prioritised. Melioidosis, caused by the environmental bacterium Burkholderia pseudomallei, disproportionately affects Australian First Nations peoples in the Northern Territory of Australia. The Katherine region has some of the highest rates of homelessness in Australia, and social inequity impacts health outcomes for First Nations people whose access to care is further complicated by remoteness. In this study, we describe the clinical features and epidemiology of melioidosis in the Katherine region over a 32-year period. Almost three quarters of melioidosis cases were First Nations Australians, over half lived in a very remote region, and diabetes and hazardous alcohol consumption were common risk factors. Following a severe flooding event in the region in 1998, a spike in cases of melioidosis was seen, the majority presenting as skin and soft tissue infections. The B. pseudomallei isolates in the study were extremely genetically diverse, reflecting the large geographic area of the Katherine region. With predicted climate change-driven increases in severe weather events and subsequent increases in melioidosis cases, public health priorities in the region should include addressing high rates of homelessness and hazardous alcohol consumption, optimisation of diabetes management, and ongoing education in First Nations languages regarding prevention of B. pseudomallei exposure.
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Affiliation(s)
- Kay Hodgetts
- Department of Infectious Diseases, Wellington Regional Hospital, Wellington, New Zealand
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Mariana Kleinecke
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Celeste Woerle
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Richard Budd
- Katherine District Hospital, Katherine, Northern Territory, Australia
| | - Jessica R. Webb
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Department of Microbiology & Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Linda Ward
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Bart J. Currie
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ella M. Meumann
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
- * E-mail:
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Currie BJ, Woerle C, Mayo M, Meumann EM, Baird RW. What is the role of lateral flow immunoassay for the diagnosis of melioidosis? Open Forum Infect Dis 2022; 9:ofac149. [PMID: 35493111 PMCID: PMC9043003 DOI: 10.1093/ofid/ofac149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Culture of Burkholderia pseudomallei remains the gold standard for diagnosis of melioidosis but is not possible in many resource-limited settings where melioidosis is endemic. Direct identification of B. pseudomallei antigen in clinical samples has been developed using a lateral flow immunoassay (LFA) targeting B. pseudomallei capsular polysaccharide.
Methods
We summarised the findings from the 8 studies to date of the Active Melioidosis Detect (AMD) LFA and compared these with our results from 232 patients with culture-confirmed melioidosis. We have also optimised the methodology for testing different clinical samples.
Results
Sensitivity and specificity for different samples was broadly similar in our study to those published from Thailand, India, Laos and Malaysia. 130/232 (56%) of our melioidosis patients were positive on one or more AMD tests: 27% for serum (rising to 39% in those with bacteremic melioidosis and 68% in those with septic shock); 63% for urine (72% in bacteremic melioidosis and 90% in septic shock); 85% in sputum that was culture positive; and 83% in pus that was culture positive. Heating sputum and pus samples increased sensitivity. Faint false positive urine bands seen on earlier AMD versions were not seen when re-tested using the most recent version, AMD-Plus.
Conclusions
While sensitivity of melioidosis LFA is low overall for blood samples, there is potential for use as a rapid diagnostic; testing serum and urine from those with severe sepsis who may have melioidosis and testing sputum and pus samples from clinically relevant scenarios. Prospective studies of patients with sepsis and other clinical presentations resembling melioidosis are required to ascertain if the specificity of AMD-PLUS is adequate to enable diagnosis of melioidosis with a high positive predictive value.
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Affiliation(s)
- Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Department of Infectious Diseases and Pathology and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Celeste Woerle
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Department of Infectious Diseases and Pathology and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Robert W Baird
- Department of Infectious Diseases and Pathology and Northern Territory Medical Program, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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12
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Gora H, Hasan T, Smith S, Wilson I, Mayo M, Woerle C, Webb JR, Currie BJ, Hanson J, Meumann EM. Melioidosis of the central nervous system; impact of the bimABm allele on patient presentation and outcome. Clin Infect Dis 2022:ciac111. [PMID: 35137005 DOI: 10.1093/cid/ciac111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The autotransporter protein Burkholderia intracellular motility A (BimA) facilitates the entry of Burkholderia pseudomallei into the central nervous system (CNS) in mouse models of melioidosis. Its role in the pathogenesis of human cases of CNS melioidosis is incompletely defined. METHODS Consecutive culture-confirmed cases of melioidosis at two sites in tropical Australia after 1989 were reviewed. Demographic, clinical and radiological data of the patients with CNS melioidosis were recorded. The bimA allele (bimABm or bimABp) of the B. pseudomallei isolated from each patient was determined. RESULTS Of the 1587 cases diagnosed at the two sites during the study period, 52 (3.3%) had confirmed CNS melioidosis; 20 (38.5%) had a brain abscess, 18 (34.6%) had encephalomyelitis, 4 (7.7%) had isolated meningitis and 10 (19.2%) had extra-meningeal disease. Among the 52 patients, there were 8 (15.4%) deaths; 17/44 (38.6%) survivors had residual disability. The bimA allele was characterized in 47/52; 17/47 (36.2%) had the bimABm allele and 30 (63.8%) had the bimABp allele. Patients with a bimABm variant were more likely to have a predominantly neurological presentation (odds ratio (OR) (95% confidence interval (CI)): 5.60 (1.52-20.61), p=0.01), to have brainstem involvement (OR (95%CI): 7.33 (1.92-27.95), p=0.004) and to have encephalomyelitis (OR (95%CI): 4.69 (1.30-16.95), p=0.02. Patients with a bimABm variant were more likely to die or have residual disability (odds ratio (95%CI): 4.88 (1.28-18.57), p=0.01). CONCLUSIONS The bimA allele of B. pseudomallei has a significant impact on the clinical presentation and outcome of patients with CNS melioidosis.
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Affiliation(s)
- Hannah Gora
- College of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Tasnim Hasan
- Centre for Disease Control, Northern Territory Top End Health Services, Darwin, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Ian Wilson
- Department of Medicine, Cairns Hospital, Cairns, Australia
| | - Mark Mayo
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Celeste Woerle
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Jessica R Webb
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Bart J Currie
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- The Kirby Institute, University of New South Wales, Kensington, Australia
| | - Ella M Meumann
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
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13
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Meumann EM, Bainomugisa A. Molecular epidemiology of tuberculosis in northern Australia. Microbiol Aust 2022. [DOI: 10.1071/ma22037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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Meumann EM, Horan K, Ralph AP, Farmer B, Globan M, Stephenson E, Popple T, Boyd R, Kaestli M, Seemann T, Vandelannoote K, Lowbridge C, Baird RW, Stinear TP, Williamson DA, Currie BJ, Krause VL. Tuberculosis in Australia's tropical north: a population-based genomic epidemiological study. Lancet Reg Health West Pac 2021; 15:100229. [PMID: 34528010 PMCID: PMC8350059 DOI: 10.1016/j.lanwpc.2021.100229] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Northern Territory (NT) has the highest tuberculosis (TB) rate of all Australian jurisdictions. We combined TB public health surveillance data with genomic sequencing of Mycobacterium tuberculosis isolates in the tropical 'Top End' of the NT to investigate trends in TB incidence and transmission. METHODS This retrospective observational study included all 741 culture-confirmed cases of TB in the Top End over three decades from 1989-2020. All 497 available M. tuberculosis isolates were sequenced. We used contact tracing data to define a threshold pairwise SNP distance for hierarchical single linkage clustering, and examined putative transmission clusters in the context of epidemiologic information. FINDINGS There were 359 (48%) cases born overseas, 329 (44%) cases among Australian First Nations peoples, and 52 (7%) cases were Australian-born and non-Indigenous. The annual incidence in First Nations peoples from 1989-2019 fell from average 50.4 to 11.0 per 100,000 (P<0·001). First Nations cases were more likely to die from TB (41/329, 12·5%) than overseas-born cases (11/359, 3·1%; P<0·001). Using a threshold of ≤12 SNPs, 28 clusters of between 2-64 individuals were identified, totalling 250 cases; 214 (86%) were First Nations cases and 189 (76%) were from a remote region. The time between cases and past epidemiologically- and genomically-linked contacts ranged from 4·5 months to 24 years. INTERPRETATION Our findings support prioritisation of timely case detection, contact tracing augmented by genomic sequencing, and latent TB treatment to break transmission chains in Top End remote hotspot regions.
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Affiliation(s)
- Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Belinda Farmer
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Elizabeth Stephenson
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Tracy Popple
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Rowena Boyd
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Koen Vandelannoote
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Christopher Lowbridge
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
| | - Robert W. Baird
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
- Territory Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Timothy P. Stinear
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Deborah A. Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Bart J. Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
- Department of Infectious Diseases, Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - Vicki L. Krause
- Nothern Territory Centre for Disease Control, Northern Territory Government, Darwin, Australia
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15
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Lane CR, Sherry NL, Porter AF, Duchene S, Horan K, Andersson P, Wilmot M, Turner A, Dougall S, Johnson SA, Sait M, Gonçalves da Silva A, Ballard SA, Hoang T, Stinear TP, Caly L, Sintchenko V, Graham R, McMahon J, Smith D, Leong LEX, Meumann EM, Cooley L, Schwessinger B, Rawlinson W, van Hal SJ, Stephens N, Catton M, Looker C, Crouch S, Sutton B, Alpren C, Williamson DA, Seemann T, Howden BP. Genomics-informed responses in the elimination of COVID-19 in Victoria, Australia: an observational, genomic epidemiological study. Lancet Public Health 2021; 6:e547-e556. [PMID: 34252365 PMCID: PMC8270762 DOI: 10.1016/s2468-2667(21)00133-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND A cornerstone of Australia's ability to control COVID-19 has been effective border control with an extensive supervised quarantine programme. However, a rapid recrudescence of COVID-19 was observed in the state of Victoria in June, 2020. We aim to describe the genomic findings that located the source of this second wave and show the role of genomic epidemiology in the successful elimination of COVID-19 for a second time in Australia. METHODS In this observational, genomic epidemiological study, we did genomic sequencing of all laboratory-confirmed cases of COVID-19 diagnosed in Victoria, Australia between Jan 25, 2020, and Jan 31, 2021. We did phylogenetic analyses, genomic cluster discovery, and integrated results with epidemiological data (detailed information on demographics, risk factors, and exposure) collected via interview by the Victorian Government Department of Health. Genomic transmission networks were used to group multiple genomic clusters when epidemiological and genomic data suggested they arose from a single importation event and diversified within Victoria. To identify transmission of emergent lineages between Victoria and other states or territories in Australia, all publicly available SARS-CoV-2 sequences uploaded before Feb 11, 2021, were obtained from the national sequence sharing programme AusTrakka, and epidemiological data were obtained from the submitting laboratories. We did phylodynamic analyses to estimate the growth rate, doubling time, and number of days from the first local infection to the collection of the first sequenced genome for the dominant local cluster, and compared our growth estimates to previously published estimates from a similar growth phase of lineage B.1.1.7 (also known as the Alpha variant) in the UK. FINDINGS Between Jan 25, 2020, and Jan 31, 2021, there were 20 451 laboratory-confirmed cases of COVID-19 in Victoria, Australia, of which 15 431 were submitted for sequencing, and 11 711 met all quality control metrics and were included in our analysis. We identified 595 genomic clusters, with a median of five cases per cluster (IQR 2-11). Overall, samples from 11 503 (98·2%) of 11 711 cases clustered with another sample in Victoria, either within a genomic cluster or transmission network. Genomic analysis revealed that 10 426 cases, including 10 416 (98·4%) of 10 584 locally acquired cases, diagnosed during the second wave (between June and October, 2020) were derived from a single incursion from hotel quarantine, with the outbreak lineage (transmission network G, lineage D.2) rapidly detected in other Australian states and territories. Phylodynamic analyses indicated that the epidemic growth rate of the outbreak lineage in Victoria during the initial growth phase (samples collected between June 4 and July 9, 2020; 47·4 putative transmission events, per branch, per year [1/years; 95% credible interval 26·0-85·0]), was similar to that of other reported variants, such as B.1.1.7 in the UK (mean approximately 71·5 1/years). Strict interventions were implemented, and the outbreak lineage has not been detected in Australia since Oct 29, 2020. Subsequent cases represented independent international or interstate introductions, with limited local spread. INTERPRETATION Our study highlights how rapid escalation of clonal outbreaks can occur from a single incursion. However, strict quarantine measures and decisive public health responses to emergent cases are effective, even with high epidemic growth rates. Real-time genomic surveillance can alter the way in which public health agencies view and respond to COVID-19 outbreaks. FUNDING The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund.
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Affiliation(s)
- Courtney R Lane
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Norelle L Sherry
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Ashleigh F Porter
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Sebastian Duchene
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Kristy Horan
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Patiyan Andersson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Mathilda Wilmot
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | | | - Sally Dougall
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Sandra A Johnson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Michelle Sait
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Anders Gonçalves da Silva
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Doherty Applied Microbial Genomics, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Susan A Ballard
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Tuyet Hoang
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Timothy P Stinear
- Doherty Applied Microbial Genomics, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Leon Caly
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology Public Health, Westmead Hospital, Sydney, NSW, Australia,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Rikki Graham
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, QLD, Australia
| | - Jamie McMahon
- Public Health Microbiology, Forensic and Scientific Services, Queensland Department of Health, Brisbane, QLD, Australia
| | - David Smith
- Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Perth, WA, Australia,School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Lex EX Leong
- Public Health Laboratory, Microbiology and Infectious Diseases, SA Pathology, Adelaide, SA, Australia
| | - Ella M Meumann
- Territory Pathology, Royal Darwin Hospital, Darwin, NT, Australia,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Louise Cooley
- Royal Hobart Hospital, Hobart, TAS, Australia,School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | - William Rawlinson
- Virology Research Laboratory, Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Sebastiaan J van Hal
- Department of Infectious Disease and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicola Stephens
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Mike Catton
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Clare Looker
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Simon Crouch
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Brett Sutton
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Charles Alpren
- Victorian Department of Health, Melbourne, VIC, Australia
| | - Deborah A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Department of Microbiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Torsten Seemann
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia,Doherty Applied Microbial Genomics, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Doherty Applied Microbial Genomics, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia; Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.
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16
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Currie BJ, Mayo M, Ward LM, Kaestli M, Meumann EM, Webb JR, Woerle C, Baird RW, Price RN, Marshall CS, Ralph AP, Spencer E, Davies J, Huffam SE, Janson S, Lynar S, Markey P, Krause VL, Anstey NM. The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation. Lancet Infect Dis 2021; 21:1737-1746. [PMID: 34303419 DOI: 10.1016/s1473-3099(21)00022-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND The global distribution of melioidosis is under considerable scrutiny, with both unmasking of endemic disease in African and Pacific nations and evidence of more recent dispersal in the Americas. Because of the high incidence of disease in tropical northern Australia, The Darwin Prospective Melioidosis Study commenced in October, 1989. We present epidemiology, clinical features, outcomes, and bacterial genomics from this 30-year study, highlighting changes in the past decade. METHODS The present study was a prospective analysis of epidemiological, clinical, and laboratory data for all culture-confirmed melioidosis cases from the tropical Northern Territory of Australia from Oct 1, 1989, until Sept 30, 2019. Cases were identified on the basis of culture-confirmed melioidosis, a laboratory-notifiable disease in the Northern Territory of Australia. Patients who were culture-positive were included in the study. Multivariable analysis determined predictors of clinical presentations and outcome. Incidence, survival, and cluster analyses were facilitated by population and rainfall data and genotyping of Burkholderia pseudomallei, including multilocus sequence typing and whole-genome sequencing. FINDINGS There were 1148 individuals with culture-confirmed melioidosis, of whom 133 (12%) died. Median age was 50 years (IQR 38-60), 48 (4%) study participants were children younger than 15 years of age, 721 (63%) were male individuals, and 600 (52%) Indigenous Australians. All but 186 (16%) had clinical risk factors, 513 (45%) had diabetes, and 455 (40%) hazardous alcohol use. Only three (2%) of 133 fatalities had no identified risk. Pneumonia was the most common presentation occurring in 595 (52%) patients. Bacteraemia occurred in 633 (56%) of 1135 patients, septic shock in 240 (21%) patients, and 180 (16%) patients required mechanical ventilation. Cases correlated with rainfall, with 80% of infections occurring during the wet season (November to April). Median annual incidence was 20·5 cases per 100 000 people; the highest annual incidence in Indigenous Australians was 103·6 per 100 000 in 2011-12. Over the 30 years, annual incidences increased, as did the proportion of patients with diabetes, although mortality decreased to 17 (6%) of 278 patients over the past 5 years. Genotyping of B pseudomallei confirmed case clusters linked to environmental sources and defined evolving and new sequence types. INTERPRETATION Melioidosis is an opportunistic infection with a diverse spectrum of clinical presentations and severity. With early diagnosis, specific antimicrobial therapy, and state-of-the-art intensive care, mortality can be reduced to less than 10%. However, mortality remains much higher in the many endemic regions where health resources remain scarce. Genotyping of B pseudomallei informs evolving local and global epidemiology. FUNDING The Australian National Health and Medical Research Council.
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Affiliation(s)
- Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia.
| | - Mark Mayo
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Linda M Ward
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Mirjam Kaestli
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Jessica R Webb
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Celeste Woerle
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Robert W Baird
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia; Pathology Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Ric N Price
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Catherine S Marshall
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Anna P Ralph
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Emma Spencer
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Jane Davies
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Sarah E Huffam
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Sonja Janson
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Sarah Lynar
- Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
| | - Peter Markey
- Centre for Disease Control, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Vicki L Krause
- Centre for Disease Control, Top End Health Services, Northern Territory Department of Health, Darwin, NT, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Infectious Diseases Department, Royal Darwin Hospital and Northern Territory Medical Programme, Darwin, NT, Australia
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17
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Meumann EM, Kaestli M, Mayo M, Ward L, Rachlin A, Webb JR, Kleinecke M, Price EP, Currie BJ. Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia. Emerg Infect Dis 2021; 27:1057-1067. [PMID: 33754984 PMCID: PMC8007296 DOI: 10.3201/eid2704.202716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Since 2005, the range of Burkholderia pseudomallei sequence type 562 (ST562) has expanded in northern Australia. During 2005–2019, ST562 caused melioidosis in 61 humans and 3 animals. Cases initially occurred in suburbs surrounding a creek before spreading across urban Darwin, Australia and a nearby island community. In urban Darwin, ST562 caused 12% (53/440) of melioidosis cases, a proportion that increased during the study period. We analyzed 2 clusters of cases with epidemiologic links and used genomic analysis to identify previously unassociated cases. We found that ST562 isolates from Hainan Province, China, and Pingtung County, Taiwan, were distantly related to ST562 strains from Australia. Temporal genomic analysis suggested a single ST562 introduction into the Darwin region in ≈1988. The origin and transmission mode of ST562 into Australia remain uncertain.
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18
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Bainomugisa A, Meumann EM, Rajahram GS, Ong RTH, Coin L, Paul DC, William T, Coulter C, Ralph AP. Genomic epidemiology of tuberculosis in eastern Malaysia: insights for strengthening public health responses. Microb Genom 2021; 7:000573. [PMID: 33945455 PMCID: PMC8209721 DOI: 10.1099/mgen.0.000573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
Tuberculosis is a leading public health priority in eastern Malaysia. Knowledge of the genomic epidemiology of tuberculosis can help tailor public health interventions. Our aims were to determine tuberculosis genomic epidemiology and characterize resistance mutations in the ethnically diverse city of Kota Kinabalu, Sabah, located at the nexus of Malaysia, Indonesia, Philippines and Brunei. We used an archive of prospectively collected Mycobacterium tuberculosis samples paired with epidemiological data. We collected sputum and demographic data from consecutive consenting outpatients with pulmonary tuberculosis at the largest tuberculosis clinic from 2012 to 2014, and selected samples from tuberculosis inpatients from the tertiary referral centre during 2012-2014 and 2016-2017. Two hundred and eight M. tuberculosis sequences were available for analysis, representing 8 % of cases notified during the study periods. Whole-genome phylogenetic analysis demonstrated that most strains were lineage 1 (195/208, 93.8 %), with the remainder being lineages 2 (8/208, 3.8 %) or 4 (5/208, 2.4 %). Lineages or sub-lineages were not associated with patient ethnicity. The lineage 1 strains were diverse, with sub-lineage 1.2.1 being dominant (192, 98 %). Lineage 1.2.1.3 isolates were geographically most widely distributed. The greatest diversity occurred in a border town sub-district. The time to the most recent common ancestor for the three major lineage 1.2.1 clades was estimated to be the year 1966 (95 % HPD 1948-1976). An association was found between failure of culture conversion by week 8 of treatment and infection with lineage 2 (4/6, 67 %) compared with lineage 1 strains (4/83, 5 %) (P<0.001), supporting evidence of greater virulence of lineage 2 strains. Eleven potential transmission clusters (SNP difference ≤12) were identified; at least five included people living in different sub-districts. Some linked cases spanned the whole 4-year study period. One cluster involved a multidrug-resistant tuberculosis strain matching a drug-susceptible strain from 3 years earlier. Drug resistance mutations were uncommon, but revealed one phenotype-genotype mismatch in a genotypically multidrug-resistant isolate, and rare nonsense mutations within the katG gene in two isolates. Consistent with the regionally mobile population, M. tuberculosis strains in Kota Kinabalu were diverse, although several lineage 1 strains dominated and were locally well established. Transmission clusters - uncommonly identified, likely attributable to incomplete sampling - showed clustering occurring across the community, not confined to households or sub-districts. The findings indicate that public health priorities should include active case finding and early institution of tuberculosis management in mobile populations, while there is a need to upscale effective contact investigation beyond households to include other contacts within social networks.
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Affiliation(s)
| | - Ella M. Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
- Department of Medicine, Royal Darwin Hospital, Northern Territory, Australia
| | - Giri Shan Rajahram
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Sabah, Malaysia
| | - Rick Twee-Hee Ong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Lachlan Coin
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | | | - Timothy William
- Infectious Diseases Society Sabah-Menzies School of Health Research Clinical Research Unit, Kota Kinabalu, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth Hospital, Sabah, Malaysia
- Gleneagles Hospital Kota Kinabalu, Sabah, Malaysia
| | | | - Anna P. Ralph
- Queensland Mycobacterium Reference Laboratory, Brisbane, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
- Department of Medicine, Royal Darwin Hospital, Northern Territory, Australia
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19
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Douglas NM, Meumann EM, Krause VL, Davies J. Successful containment to date of SARS-CoV-2 transmission in the Northern Territory. Med J Aust 2020; 214:218-219. [PMID: 33111312 PMCID: PMC7984294 DOI: 10.5694/mja2.50840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas M Douglas
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Ella M Meumann
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Charles Darwin University, Darwin, NT
| | - Vicki L Krause
- Northern Territory Centre for Disease Control, Department of Health, Darwin, NT
| | - Jane Davies
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Charles Darwin University, Darwin, NT
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20
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Davidson N, Campbell K, Foroughi F, Tayal V, Lynar S, Crawford LC, Kidd SE, Baird R, Davies J, Meumann EM. Disseminated Saksenaea infection in an immunocompromised host associated with a good clinical outcome: a case report and review of the literature. BMC Infect Dis 2020; 20:755. [PMID: 33054720 PMCID: PMC7559758 DOI: 10.1186/s12879-020-05459-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 09/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Saksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown. Case presentation A 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived. Conclusions We describe an unusual case of disseminated infection with a favourable outcome to date.
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Affiliation(s)
- N Davidson
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia. .,Sullivan and Nicolaides Pathology, Brisbane, Australia.
| | - K Campbell
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - F Foroughi
- Department of Pathology, Royal Darwin Hospital, Darwin, Australia
| | - V Tayal
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia
| | - S Lynar
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Charles Darwin University, Menzies School of Health Research, Darwin, Australia
| | - L C Crawford
- National Mycology Reference Centre, Microbiology and Infectious Diseases, SA Pathology, Frome Road, Adelaide, South Australia, Australia
| | - S E Kidd
- National Mycology Reference Centre, Microbiology and Infectious Diseases, SA Pathology, Frome Road, Adelaide, South Australia, Australia
| | - R Baird
- Department of Pathology, Royal Darwin Hospital, Darwin, Australia
| | - J Davies
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Charles Darwin University, Menzies School of Health Research, Darwin, Australia
| | - E M Meumann
- Division of Medicine, Royal Darwin Hospital, Darwin, Australia.,Global and Tropical Health Division, Charles Darwin University, Menzies School of Health Research, Darwin, Australia
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21
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Caly L, Davidson N, Ghimire R, Rajaratnam B, Marrow J, Baird R, Meumann EM, Druce J. Extended detection and isolation of Murray Valley encephalitis virus in whole blood and urine. Med J Aust 2019; 211:499-500.e1. [PMID: 31745993 DOI: 10.5694/mja2.50423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Leon Caly
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | | | | | | | | | | | - Ella M Meumann
- Royal Darwin Hospital, Darwin, NT.,Menzies School of Health Research, Darwin, NT
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
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22
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Meumann EM, Anstey NM, Currie BJ, Piera KA, Baird R, Sarovich DS, Davis JS. Whole-Genome Sequencing to Differentiate Relapse From Reinfection in Community-Onset Bacteremic Acinetobacter baumannii Pneumonia. Open Forum Infect Dis 2019; 6:ofz263. [PMID: 31281860 PMCID: PMC6602382 DOI: 10.1093/ofid/ofz263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/31/2019] [Indexed: 11/13/2022] Open
Abstract
Community-onset bacteremic Acinetobacter baumannii pneumonia recurred in 3 of 30 (10%) patients followed prospectively, all with ongoing hazardous alcohol intake, 3-56 months after initial pneumonia. Paired isolates underwent whole-genome sequencing. Phylogenetic analysis showed that recurrence strains were all distinct from preceding strains, indicating reinfection in susceptible individuals rather than relapse.
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Affiliation(s)
- Ella M Meumann
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Nicholas M Anstey
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia
| | - Kim A Piera
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia
| | - Robert Baird
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Australia.,Department of Pathology, Royal Darwin Hospital, Darwin, Australia
| | - Derek S Sarovich
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,GeneCology Research Centre, University of the Sunshine Coast, Sippy Downs, Australia
| | - Joshua S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, Australia.,Department of Infectious Diseases, John Hunter Hospital and the University of Newcastle, Newcastle, Australia
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Meumann EM, Anstey NM, Currie BJ, Piera KA, Kenyon JJ, Hall RM, Davis JS, Sarovich DS. Genomic epidemiology of severe community-onset Acinetobacter baumannii infection. Microb Genom 2019; 5. [PMID: 30806611 PMCID: PMC6487312 DOI: 10.1099/mgen.0.000258] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Acinetobacter baumannii causes severe, fulminant, community-acquired pneumonia (CAP) in tropical and subtropical regions. We compared the population structure, virulence and antimicrobial resistance determinants of northern Australian community-onset A. baumannii strains with local and global strains. We performed whole-genome sequencing on 55 clinical and five throat colonization A. baumannii isolates collected in northern Australia between 1994 and 2016. Clinical isolates included CAP (n=41), healthcare-associated pneumonia (n=7) and nosocomial bloodstream (n=7) isolates. We also included 93 publicly available international A. baumannii genome sequences in the analyses. Patients with A. baumannii CAP were almost all critically unwell; 82 % required intensive care unit admission and 18 % died during their inpatient stay. Whole-genome phylogenetic analysis demonstrated that community-onset strains were not phylogenetically distinct from nosocomial strains. Some non-multidrug-resistant local strains were closely related to multidrug-resistant strains from geographically distant locations. Pasteur sequence type (ST)10 was the dominant ST and accounted for 31/60 (52 %) northern Australian strains; the remainder belonged to a diverse range of STs. The most recent common ancestor for ST10 was estimated to have occurred in 1738 (95 % highest posterior density, 1626–1826), with evidence of multiple introduction events between Australia and Southeast Asia between then and the present day. Virulence genes associated with biofilm formation and the type 6 secretion system (T6SS) were absent in many strains, and were not associated with in-hospital mortality. All strains were susceptible to gentamicin and meropenem; none carried an AbaR resistance island. Our results suggest that international dissemination of A. baumannii is occurring in the community on a contemporary timescale. Genes associated with biofilm formation and the T6SS may not be required for survival in community niches. The relative contributions of host and bacterial factors to the clinical severity of community-onset A. baumannii infection require further investigation.
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Affiliation(s)
- Ella M Meumann
- 1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia.,2Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Australia
| | - Nicholas M Anstey
- 1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia.,2Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Australia
| | - Bart J Currie
- 1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia.,2Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Australia
| | - Kim A Piera
- 1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia
| | - Johanna J Kenyon
- 3School of Biomedical Sciences, Queensland University of Technology, Brisbane 4001, Australia
| | - Ruth M Hall
- 4School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia
| | - Joshua S Davis
- 1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia.,5Department of Infectious Diseases, John Hunter Hospital and the University of Newcastle, Newcastle 2305, Australia
| | - Derek S Sarovich
- 1Global and Tropical Health Division, Menzies School of Health Research, Darwin 0810, Australia.,6Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs 4072, Australia
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Meumann EM, Andersson P, Yeaman F, Oldfield S, Lilliebridge R, Bentley SD, Krause V, Beaman M, Currie BJ, Holt DC, Giffard PM, Tong SYC. Whole genome sequencing to investigate a putative outbreak of the virulent community-associated methicillin-resistant Staphylococcus aureus ST93 clone in a remote Indigenous community. Microb Genom 2016; 2:e000098. [PMID: 28348837 PMCID: PMC5359412 DOI: 10.1099/mgen.0.000098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/28/2016] [Indexed: 11/20/2022] Open
Abstract
We report two cases of severe pneumonia due to clone ST93 methicillin-resistant Staphylococcus aureus (MRSA) presenting from a remote Australian Indigenous community within a 2-week period, and the utilization of whole genome sequences to determine whether these were part of an outbreak. S. aureus was isolated from 12 of 92 nasal swabs collected from 25 community households (including the two index households); one isolate was ST93. Three of five skin lesion S. aureus isolates obtained at the community were ST93. Whole genome sequencing of the ST93 isolates from this study and a further 20 ST93 isolates from the same region suggested that recent transmission and progression to disease had not taken place. The proximity in time and space of the two severe pneumonia cases is probably a reflection of the high burden of disease due to ST93 MRSA in this population where skin infections and household crowding are common.
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Affiliation(s)
- Ella M Meumann
- 3Centre for Disease Control, Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia.,2Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Patiyan Andersson
- 1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Fiona Yeaman
- 2Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Sarah Oldfield
- 2Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rachael Lilliebridge
- 1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | - Vicki Krause
- 3Centre for Disease Control, Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Miles Beaman
- 5School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Bart J Currie
- 1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,2Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Deborah C Holt
- 1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Philip M Giffard
- 1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Steven Y C Tong
- 1Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,2Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Meumann EM, Globan M, Fyfe JAM, Leslie D, Porter JL, Seemann T, Denholm J, Stinear TP. Genome sequence comparisons of serial multi-drug-resistant Mycobacterium tuberculosis isolates over 21 years of infection in a single patient. Microb Genom 2015; 1:e000037. [PMID: 28348821 PMCID: PMC5320678 DOI: 10.1099/mgen.0.000037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022] Open
Abstract
We report a case of chronic pulmonary multi-drug-resistant tuberculosis. Despite 14 years of treatment, Mycobacterium tuberculosis was persistently isolated from sputum. Following treatment cessation the patient remained well, although M. tuberculosis was isolated from sputum for a further 8 years. Genome sequencing of eight serial M. tuberculosis isolates cultured between 1991 and 2011 revealed 17 mutations (0.8 mutations per genome year- 1). Eight of these were persisting mutations and only two mutations were detected in the 7 years following cessation of treatment in 2004. In four isolates there were mixed alleles, suggesting the likely presence of bacterial subpopulations. The initial 1991 isolate demonstrated genotypic resistance to isoniazid (katG W91R), rifampicin (rpoB S531L), ethambutol (embB M306V), streptomycin (gidB L16R), quinolones (gyrA S95T) and P-aminosalicylic acid (thyA T202A). Subsequent resistance mutations developed for pyrazinamide (pncA I31F) and ethionamide (ethA frameshift). Such information might have been instructive when developing a treatment regimen. In retrospect and with the benefit of high-resolution genomic hindsight we were able to determine that the patient received only one or two active anti-tuberculous agents for most of their treatment. Additionally, mutations in bacA and Rv2326c were detected, which may have contributed to the persistent but mild disease course. BacA is likely to be associated with maintenance of chronic infection and Rv2326c with a decreased bacterial metabolic state. These results expand our understanding of M. tuberculosis evolution during human infection and underline the link between antibiotic resistance and clinical persistence.
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Affiliation(s)
- Ella M Meumann
- Victorian Infectious Disease Service, Melbourne Health, Melbourne, Victoria 3000, Australia.,Doherty Institute for Infection and Immunity, Victoria 3000, Australia
| | - Maria Globan
- Doherty Institute for Infection and Immunity, Victoria 3000, Australia.,Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Melbourne Health, Melbourne, Victoria 3000, Australia
| | - Janet A M Fyfe
- Doherty Institute for Infection and Immunity, Victoria 3000, Australia.,Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Melbourne Health, Melbourne, Victoria 3000, Australia
| | - David Leslie
- Doherty Institute for Infection and Immunity, Victoria 3000, Australia.,Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory, Melbourne Health, Melbourne, Victoria 3000, Australia
| | - Jessica L Porter
- Doherty Institute for Infection and Immunity, Victoria 3000, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Torsten Seemann
- Victorian Life Sciences Computation Initiative, University of Melbourne, Parkville, Victoria 3010, Australia.,Doherty Applied Microbial Genomics, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia
| | - Justin Denholm
- Victorian Tuberculosis Program, Melbourne, Victoria 3000, Australia.,Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia.,Doherty Institute for Infection and Immunity, Victoria 3000, Australia.,Victorian Infectious Disease Service, Melbourne Health, Melbourne, Victoria 3000, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Victoria 3000, Australia.,Doherty Applied Microbial Genomics, Doherty Institute for Infection and Immunity, Melbourne, Victoria 3000, Australia.,Doherty Institute for Infection and Immunity, Victoria 3000, Australia
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Meumann EM, Mitchell BG, McGregor A, McBryde E, Cooley L. Urinary Escherichia coli antimicrobial susceptibility profiles and their relationship with community antibiotic use in Tasmania, Australia. Int J Antimicrob Agents 2015; 46:389-93. [PMID: 26187365 DOI: 10.1016/j.ijantimicag.2015.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 05/13/2015] [Accepted: 05/13/2015] [Indexed: 11/19/2022]
Abstract
This study assessed urinary Escherichia coli antibiotic susceptibility patterns in Tasmania, Australia, and examined their association with community antibiotic use. The susceptibility profiles of all urinary E. coli isolates collected in Tasmania between January 2010 and December 2012 were included. The amount of Pharmaceutical Benefits Scheme (PBS)-subsidised use of amoxicillin, amoxicillin/clavulanic acid (AMC), cefalexin, norfloxacin, ciprofloxacin and trimethoprim was retrieved (at the Tasmanian population level) and the number of defined daily doses per 1000 population per day in Tasmania for these antibiotics was calculated for each month during the study period. Antimicrobial susceptibility data were assessed for changes over time in the 3-year study period. Antimicrobial use and susceptibility data were assessed for seasonal differences and lag in resistance following antibiotic use. Excluding duplicates, 28145 E. coli isolates were included. Resistance levels were low; 35% of isolates were non-susceptible to amoxicillin, 14% were non-susceptible to trimethoprim and <5% were non-susceptible to AMC, cefalexin, gentamicin and norfloxacin. Amoxicillin use increased by 35% during winter/spring compared with summer/autumn, and AMC use increased by 21%. No seasonal variation in quinolone use or resistance was detected. The low levels of antimicrobial resistance identified may relate to Tasmania's isolated geographical location. Significant seasonal variation in amoxicillin and AMC use is likely to be due to increased use of these antibiotics for treatment of respiratory tract infections in winter. Quinolone use is restricted by the PBS in Australia, which is the likely explanation for the low levels of quinolone use and resistance identified.
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Affiliation(s)
- Ella M Meumann
- Department of Infectious Diseases & Microbiology, Royal Hobart Hospital, GPO Box 1061, Hobart, TAS 7000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia.
| | - Brett G Mitchell
- Faculty of Nursing and Health, Avondale College of Higher Education, P.O. Box 19, Cooranbong, NSW 2265, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, P.O. Box 256, Dickson, ACT 2602, Australia
| | - Alistair McGregor
- Department of Infectious Diseases & Microbiology, Royal Hobart Hospital, GPO Box 1061, Hobart, TAS 7000, Australia
| | - Emma McBryde
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC 3050, Australia
| | - Louise Cooley
- Department of Infectious Diseases & Microbiology, Royal Hobart Hospital, GPO Box 1061, Hobart, TAS 7000, Australia
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Meumann EM, Chuen J, Fitt G, Perchyonok Y, Pond F, Dewey HM. Thromboembolic stroke associated with thoracic outlet syndrome. J Clin Neurosci 2013; 21:886-9. [PMID: 24321459 DOI: 10.1016/j.jocn.2013.07.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 07/11/2013] [Accepted: 07/14/2013] [Indexed: 12/18/2022]
Abstract
Thoracic outlet syndrome occurs due to compression of the neurovascular structures as they exit the thorax. Subclavian arterial compression is usually due to a cervical rib, and is rarely associated with thromboembolic stroke. The mechanism of cerebral embolisation associated with the thoracic outlet syndrome is poorly understood, but may be due to retrograde propagation of thrombus or transient retrograde flow within the subclavian artery exacerbated by arm abduction. We report an illustrative patient and review the clinical features, imaging findings and management of stroke associated with thoracic outlet syndrome.
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Affiliation(s)
- Ella M Meumann
- Department of Neurology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia.
| | - Jason Chuen
- Department of Vascular Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Greg Fitt
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Yuliya Perchyonok
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Franklin Pond
- Department of Vascular Surgery, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Helen M Dewey
- Department of Neurology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
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Meumann EM, Cheng AC, Ward L, Currie BJ. Clinical features and epidemiology of melioidosis pneumonia: results from a 21-year study and review of the literature. Clin Infect Dis 2011; 54:362-9. [PMID: 22057702 DOI: 10.1093/cid/cir808] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Melioidosis is an important cause of community-acquired sepsis in Southeast Asia and northern Australia, and pneumonia is the most common presentation. Clinical manifestations range from acute fulminant sepsis to chronic infection mimicking tuberculosis. Pneumonia may be the primary presenting feature, or it can develop secondary to initial disease at a distant focus. METHODS A prospective database of all melioidosis patients at Royal Darwin Hospital (Australia) between 1989 and 2010 was reviewed. RESULTS Of 624 patients with culture-confirmed melioidosis, 319 (51%) presented with pneumonia as the primary diagnosis. Acute/subacute presentations accounted for the majority of primary pneumonia cases (91%); chronic disease was seen less commonly (9%). Secondary pneumonia developed in 20% of patients with other primary melioidosis presentations and was particularly common in those with positive blood cultures. Risk factors for presentation with primary pneumonia (compared with other primary presentations) were rheumatic heart disease or congestive cardiac failure, chronic obstructive pulmonary disease, smoking, and diabetes mellitus, with P < .05 for these conditions in a multivariate logistic regression model. Patients presenting with pneumonia more frequently developed septic shock (33% vs 10%; P < .001) and died (20% vs 8%; P <.001) compared with patients with other primary presentations. Multilobar disease occurred in 28% of primary pneumonia patients and was associated with greater mortality (32%) than in those with single-lobe disease (14%; P < .001). CONCLUSIONS Melioidosis pneumonia is often a rapidly progressive illness with high mortality, particularly among those with multilobar disease. Risk factors have been identified, and early diagnosis and treatment should be priorities.
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Affiliation(s)
- Ella M Meumann
- Infectious Diseases Department and Northern Territory Clinical School, Royal Darwin Hospital, Darwin, Australia
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Meumann EM, Novak RT, Gal D, Kaestli ME, Mayo M, Hanson JP, Spencer E, Glass MB, Gee JE, Wilkins PP, Currie BJ. Clinical evaluation of a type III secretion system real-time PCR assay for diagnosing melioidosis. J Clin Microbiol 2006; 44:3028-30. [PMID: 16891534 PMCID: PMC1594648 DOI: 10.1128/jcm.00913-06] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A Burkholderia pseudomallei type III secretion system real-time PCR assay was evaluated on clinical specimens in a region where melioidosis is endemic. The PCR was positive in 30/33 (91%) patients with culture-confirmed melioidosis. All six patients with melioidosis septic shock were blood PCR positive, suggesting potential for rapid diagnosis and commencement of appropriate therapy.
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Affiliation(s)
- Ella M Meumann
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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