Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei.
Sharon J. Peacock,Herbert P. Schweizer,David A. B. Dance,Theresa L. Smith,Jay E. Gee,Vanaporn Wuthiekanun,David DeShazer,Ivo Steinmetz,Patrick Tan,Bart J. Currie +9 more
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Melioidosis develops after bacterial inoculation or inhalation, often in relation to occupational exposure in areas where the disease is endemic; with diabetes mellitus, excess alcohol consumption, chronic renal failure, and chronic lung disease acting as independent risk factors.Abstract:
The gram-negative bacillus Burkholderia pseudomallei is a saprophyte and the cause of melioidosis. Natural infection is most commonly reported in northeast Thailand and northern Australia but also occurs in other parts of Asia, South America, and the Caribbean. Melioidosis develops after bacterial inoculation or inhalation, often in relation to occupational exposure in areas where the disease is endemic. Clinical infection has a peak incidence between the fourth and fifth decades; with diabetes mellitus, excess alcohol consumption, chronic renal failure, and chronic lung disease acting as independent risk factors. Most affected adults ( approximately 80%) in northeast Thailand, northern Australia, and Malaysia have >/=1 underlying diseases. Symptoms of melioidosis may be exhibited many years after exposure, commonly in association with an alteration in immune status. Manifestations of disease are extremely broad ranging and form a spectrum from rapidly life-threatening sepsis to chronic low-grade infection. A common clinical picture is that of sepsis associated with bacterial dissemination to distant sites, frequently causing concomitant pneumonia and liver and splenic abscesses. Infection may also occur in bone, joints, skin, soft tissue, or the prostate. The clinical symptoms of melioidosis mimic those of many other diseases; thus, differentiating between melioidosis and other acute and chronic bacterial infections, including tuberculosis, is often impossible. Confirmation of the diagnosis relies on good practices for specimen collection, laboratory culture, and isolation of B. pseudomallei. The overall mortality rate of infected persons is 50% in northeast Thailand (35% in children) and 19% in Australia.read more
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Medical progress: Melioidosis
Journal ArticleDOI
Melioidosis: Evolving Concepts in Epidemiology, Pathogenesis, and Treatment
TL;DR: While biothreat research is directed toward potential aerosol exposure to B. pseudomallei, the overall proportion of melioidosis cases resulting from inhalation rather than from percutaneous inoculation remains entirely uncertain, although the epidemiology supports a shift to inhalation during severe weather events such as cyclones and typhoons.
Journal ArticleDOI
Antibiotic resistance in Burkholderia species.
TL;DR: Although antibiotic resistance hampers therapy of Burkholderia infections, the characterization of resistance mechanisms lags behind other non-enteric Gram-negative pathogens, especially ESKAPE bacteria such as Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa.
Journal ArticleDOI
Treatment and prophylaxis of melioidosis.
TL;DR: Treatment for melioidosis is unaffordable for many in endemic areas of the developing world, but the relative costs have reduced over the past decade, and there is no likelihood of any new or cheaper options becoming available in the immediate future.
Journal ArticleDOI
Mechanisms of antibiotic resistance in Burkholderia pseudomallei: implications for treatment of melioidosis.
TL;DR: Novel agents and therapeutic strategies are being tested and, in some instances, show promise as anti-B.
References
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Journal ArticleDOI
Melioidosis: Epidemiology, Pathophysiology, and Management
TL;DR: Melioidosis is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans, and the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease.
Journal ArticleDOI
Endemic Melioidosis in Tropical Northern Australia: A 10-Year Prospective Study and Review of the Literature
Bart J. Currie,Dale A. Fisher,Diane M. Howard,James N. C. Burrow,David Lo,Sid Selva-nayagam,Nicholas M. Anstey,S. Huffam,Paul Snelling,Paul J. Marks,Diane P. Stephens,Gary D. Lum,Susan P. Jacups,Vicki Krause +13 more
TL;DR: Intensive therapy with ceftazidime or carbapenems, followed by at least 3 months of eradication therapy with trimethoprim-sulfamethoxazole, was associated with decreased mortality.
Journal ArticleDOI
Structural flexibility in the Burkholderia mallei genome
William C. Nierman,David DeShazer,H. Stanley Kim,Hervé Tettelin,Karen E. Nelson,Tamara Feldblyum,Ricky L. Ulrich,Catherine M. Ronning,Lauren M. Brinkac,Sean C. Daugherty,Tanja Davidsen,Robert T. DeBoy,George Dimitrov,Robert J. Dodson,A. Scott Durkin,Michelle L. Gwinn,Daniel H. Haft,Hoda Khouri,James F. Kolonay,Ramana Madupu,Yasmin Mohammoud,William C. Nelson,Diana Radune,Claudia M. Romero,Saul H Sarria,Jeremy D. Selengut,Christine Shamblin,Steven A. Sullivan,Owen White,Yan Yu,Nikhat Zafar,Liwei Zhou,Claire M. Fraser,Claire M. Fraser +33 more
TL;DR: Variation in simple sequence repeats in key genes can provide a mechanism for generating antigenic variation that may account for the mammalian host's inability to mount a durable adaptive immune response to a B. mallei infection.
Journal ArticleDOI
Risk factors for melioidosis and bacteremic melioidosis.
Yupin Suputtamongkol,Wipada Chaowagul,Ploenchan Chetchotisakd,Nimit Lertpatanasuwun,Sunanta Intaranongpai,Theera Ruchutrakool,Duangkao Budhsarawong,Piroon Mootsikapun,Vanaporn Wuthiekanun,Nitaya Teerawatasook,Aroonlug Lulitanond +10 more
TL;DR: Only diabetes mellitus was a significant factor associated with bacteremic melioidosis, as compared with nonbacteremia, and diabetic rice farmers would be the most appropriate population group for targeted control measures such as vaccination in the future.
Journal ArticleDOI
Cutaneous Melioidosis in a Man Who Was Taken as a Prisoner of War by the Japanese during World War II
TL;DR: A case of a man who was taken as a prisoner of war by the Japanese during World War II who presented with a nonhealing ulcer on his right hand 62 years after the initial exposure is reported.
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