Melioidosis: an under-diagnosed entity in western coastal India: a clinico-microbiological analysis

Clinico-microbiological analysis of a series of 25 patients with culture proven melioidosis was done. All patients came from the coastal regions of Kerala and Karnataka and presented between June 2005 to July 2006. They were analysed with respect to clinical presentation, occupation, epidemiology and microbiological features. No single presenting clinical feature was found to be typical of melioidosis. The disease was found to mimic a variety of conditions, including tuberculosis and malignancy. Burkholderia pseudomallei was isolated from blood, sputum, pus, urine, synovial, peritoneal and pericardial fluids. Diabetes mellitus was the most common predisposing factor and 80% of the cases presented during the Southwest monsoon (June to September). It is probable that melioidosis is highly prevalent in western coastal India and yet, greatly underestimated. Better awareness, both among clinicians and microbiologists, coupled with improved diagnostic methods to allow early diagnosis and hence early treatment, will significantly reduce the morbidity and mortality associated with this disease.     

A Melioidosis Patient Presenting with Brainstem Signs in the Emergency Department

Background

Neurological abnormalities in melioidosis are rare but may manifest as an acute stroke, and in the emergency department (ED), an inappropriate stroke treatment may threaten a patient’s life.

Objectives

A case of cerebral melioidosis is reported in a patient presenting with brainstem signs to increase awareness of the uncommon presentations of melioidosis that may cause a delayed diagnosis in the ED.

Case Report

A 45-year-old man who worked as a construction worker, with diabetes mellitus and alcoholic liver cirrhosis, presented to the ED after a 10-day period of fever and cough. He was initially diagnosed and treated as a case of community-acquired pneumonia. However, a sudden change in consciousness with 6th and 7th cranial nerve palsy and flaccid paralysis were noted while he was in the ED, and acute brainstem stroke was suspected. Brain magnetic resonance imaging disclosed brainstem lesions, slightly hypointense on T1-weighted images and hyperintense on T2-weighted images. Blood and urine cultures subsequently yielded Burkholderia pseudomallei. Abdominal computed tomography revealed multiple small consolidated patches, ground-glass opacities, small nodules in the lower lungs bilaterally, and a pancreatic tail abscess. Systemic melioidosis with lung, pancreas, urogenic tract, and brainstem involvement was diagnosed. Three weeks after admission, the patient died from a sudden onset of apnea and asystole.

Conclusions

In light of this case, patients with identifiable risk factors, especially underlying diabetes, a history of positive soil contact, and those who lived in an endemic area or ever traveled to an endemic area, and who present themselves with fever and neurologic deficit or multi-organ involvement, should have melioidosis considered in the differential diagnosis.     

海南地区类鼻疽伯克霍尔德菌的多位点序列分型

目的 研究海南省类鼻疽伯克霍尔德菌多位点序列类型(STs)多态性,了解该省与其他类鼻疽流行地区菌株间的遗传背景差异方法 选取7个管家基因位点ace、glt B、gmh D、lep A、lip A、nar K、ndh进行PCR扩增、测序,与MLST数据库中的等位基因序列进行比对,确定菌株的序列型结果 18株类鼻疽伯克霍尔德菌属于12个不同的STs,其中ST50有4株,检出率占22.2%,ST58、ST232、ST1094各检出2株,发现一株新STs命名为ST1676结论 海南省类鼻疽伯克霍尔德菌具有高度遗传多样性,gmhD是7个管家基因中变异最大的等位基因,表明gmhD突变可能是该地区菌株STs多样性的原因。     

Mycotic aneurysm caused by Burkholderia pseudomallei: report of a Brazilian strain genetically related to Thai strains

Melioidosis, a severe infectious disease caused by Burkholderia pseudomallei that is prevalent in Southeast Asia and Northern Australia, has been sporadically reported in Brazil since 2003. We report a case of aortic aneurysm with blood culture positive for B. pseudomallei. The phylogenetic analysis of 16S ribosomal DNA showed this isolate to be evolutionarily grouped with the MSHR346 strains from Thailand.     

Epidemiology and Investigation of Melioidosis, Southern Arizona

Burkholderia pseudomallei is a bacterium endemic to Southeast Asia and northern Australia, but it has not been found to occur endemically in the United States. We report an ostensibly autochthonous case of melioidosis in the United States. Despite an extensive investigation, the source of exposure was not identified.     

Nonclonal Burkholderia pseudomallei Population in Melioidosis Case Cluster,Sri Lanka

A melioidosis case cluster of 10 blood culture–positive patients occurred in eastern Sri Lanka after an extreme weather event. Four infections were caused by Burkholderia pseudomallei isolates of sequence type 594. Whole-genome analysis showed that the isolates were genetically diverse and the case cluster was nonclonal.     

Consensus on the Development of Vaccines against Naturally Acquired Melioidosis

Several candidates for a vaccine against Burkholderia pseudomallei, the causal bacterium of melioidosis, have been developed, and a rational approach is now needed to select and advance candidates for testing in relevant nonhuman primate models and in human clinical trials. Development of such a vaccine was the topic of a meeting in the United Kingdom in March 2014 attended by international candidate vaccine developers, researchers, and government health officials. The focus of the meeting was advancement of vaccines for prevention of natural infection, rather than for protection from the organism’s known potential for use as a biological weapon. A direct comparison of candidate vaccines in well-characterized mouse models was proposed. Knowledge gaps requiring further research were identified. Recommendations were made to accelerate the development of an effective vaccine against melioidosis.