Melioidosis in a rural community of Western Province, Papua New Guinea.

A prospective study was conducted to determine the significance of melioidosis in the Balimo district of Western Province, Papua New Guinea. During 1998, after the establishment of laboratory procedures and increasing local clinical awareness, the disease was found in 1.8% (95% CI 0.37-5.1%) of individuals presenting with fever refractory to standard treatment. The clinical incidence was 20.0 per 100,000 population (95% CI 12.2-30.9). The median age of culture-confirmed cases was 9.5 years (interquartile range 8.3-14.8 years). The seroprevalence of 747 community children in the region tested was 8.2% (95% CI 6.2-10.4%). Most individuals presented during the rainy season with a febrile disease refractory to standard treatment, sometimes mimicking tuberculosis. Some family clustering was apparent. All patients with bacteraemic melioidosis died, but treatment with the available conventional therapies of chloramphenicol, co-trimoxazole or doxycycline resulted in survival and cure in six patients with subacute/localised melioidosis. Further studies are needed to ascertain the local epidemiology and why children appear particularly at risk, as well as to establish the true extent of melioidosis in Papua New Guinea.

Burkholderia pseudomallei virulence: definition, stability and association with clonality.

Clinical presentations of melioidosis, caused by Burkholderia pseudomallei are protean, but the mechanisms underlying development of the different forms of disease remain poorly understood. In murine melioidosis, the level of virulence of B. pseudomallei is important in disease pathogenesis and progression. In this study, we used B. pseudomallei-susceptible BALB/c mice to determine the virulence of a library of clinical and environmental B. pseudomallei isolates from Australia and Papua New Guinea. Among 42 non-arabinose-assimilating (ara(-)) isolates, LD(50) ranged from 10 to > 10(6) CFU. There were numerous correlations between virulence and disease presentation in patients; however, this was not a consistent observation. Virulence did not correlate with isolate origin (i.e. clinical vs environmental), since numerous ara(-) environmental isolates were highly virulent. The least virulent isolate was a soil isolate from Papua New Guinea, which was arabinose assimilating (ara(+)). Stability of B. pseudomallei virulence was investigated by in vivo passage of isolates through mice and repetitive in vitro subculture. Virulence increased following in vivo exposure in only one of eight isolates tested. In vitro subculture on ferric citrate-containing medium caused attenuation of virulence, and this correlated with changes in colony morphology. Pulsed-field gel electrophoresis and randomly amplified polymorphic DNA typing demonstrated that selected epidemiologically related isolates that had variable clinical outcomes and different in vivo virulence were clonal strains. No molecular changes were observed in isolates after in vivo or in vitro exposure despite changes in virulence. These results indicate that virulence of selected B. pseudomallei isolates is variable, being dependent on factors such as iron bioavailability. They also support the importance of other variables such as inoculum size and host risk factors in determining the clinical severity of melioidosis.

Diagnostic potential of a serological assay for the diagnosis of ulcerans disease based on the putative Mycobacterium ulcerans toxin.

Mycobacterium ulcerans infection is an important and potentially disfiguring disease of man. A rapid diagnostic assay for detection of this organism is required urgently. Serological assays require a species-specific protein to ensure a high level of specificity and thus reduce the occurrence of false positive results. As M. ulcerans had been reported to produce a unique cytotoxin, it was thought that this would provide an ideal antigen on which to base a serological assay for detection of M. ulcerans during infection. Crude culture filtrates, prepared by previously documented methods, were assayed for toxic activity by in-vitro cytotoxicity assays and in-vivo mouse footpad assays. To evaluate the uniqueness of the cytotoxic factor, other species of mycobacteria were also assayed. Analysis of these assays showed that similar biological activity is present in various other mycobacterial species. Furthermore, it was possible to neutralise this activity in all species tested with a polyclonal antiserum raised against M. ulcerans. As the cytotoxic factor was found not to be specific to M. ulcerans, it is unlikely that a serological assay based on such a molecule will be of use.

A novel serotype of enteropathogenic Escherichia coli (EPEC) as a major pathogen in an outbreak of infantile diarrhoea.

An outbreak of infantile diarrhoea was investigated in 32 children, all <2 years old, in the tropical north of Australia. Rotavirus (63%) and enteropathogenic Escherichia coli (EPEC) (59%) were the most common pathogens identified. Of the 19 EPEC isolates, 14 (74%) were of serotype O126:H12, hitherto unreported as an EPEC serotype. Other pathogens isolated included Salmonella spp. (16%), Campylobacter spp. (3%), Giardia (3%) and Shigella spp. (3%). EPEC-related gastro-enteritis is an uncommon but recognised cause of diarrhoeal outbreaks in Australia and clinicians need to be aware of the possibility of this serotype being implicated. This report highlights the disadvantages of relying on serotyping alone for the recognition of EPEC.

Macrophage-lymphocyte interactions mediate anti-Burkholderia pseudomallei activity.

The mechanisms involved in the pathogenesis of melioidosis, caused by the intracellular bacterium Burkholderia pseudomallei, are unclear. C57BL/6 mice are resistant to infection, while BALB/c mice are highly susceptible. Previous studies have demonstrated that peritoneal exudate cell preparations enriched for macrophages are capable of effectively eliminating intracellular pathogens. In this study we present evidence showing that interaction of macrophages with lymphocytes is necessary for efficient anti-B. pseudomallei activity.

Proinflammatory cytokine mRNA responses in experimental Burkholderia pseudomallei infection in mice.

Melioidosis is a potentially fatal disease of both human and animals caused by the bacterium Burkholderia pseudomallei. Disease is endemic in tropical and subtropical regions of Southeast Asia and Northern Australia. The pathogenesis of melioidosis is poorly understood. In particular, the host responses that occur following infection, and the specific host-pathogen interactions that result in the development of either acute or chronic infection are unclear. Using an established murine model, we investigated early proinflammatory cytokine responses believed to be critical in the development of acute and chronic B. pseudomallei infection. Semi-quantitative reverse transcription polymerase chain reaction (RT-PCR) was used to assess levels of mRNA for tumor necrosis factor-alpha (TNF-alpha), interleukin 1beta (IL-1beta) and interleukin 6 (IL-6) in the liver of mice following infection. We demonstrate that the level of mRNA for these cytokines increase moderately in chronic infection in C57BL/6 mice. However, in acute infection in BALB/c mice, mRNA responses for these cytokines were shown to be comparatively greater. These results demonstrate that early proinflammatory cytokine responses are important in the immunopathogenesis of melioidosis.

Combination antimicrobial therapy of acute Burkholderia pseudomallei infection in a mouse model.

Burkholderia pseudomallei is the causative agent of melioidosis, a disease endemic in tropical and subtropical regions of South-East Asia and Northern Australia. Antimicrobial therapy regimens for treatment of acute septicemic melioidosis are of variable efficacy. Ceftazidime is the current antibiotic of choice and is commonly administered with other agents such as cotrimoxazole or doxycycline. The emergence of resistant strains of B. pseudomallei and the persistence of high mortality rates prompted the present study. Using an established mouse model of acute disseminated B. pseudomallei infection, we compared the efficacy of ceftazidime versus cefpirome in combination with cotrimoxazole or chloramphenicol therapy in vivo. Control mice that were infected but did not receive antibiotic therapy died within 96 hours of infection. No deaths occurred in treatment groups receiving either cephalosporin or cotrimoxazole, despite the demonstrated resistance of B. pseudomallei to cotrimoxazole in vitro. The mortality rate in treatment groups receiving either cephalosporin and chloramphenicol was 66%. These results demonstrate a comparable level of efficacy between ceftazidime and cefpirome for treatment of acute B. pseudomallei infection in mice.

The importance of enterotoxigenic Escherichia coli containing the 987P antigen in causing neonatal colibacillosis in piglets in Indonesia.

A survey was undertaken in piggeries in the Bogor and Jakarta Capital Territory areas to identify the antigens associated with enterotoxigenic Escherichia coli (E. coli). Rectal swab samples were collected from 65 normal piglets and from 858 with diarrhoea. Fimbrial and O-antigens were determined by agglutination tests. The 987P antigen was only associated with non-haemolygic E. coli in colonies grown for 3-10 days in tryptic soy broth. Organisms which possessed 987P antigen were isolated from 56.4% of piglets with diarrhoea and from 10.8% of normal piglets. Most cases of diarrhoea that were associated with E. coli 987P occurred within the first 3 weeks of life. Multiple infections occurred in 13.4% of cases and were associated with E. coli K88 in eight cases (1.7%) K99 in 26 cases (5.4%) and F41 in 31 cases (6.4%). Of 959 isolates of E. coli 987P, 80.7% were O-group 20, 13% were O-group 9 and 0.5% were O-group 141 with 5.7% being non-typable. Heat stable toxin was produced by all five E. coli 987P isolates tested.

Development of a specific DNA probe and PCR for the detection of Mycoplasma bovis.

Mycoplasma bovis is responsible for several production diseases in cattle, including mastitis, arthritis, pneumonia, abortion and infertility. Current methodologies for detecting and identifying M. bovis are time consuming and difficult. Tests which rely on antigen or antibody detection have poor sensitivity and specificity. In this paper associated protocols for the development of a hybridization probe and PCR are described. A genomic library (SauIIIA digested) was prepared from M. bovis DNA (Colindale Reference Strain: NC10131:02) and cloned into pUC19. Colony hybridization, using a probe preparation made from purified M. bovis DNA, was used to identify colonies of interest. M. bovis DNA fragments were retrieved from recombinant plasmids by digestion with EcoRI and HindIII. This DNA was used to prepare randomly primed probes for dot blot hybridization analysis with immobilized DNA from M. bovis (two strains), M. dispar, M. agalactiae, M. bovigenitalium (two strains), M. ovipneumoniae, a Group 7 strain, M. arginini and bacteria belonging to different genera. Four probes were found to hybridize only with M. bovis and M. ovipneumoniae DNA, whereas one probe reacted with genomic DNA from only one of the two M. bovis strains. The level of sensitivity of the dot blot hybridization assay was 200 CFU (colony forming units)/mL. To enhance the sensitivity further, an M. bovis-specific PCR assay was developed. The primers were designed using sequences obtained from the probe DNA which discriminated M. bovis from all other Mycoplasma DNA tested. The minimum amount of target DNA that could be detected by the PCR assay was that isolated from 10-20 CFU/mL. The PCR assay was therefore 10 times more sensitive than dot blot hybridization.

Preliminary studies on the prevalence of Mycoplasma bovis mastitis in dairy in cattle in Australia.

A highly sensitive and specific PCR (MB-PCR) was used in preliminary studies to detect M. bovis in milk samples to investigate its association with high somatic cell count (SCC), an indicator of subclinical mastitis and one of the factors in down grading the quality of milk. A total of 186 and 167 herds were tested with 43% and 62% of herds positive for M. bovis in Victoria and North Queensland, respectively. The quarter milks from 52 cows with persistently high SCC were tested by MB-PCR and culture to investigate the association of M. bovis with major mastitis pathogens (MMP). M. Bovis was detected in 77% of cows of which 19% alone had M. bovis without any other bacteria, 17% had M. bovis in combination with major mastitis pathogens and 40% had M. bovis in combination with non-major mastitis pathogens. We believe that M. bovis is widespread in dairy cattle and has the potential to produce disease alone or to predispose the udder to disease caused by major mastitis and environmental pathogens. These studies have revealed a hitherto unrecognised high prevalence of M. bovis in dairy cattle in North Queensland and Victoria in Australia. These initial studies also give a clear association between M. bovis and elevated somatic cell counts.

Measurement of antibody in serum and genital fluids of bulls by ELISA after vaccination and challenge with Tritrichomonas foetus.

An enzyme-linked immunosorbent assay (ELISA) was developed for detecting antibody to Tritrichomonas foetus using both whole cell antigen (WCA) and membrane protein antigen (MPA). The test was used to detect specific antibody in serum, preputial washings and seminal plasma samples from 7 adult bulls which were vaccinated subcutaneously on 3 occasions with a membrane protein vaccine against T. foetus var brisbane in an oil adjuvant, and from 4 unvaccinated control animals. One month after administration of the third dose of vaccine, vaccinated and control bulls were repeatedly challenged with the live vaccine strain of the T. foetus. A steady increase in serum antibody titre was detected after each inoculation of vaccine when both antigens were used in the ELISA. However, MPA was more sensitive. After challenge, vaccinated bulls developed an increased titre. No specific antibody was detected in control bulls, except in one bull after challenge in which seroconversion was detected. The serum antibody titres of both groups of animals were also measured with the microagglutination test which proved less sensitive than the ELISA. Antibody titres to both antigens, although lower than in serum, were detected in the seminal plasma of vaccinated animals. The control bulls remained non-responsive. No antibody was detected by ELISA in preputial washings from either control or vaccinated bulls prior to challenge. Post-challenge, some of the vaccinated bulls were responsive with both antigens whereas the control bulls remained negative.

The epidemiology of melioidosis in the Balimo region of Papua New Guinea.

The distribution of Burkholderia pseudomallei was determined in soil collected from a rural district in Papua New Guinea (PNG) where melioidosis had recently been described, predominately affecting children. In 274 samples, 2.6% tested culture-positive for B. pseudomallei. Pulsed-field gel electrophoresis using SpeI digests and rapid polymorphic DNA PCR with five primers demonstrated a single clone amongst clinical isolates and isolates cultured from the environment that was commonly used by children from whom the clinical isolates were derived. We concluded that individuals in this region most probably acquired the organism through close contact with the environment at these sites. Burkholderia thailandensis, a closely related Burkholderia sp. was isolated from 5.5% of samples tested, an observation similar to that of melioidosis-endemic areas in Thailand. This is the first report of an environmental reservoir for melioidosis in PNG and confirms the Balimo district in PNG as melioidosis endemic.

Corynebacterium kutscheri and its alleged avirulent variant in mice.

Corynebacterium kutscheri and its alleged avirulent variant were re-examined in C57Bl/6 and Swiss Lynch mice. It was confirmed that while C57Bl/6 mice were resistant and Swiss Lynch susceptible to C. kutscheri, the alleged atypical variant was avirulent in both mouse strains. However, following immunosuppression of C57Bl/6 mice with hydrocortisone acetate, it was not possible to reactivate latent C. kutscheri or the alleged atypical variant; this was contrary to previous reports. Moreover, sequential hysterectomy derivation over four generations of C57Bl/6 mice did not eliminate their resistance to C. kutscheri compared with conventionally born animals. Vaccination with live attenuated C. kutscheri protected susceptible mice against virulent challenge; vaccination with the alleged atypical variant afforded no such protection. The suggested role of the alleged avirulent variant in resistance to C. kutscheri is challenged and an alternative explanation of such resistance is proposed.