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1.
BMC Infect Dis ; 21(1): 1069, 2021 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654392

RESUMO

BACKGROUND: Melioidosis, the infection caused by Burkholderia pseudomallei, is associated with a high case fatality rate, due in part to difficulties in clinical recognition and diagnostic confirmation of the disease. Although head and neck involvement is common in children, specific disease manifestations differ between geographic regions. The aim of this study was to provide a detailed description of melioidosis of the head and neck among children in Sarawak, Malaysia, and determine if fine-needle aspiration of suspected head or neck lesions could improve melioidosis diagnosis. METHODS: We conducted a retrospective descriptive study of all children aged < 12 years with culture-confirmed melioidosis presenting with head and neck manifestations and admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2011 until December 2020. Fine-needle aspiration of head and neck lesions suspected to be due to melioidosis with inoculation in blood culture bottles (FNA + BCB) was used from the beginning of 2016. RESULTS: Of 34 children with culture-confirmed melioidosis, 20 (59%) had an infection involving one or more sites in the head and neck. Of these, 17 (85%) were diagnosed in or after 2016. Cervical lymph nodes were the most common organ or site affected, involved in 19 (95%) children. Clinical presentations of B. pseudomallei lymph node infections were highly variable. Five (25%) children had salivary gland involvement. Lacrimal gland involvement (dacryocystitis) and skin or soft tissue infection (scalp abscess) were less frequent. B. pseudomallei was isolated from the head or neck using FNA + BCB in 15 (75%) children and by standard culture methods of direct plating of pus on agar following incision and drainage in only 2 (10%) children. B. pseudomallei was isolated from non-head or neck specimens or blood in 3 (15%) children. CONCLUSIONS: Manifestations of pediatric head and neck melioidosis in Sarawak, Malaysia, differ from those of other regions. Fine-needle aspiration, mainly of affected cervical lymph nodes, facilitates B. pseudomallei detection and enables confirmation of melioidosis infections.


Assuntos
Burkholderia pseudomallei , Melioidose , Biópsia por Agulha Fina , Criança , Humanos , Malásia/epidemiologia , Melioidose/diagnóstico , Melioidose/epidemiologia , Estudos Retrospectivos
2.
J Assoc Physicians India ; 69(9): 11-12, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34585891

RESUMO

INTRODUCTION: Forty-four percent of global cases are predicted to occur in the Indian sub-continent, but less than 2000 cases have been reported. Though the number of predicted cases in India is reported to be high, lesser numbers are being reported due to a lack of diagnostic capabilities and poor awareness of the disease. AIMS: We aimed to estimate the number of cases of melioidosis over a 5-year period, the proportion of non-survivors, and map the geographical regions of the patients. METHODS: Retrospectively, medical case records were reviewed with the search terms melioidosis and Burkholderia pseudomallei. Data on the geographical region, risk factors, clinical manifestations, and outcomes were collected and analysed. RESULTS: Thirty-four patients with melioidosis were found. 12/34 had died in the hospital. Case records of only 20 patients (M=19, F=1) could be traced. Patients who died were older and had a longer duration of symptoms, had higher total leukocyte counts, higher platelet counts, and more severe hepatic and renal dysfunction compared to those who survived. Being a teetotaller, having received intensive care, and mechanical ventilation showed statistical significance between the two groups. CONCLUSION: Three centres from Pondicherry have reported melioidosis; this study had the most significant reported number of cases from a single institution in Pondicherry. The mapping of our patients resulted in probable evidence of melioidosis in six other districts of Tamil Nadu. Since the Indian population is at high risk because of diabetes, and melioidosis can mimic tuberculosis, increased awareness among physicians is a must to diagnose and treat this disease with high mortality.


Assuntos
Burkholderia pseudomallei , Melioidose , Humanos , Índia/epidemiologia , Melioidose/diagnóstico , Melioidose/epidemiologia , Estudos Retrospectivos , Fatores de Risco
3.
Emerg Infect Dis ; 27(11): 2955-2957, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34379585

RESUMO

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.


Assuntos
Burkholderia pseudomallei , Melioidose , Burkholderia pseudomallei/genética , Humanos , Melioidose/epidemiologia , Sri Lanka/epidemiologia
4.
PLoS Negl Trop Dis ; 15(6): e0009544, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34153059

RESUMO

BACKGROUND: There is growing recognition of the contribution of the social determinants of health to the burden of many infectious diseases. However, the relationship between socioeconomic status and the incidence and outcome of melioidosis is incompletely defined. METHODS: All residents of Far North Queensland, tropical Australia with culture-proven melioidosis between January 1998 and December 2020 were eligible for the study. Their demographics, comorbidities and socioeconomic status were correlated with their clinical course. Socioeconomic status was determined using the Socio-Economic Indexes for Areas (SEIFA) Index of Relative Socio-economic Disadvantage score, a measure of socioeconomic disadvantage developed by the Australian Bureau of Statistics. Socioeconomic disadvantage was defined as residence in a region with a SEIFA score in the lowest decile in Australia. RESULTS: 321 eligible individuals were diagnosed with melioidosis during the study period, 174 (54.2%) identified as Indigenous Australians; 223/321 (69.5%) were bacteraemic, 85/321 (26.5%) required Intensive Care Unit (ICU) admission and 37/321 (11.5%) died. 156/321 (48.6%) were socioeconomically disadvantaged, compared with 56603/269002 (21.0%) of the local general population (p<0.001). Socioeconomically disadvantaged patients were younger, more likely to be female, Indigenous, diabetic or have renal disease. They were also more likely to die prior to hospital discharge (26/156 (16.7%) versus 11/165 (6.7%), p = 0.002) and to die at a younger age (median (IQR) age: 50 (38-68) versus 65 (59-81) years, p = 0.02). In multivariate analysis that included age, Indigenous status, the presence of bacteraemia, ICU admission and the year of hospitalisation, only socioeconomic disadvantage (odds ratio (OR) (95% confidence interval (CI)): 2.49 (1.16-5.35), p = 0.02) and ICU admission (OR (95% CI): 4.79 (2.33-9.86), p<0.001) were independently associated with death. CONCLUSION: Melioidosis is disease of socioeconomic disadvantage. A more holistic approach to the delivery of healthcare which addresses the social determinants of health is necessary to reduce the burden of this life-threatening disease.


Assuntos
Melioidose/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Bacteriemia , Burkholderia pseudomallei/isolamento & purificação , Criança , Comorbidade , Diabetes Mellitus , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Melioidose/mortalidade , Pessoa de Meia-Idade , Queensland/epidemiologia , Insuficiência Renal Crônica
5.
Acta Trop ; 221: 105994, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34118206

RESUMO

Establishing a diagnosis of melioidosis based on clinical grounds is difficult in hospitalized patients with sepsis or community acquired pneumonia (CAP). We aimed to ascertain the prevalence, clinico-epidemiological and laboratory profile of melioidosis in hospitalized patients with sepsis or CAP, and to evaluate the diagnostic utility of rapid lateral flow immunoassay (LFI) and PCR in comparison with culture. In all patients with sepsis or CAP, blood, sputum/throat swab, and urine sample were subjected to culture along with other samples based on clinical presentation. In addition, PCR assay targeting the type III secretion system 1 (TTS1) and LFI was performed. Thirty-three (33/196, 17%) out of the total 196 cases were diagnosed as melioidosis by culture. The prevalence of melioidosis in patients who had only sepsis without CAP, had both sepsis and CAP, had CAP without sepsis was 31% (26/84), 22 % (4/18) and 3%(3/94) respectively. All the LFI or PCR positive cases were culture positive from at least one or more samples (blood/sputum/urine/pus). The sensitivity, specificity, positive predictive value and negative predictive value of TTS1 PCR was 78% (18/23 melioidosis patients), 100% (34/34 non-melioidosis patients), 100% (18/18 melioidosis patients) and 87% (34/39 non-melioidosis patients). The sensitivity, specificity, positive predictive value and negative predictive value of Rapid LFI was 91% (21/23 melioidosis patients), 100% (22/22 non-melioidosis patients), 100% (21/21 melioidosis patients) and 91% (22/24 non-melioidosis patients). On sample wise stratification of LFI and TTS1 with respect to culture, plasma/serum samples showed the highest discordance by PCR (9/55, 16.3%) and LFI (11/35, 31.4%). The lowest discordance was noted in respiratory tract samples (2/32, 6.2%) by PCR and pus/body fluids samples (2/14, 14.2%) by LFI and these findings are in line with previous published literature. The clinical utility of PCR and LFI needs to be further validated in a large scale study for early diagnosis of septicaemic melioidosis.


Assuntos
Burkholderia pseudomallei , Melioidose , Pneumonia , Sepse , Burkholderia pseudomallei/genética , Humanos , Imunoensaio , Melioidose/complicações , Melioidose/diagnóstico , Melioidose/epidemiologia , Pneumonia/etiologia , Reação em Cadeia da Polimerase , Sepse/diagnóstico , Sepse/etiologia
6.
PLoS Negl Trop Dis ; 15(6): e0009060, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34170931

RESUMO

BACKGROUND: Melioidosis, an often-fatal infectious disease caused by the environmental Gram-negative bacillus Burkholderia pseudomallei, is endemic in tropical countries. Diabetes mellitus and environmental exposure are important risk factors for melioidosis acquisition. We aim to evaluate the effectiveness of a multifaceted prevention programme for melioidosis in diabetics in northeast Thailand. METHODOLOGY/PRINCIPAL FINDINGS: From April 2014 to December 2018, we conducted a stepped-wedge cluster-randomized controlled behaviour change trial in 116 primary care units (PCUs) in Ubon Ratchathani province, northeast Thailand. The intervention was a behavioural support group session to help diabetic patients adopt recommended behaviours, including wearing rubber boots and drinking boiled water. We randomly allocated the PCUs to receive the intervention starting in March 2016, 2017 and 2018. All diabetic patients were contacted by phone yearly, and the final follow-up was December 2018. Two primary outcomes were hospital admissions involving infectious diseases and culture-confirmed melioidosis. Of 9,056 diabetics enrolled, 6,544 (72%) received a behavioural support group session. During 38,457 person-years of follow-up, we observed 2,195 (24%) patients having 3,335 hospital admissions involved infectious diseases, 80 (0.8%) melioidosis, and 485 (5%) deaths. In the intention-to-treat analysis, implementation of the intervention was not associated with primary outcomes. In the per-protocol analysis, patients who received a behavioural support group session had lower incidence rates of hospital admissions involving infectious diseases (incidence rate ratio [IRR] 0.89; 95%CI 0.80-0.99, p = 0.03) and of all-cause mortality (IRR 0.54; 95%CI 0.43-0.68, p<0.001). However, the incidence rate of culture-confirmed melioidosis was not significantly lower (IRR 0.96, 95%CI 0.46-1.99, p = 0.66). CONCLUSIONS/SIGNIFICANCE: Clear benefits of this multifaceted prevention programme for melioidosis were not observed. More compelling invitations for the intervention, modification of or addition to the behaviour change techniques used, and more frequent intervention may be needed. TRIAL REGISTRATION: This trial is registered with ClinicalTrials.gov, number NCT02089152.


Assuntos
Complicações do Diabetes/prevenção & controle , Melioidose/prevenção & controle , Grupos de Autoajuda , Adolescente , Adulto , Idoso , Complicações do Diabetes/epidemiologia , Feminino , Hospitalização , Humanos , Incidência , Masculino , Melioidose/epidemiologia , Pessoa de Meia-Idade , Atenção Primária à Saúde , Fatores de Risco , Tailândia/epidemiologia , Adulto Jovem
7.
PLoS Negl Trop Dis ; 15(5): e0009372, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34029325

RESUMO

BACKGROUND: Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. METHODOLOGY/PRINCIPAL FINDINGS: We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70-7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19-2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21-6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant. CONCLUSION/SIGNIFICANCE: This study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar.


Assuntos
Burkholderia pseudomallei/isolamento & purificação , Melioidose/epidemiologia , Microbiologia do Solo , Geografia , Humanos , Mianmar/epidemiologia
8.
Trans R Soc Trop Med Hyg ; 115(8): 914-921, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-33681986

RESUMO

BACKGROUND: Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. METHODS: A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. RESULTS: Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. CONCLUSIONS: TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.


Assuntos
Melioidose , Mycobacterium tuberculosis , Infecções Respiratórias , Tuberculose Pulmonar , Tuberculose , Adulto , Farmacorresistência Bacteriana , Humanos , Melioidose/diagnóstico , Melioidose/tratamento farmacológico , Melioidose/epidemiologia , Mianmar/epidemiologia , Atenção Primária à Saúde , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Sensibilidade e Especificidade , Escarro , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/epidemiologia
9.
Trop Med Int Health ; 26(6): 664-671, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33590932

RESUMO

OBJECTIVES: Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak. METHODS: For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality. RESULTS: Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality. CONCLUSION: Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.


Assuntos
Melioidose/complicações , Melioidose/epidemiologia , Melioidose/microbiologia , Melioidose/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/etiologia , Bicarbonatos/sangue , Biomarcadores/sangue , Burkholderia pseudomallei/isolamento & purificação , Comorbidade , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Estudos Retrospectivos , Albumina Sérica , Choque Séptico/etiologia , Adulto Jovem
10.
mSphere ; 6(1)2021 02 03.
Artigo em Inglês | MEDLINE | ID: mdl-33536328

RESUMO

Burkholderia pseudomallei is a Gram-negative bacterium that causes the sapronotic disease melioidosis. An outbreak in 2003 in the state of Ceara, Brazil, resulted in subsequent surveillance and environmental sampling which led to the recognition of B. pseudomallei as an endemic pathogen in that area. From 2003 to 2015, 24 clinical and 12 environmental isolates were collected across Ceara along with one from the state of Alagoas. Using next-generation sequencing, multilocus sequence typing, and single nucleotide polymorphism analysis, we characterized the genomic diversity of this collection to better understand the population structure of B. pseudomallei associated with Ceara. We found that the isolates in this collection form a distinct subclade compared to other examples from the Western Hemisphere. Substantial genetic diversity among the clinical and environmental isolates was observed, with 14 sequence types (STs) identified among the 37 isolates. Of the 31,594 core single-nucleotide polymorphisms (SNPs) identified, a high proportion (59%) were due to recombination. Because recombination events do not follow a molecular clock, the observation of high occurrence underscores the importance of identifying and removing recombination SNPs prior to evolutionary reconstructions and inferences in public health responses to B. pseudomallei outbreaks. Our results suggest long-term B. pseudomallei prevalence in this recently recognized region of melioidosis endemicity.IMPORTANCE B. pseudomallei causes significant morbidity and mortality, but its geographic prevalence and genetic diversity are not well characterized, especially in the Western Hemisphere. A better understanding of the genetic relationships among clinical and environmental isolates will improve knowledge of the population structure of this bacterium as well as the ability to conduct epidemiological investigations of cases of melioidosis.


Assuntos
Burkholderia pseudomallei/classificação , Burkholderia pseudomallei/genética , Variação Genética , Genoma Bacteriano , Técnicas de Tipagem Bacteriana , Brasil/epidemiologia , DNA Bacteriano/genética , Surtos de Doenças/estatística & dados numéricos , Genômica/métodos , Genótipo , Humanos , Masculino , Melioidose/epidemiologia , Melioidose/microbiologia , Filogenia , Análise de Sequência de DNA
11.
Emerg Infect Dis ; 27(2): 463-470, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33496230

RESUMO

Melioidosis is a life-threatening infectious disease caused by the gram-negative bacillus Burkholderia pseudomallei. An effective vaccine is needed, but data on protective immune responses in human melioidosis are lacking. We used ELISA and an antibody-dependent cellular phagocytosis assay to identify the major features of protective antibodies in patients with acute melioidosis in Thailand. We found that high levels of B. pseudomallei-specific IgG2 are associated with protection against death in a multivariable logistic regression analysis adjusting for age, diabetes, renal disease, and neutrophil count. Serum from melioidosis survivors enhanced bacteria uptake into human monocytes expressing FcγRIIa-H/R131, an intermediate-affinity IgG2-receptor, compared with serum from nonsurvivors. We did not find this enhancement when using monocytes carrying the low IgG2-affinity FcγRIIa-R131 allele. The findings indicate the importance of IgG2 in protection against death in human melioidosis, a crucial finding for antibody-based therapeutics and vaccine development.


Assuntos
Anticorpos Antibacterianos/imunologia , Burkholderia pseudomallei , Imunoglobulina G/imunologia , Melioidose , Adulto , Ensaio de Imunoadsorção Enzimática , Humanos , Melioidose/epidemiologia , Melioidose/imunologia , Tailândia
12.
Emerg Infect Dis ; 27(2): 655-658, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33496648

RESUMO

We report an analysis of the genomic diversity of isolates of Burkholderia pseudomallei, the cause of melioidosis, recovered in Colombia from routine surveillance during 2016-2017. B. pseudomallei appears genetically diverse, suggesting it is well established and has spread across the region.


Assuntos
Burkholderia pseudomallei , Melioidose , Burkholderia pseudomallei/genética , Colômbia/epidemiologia , Genômica , Humanos , Melioidose/epidemiologia , Tipagem de Sequências Multilocus
13.
Trop Doct ; 51(2): 174-177, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32727288

RESUMO

As it is increasingly being reported from India, we carried out a prospective study of patients with culture-proven melioidosis from south India, examining clinical, laboratory features, epidemiological data, risk factors, treatments, outcomes at three and six months, and factors associated with mortality.Between 2014 and 2018, 31 cases were identified. Diabetes (83.9%) and alcohol abuse (58.1%) were common risk factors. Musculoskeletal, skin and soft tissue manifestations together constituted 48.4% of presentations, while 29% had pneumonia. During the intensive phase, 74.2% received one of three recommended antibiotic regimes, but 51.6% did not receive continuation treatment. Pneumonia and lack of continuation treatment were independently associated with a high mortality of 25.8%. Hot spots for melioidosis exist in India, and there is considerable diversity of presentation, including skin, soft tissue, musculoskeletal and neurological involvement. High rates of bacteraemia are shown.


Assuntos
Melioidose/epidemiologia , Adulto , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
14.
PLoS Negl Trop Dis ; 14(12): e0008979, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33370273

RESUMO

BACKGROUND: Melioidosis is a neglected tropical disease with rising global public health and clinical importance. Melioidosis is endemic in Southeast Asia and Northern Australia and is of increasing concern in Malaysia. Despite a number of reported studies from Malaysia, these reports are limited to certain parts of the country and do not provide a cohesive link between epidemiology of melioidosis cases and the nation-wide distribution of the causative agent Burkholderia pseudomallei. METHODOLOGY/PRINCIPLE FINDINGS: Here we report on the distribution of B. pseudomallei sequence types (STs) in Malaysia and how the STs are related to STs globally. We obtained 84 culture-confirmed B. pseudomallei from confirmed septicaemic melioidosis patients from all over Malaysia. Prior to performing Multi Locus Sequence Typing, the isolates were subjected to antimicrobial susceptibility testing and detection of the YLF/BTFC genes and BimA allele. Up to 90.5% of the isolates were sensitive to all antimicrobials tested while resistance was observed for antimicrobials typically administered during the eradication stage of treatment. YLF gene cluster and bimABp allele variant were detected in all the isolates. The epidemiological distribution patterns of the Malaysian B. pseudomallei isolates were analysed in silico using phylogenetic tools and compared to Southeast Asian and world-wide isolates. Genotyping of the 84 Malaysian B. pseudomallei isolates revealed 29 different STs of which 6 (7.1%) were novel. ST50 was identified as the group founder followed by subgroup founders ST376, ST211 and ST84. A low-level diversity is noted for the B. pseudomallei isolates described in this study while phylogenetic analysis associated the Malaysian STs to Southeast Asian isolates especially isolates from Thailand. Further analysis also showed a strong association that implicates agriculture and domestication activities as high-risk routes of infection. CONCLUSIONS/SIGNIFICANCE: In conclusion, MLST analysis of B. pseudomallei clinical isolates from all states in Malaysia revealed low diversity and a close association to Southeast Asian isolates.


Assuntos
Burkholderia pseudomallei/genética , Burkholderia pseudomallei/isolamento & purificação , Melioidose/epidemiologia , Técnicas de Tipagem Bacteriana , DNA Bacteriano/genética , Humanos , Malásia/epidemiologia , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Análise de Sequência de DNA
15.
Emerg Infect Dis ; 26(11): 2773-2775, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33079041

RESUMO

The distribution of Burkholderia pseudomallei in the Caribbean is poorly understood. We isolated B. pseudomallei from US Virgin Islands soil. The soil isolate was genetically similar to other isolates from the Caribbean, suggesting that B. pseudomallei might have been introduced to the islands multiple times through severe weather events.


Assuntos
Burkholderia pseudomallei , Melioidose , Microbiologia do Solo , Burkholderia pseudomallei/genética , Humanos , Ilhas , Melioidose/epidemiologia , Filogenia , Ilhas Virgens Americanas
16.
Sci Rep ; 10(1): 16260, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004984

RESUMO

Melioidosis was first identified in Myanmar in 1911 but for the last century it has remained largely unreported there. Burkholderia pseudomallei was first isolated from the environment of Myanmar in 2016, confirming continuing endemicity. Recent genomic studies showed that B. pseudomallei originated in Australia and spread to Asia, with phylogenetic evidence of repeated reintroduction of B. pseudomallei across countries bordered by the Mekong River and the Malay Peninsula. We present the first whole-genome sequences of B. pseudomallei isolates from Myanmar: nine clinical and seven environmental isolates. We used large-scale comparative genomics to assess the genetic diversity, phylogeography and potential origins of B. pseudomallei in Myanmar. Global phylogenetics demonstrated that Myanmar isolates group in two distantly related clades that reside in a more ancestral Asian clade with high amounts of genetic diversity. The diversity of B. pseudomallei from Myanmar and divergence within our global phylogeny suggest that the original introduction of B. pseudomallei to Myanmar was not a recent event. Our study provides new insights into global patterns of B. pseudomallei dissemination, most notably the dynamic nature of movement of B. pseudomallei within densely populated Southeast Asia. The role of anthropogenic influences in both ancient and more recent dissemination of B. pseudomallei to Myanmar and elsewhere in Southeast Asia and globally requires further study.


Assuntos
Burkholderia pseudomallei/genética , Ásia Sudeste/epidemiologia , Austrália/epidemiologia , Variação Genética/genética , Humanos , Melioidose/epidemiologia , Melioidose/microbiologia , Tipagem de Sequências Multilocus , Mianmar/epidemiologia , Filogenia , Análise de Sequência de DNA
17.
Am J Trop Med Hyg ; 103(6): 2510-2514, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32996455

RESUMO

Prediction models indicate that melioidosis may be common in parts of East Africa, but there are few empiric data. We evaluated the prevalence of melioidosis among patients presenting with fever to hospitals in Tanzania. Patients with fever were enrolled at two referral hospitals in Moshi, Tanzania, during 2007-2008, 2012-2014, and 2016-2019. Blood was collected from participants for aerobic culture. Bloodstream isolates were identified by conventional biochemical methods. Non-glucose-fermenting Gram-negative bacilli were further tested using a Burkholderia pseudomallei latex agglutination assay. Also, we performed B. pseudomallei indirect hemagglutination assay (IHA) serology on serum samples from participants enrolled from 2012 to 2014 and considered at high epidemiologic risk of melioidosis on the basis of admission within 30 days of rainfall. We defined confirmed melioidosis as isolation of B. pseudomallei from blood culture, probable melioidosis as a ≥ 4-fold rise in antibody titers between acute and convalescent sera, and seropositivity as a single antibody titer ≥ 40. We enrolled 3,716 participants and isolated non-enteric Gram-negative bacilli in five (2.5%) of 200 with bacteremia. As none of these five isolates was B. pseudomallei, there were no confirmed melioidosis cases. Of 323 participants tested by IHA, 142 (44.0%) were male, and the median (range) age was 27 (0-70) years. We identified two (0.6%) cases of probable melioidosis, and 57 (17.7%) were seropositive. The absence of confirmed melioidosis from 9 years of fever surveillance indicates melioidosis was not a major cause of illness.


Assuntos
Hemocultura/métodos , Febre , Testes de Hemaglutinação/métodos , Melioidose/sangue , Melioidose/diagnóstico , Adolescente , Adulto , Idoso , Burkholderia pseudomallei , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Melioidose/epidemiologia , Pessoa de Meia-Idade , Testes Sorológicos , Tanzânia/epidemiologia , Adulto Jovem
18.
Am J Trop Med Hyg ; 103(5): 1844-1845, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32876008

RESUMO

Melioidosis is an emerging disease caused by the environmental Gram-negative bacillus Burkholderia pseudomallei. Melioidosis has been reported to be endemic mainly in northern Australia and Southeast Asia. Here, we report the first two cases of melioidosis on the Comorian island of Mayotte. We also describe four cases that occurred over a short period of time in patients who had traveled between Mayotte, Madagascar, and Reunion Island.


Assuntos
Melioidose/diagnóstico , Melioidose/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Comores/epidemiologia , Humanos , Madagáscar/epidemiologia , Masculino , Melioidose/tratamento farmacológico , Pessoa de Meia-Idade , Reunião/epidemiologia
19.
Am J Trop Med Hyg ; 103(5): 1838-1840, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32748772

RESUMO

Burkholderia pseudomallei is an emerging pathogen in the Americas. Cases of mother-to-child transmission of B. pseudomallei are rare and probably occur by placental or perinatal infection. We report the first case of native gestational and neonatal melioidosis in the Western hemisphere. The isolated strains in the mother and newborn were confirmed by whole-genome sequencing and identified as a novel sequence type ST1748. The comparison of both genomes revealed a nucleotide similarity of 100%. Melioidosis should be considered within the differential diagnosis of febrile illness or pneumonia in pregnant women and newborns from endemic areas of the Americas.


Assuntos
Transmissão Vertical de Doenças Infecciosas , Melioidose/diagnóstico , Melioidose/transmissão , Antibacterianos , Burkholderia pseudomallei/genética , Burkholderia pseudomallei/isolamento & purificação , Colômbia/epidemiologia , Feminino , Genoma Bacteriano , Humanos , Recém-Nascido , Melioidose/tratamento farmacológico , Melioidose/epidemiologia , Gravidez , Adulto Jovem
20.
Artigo em Inglês | MEDLINE | ID: mdl-32708490

RESUMO

(1) Background: Burkholderia pseudomallei is an environmentally mediated saprophytic pathogen that can cause severe disease in humans. It is well known that B. pseudomallei survives in tropical moist soil environments worldwide, but melioidosis is gaining recognition as a public and veterinary health issue in Vietnam. The contribution of animals to human disease is unknown, necessitating further investigation. (2) Methods: Swine sera were collected from two populations, one grazing and one commercially farmed, from three provinces in Vietnam. ELISAs utilizing B. pseudomallei capsular polysaccharide (CPS), outer polysaccharide (OPS), and Hcp1 protein were used to screen serum samples. Positive samples were mapped to the commune level. Seroprevalence calculations and pig population estimates were used to approximate number of swine exposures per commune. (3) Results: Grazing pigs from Hoa Binh had significantly higher seropositivity levels (11.4%, 95% CI: 9.7-13.1) compared to farmed pigs from Ha Tinh and Nghe An (4%, 95% CI: 3.3-4.7). Average swine seropositivity rates were ~6.3% (95% CI: 5-7.9), higher than previously identified in Vietnam (~0.88%). (4) Conclusions: Initial serological sampling identified a significant number of seropositive and potential melioidosis infections occurring in swine in Vietnam. This work is a critical step in understanding the role swine may play in the epidemiology of human melioidosis in Vietnam.


Assuntos
Burkholderia pseudomallei/isolamento & purificação , Melioidose/diagnóstico , Melioidose/veterinária , Testes Sorológicos/métodos , Animais , Anticorpos Antibacterianos/sangue , Burkholderia pseudomallei/genética , Ensaio de Imunoadsorção Enzimática , Humanos , Melioidose/epidemiologia , Estudos Soroepidemiológicos , Suínos , Vietnã/epidemiologia
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