MEILIODOSIS - AN ENIGMA WITH VARYING ANTIBIOTIC RESPONSE

2021 ◽  
pp. 19-21
Author(s):  
Priyadharshini Swaminathan ◽  
Sankavi SB ◽  
Indumathi K DCP ◽  
Theranirajan Theranirajan
Keyword(s):  
Burkholderia Pseudomallei ◽  
Antimicrobial Agents ◽  
Eradication Therapy ◽  
Clinical Manifestations ◽  
Positive Culture ◽  
Skin Ulcers ◽  
Intravenous Antibiotics ◽  
Amoxicillin Clavulanic Acid ◽  
Antibiotic Response ◽  
Tropical Climates

Melioidosis or Whitmore's disease is an infection of humans and animals caused by aerobic gram negative bacillus Burkholderia pseudomallei. This infection with a wide clinical spectrum is predominantly present in tropical climates, mainly Southeast Asia and Northern Australia. The clinical manifestations include pneumonia, skin ulcers or abscesses, osteomyelitis, prostatitis, encephalomyelitis and fulminant septic shock. The denitive diagnosis is made by a positive culture of Burkholderia pseudomallei. The bacteria is innately resistant to 6 classes of commonly used antibiotics. CDC recommends an intensive phase of intravenous antibiotics for 10 to 14 days followed by eradication therapy with oral antibiotics for 3 – 6 months. The intravenous agents effective against the bacteria are meropenem and ceftazidime. Trimethoprim sulfamethoxazole and amoxicillin/clavulanic acid are the oral antimicrobial agents used. Here we present two cases of Melioidosis, at opposite ends of the spectrum with varying antibiotic response. One patient is a young non immunocompromised female and the second an elderly immunocompromised (T2DM) male, both presented with skeletal melioidosis.

scholarly journals Antimicrobial agents and Burkholderia pseudomallei: perspectives from Thailand

2014 ◽  
Vol 8 (2) ◽  
pp. 167-172
Author(s):  
Pawana Panomket
Keyword(s):  
Acute Phase ◽  
Burkholderia Pseudomallei ◽  
Antimicrobial Agents ◽  
Current Knowledge ◽  
Effective Agent ◽  
Primary Resistance ◽  
High Relapse Rate ◽  
Wide Range ◽  
Life Threatening ◽  
Amoxicillin Clavulanic Acid

AbstractBackground: Burkholderia pseudomallei are the causative agent of melioidosis, a potentially life-threatening disease in humans and animals. It is a common public health threat in parts of Thailand.Objective: To summarizes the current knowledge regarding antimicrobial agents and B. pseudomallei.Methods: A literature search using MEDLINE (PubMed), SCOPUS, and OVID/LWWW databases.Results: B. pseudomallei are intrinsically resistant to a wide range of antimicrobial agents including β-lactam antibiotics, aminoglycosides, and macrolides. Antimicrobial therapy for melioidosis is divided into an acute phase and an eradication phase. The current recommendations for the acute phase are parenteral antimicrobial agents for ≥10 days using ceftazidime or a carbapenem. The eradication phase involves oral antimicrobial agents for ≥180 days using trimethoprim-sulfamethoxazole. Amoxicillin-clavulanic acid may be used as an alternative. Ceftazidime revealed rare primary resistance and a high relapse rate.Conclusion: Patients with acute melioidosis usually need intensive care and appropriate antibiotics for the acute and eradication phases. Ceftazidime is remains an effective agent in Thailand. A trend for decreasing susceptibility to antibiotics requires monitoring.

scholarly journals Antibiotic Resistance Markers in Burkholderia pseudomallei Strain Bp1651 Identified by Genome Sequence Analysis

2017 ◽  
Vol 61 (6) ◽  
Author(s):  
Julia V. Bugrysheva ◽  
David Sue ◽  
Jay E. Gee ◽  
Mindy G. Elrod ◽  
Alex R. Hoffmaster ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Clavulanic Acid ◽  
Burkholderia Pseudomallei ◽  
Efflux Pump ◽  
Point Mutations ◽  
Comparative Genomic ◽  
Content Type ◽  
Reductase Gene ◽  
Amoxicillin Clavulanic Acid ◽  
Imipenem Resistance

ABSTRACT Burkholderia pseudomallei Bp1651 is resistant to several classes of antibiotics that are usually effective for treatment of melioidosis, including tetracyclines, sulfonamides, and β-lactams such as penicillins (amoxicillin-clavulanic acid), cephalosporins (ceftazidime), and carbapenems (imipenem and meropenem). We sequenced, assembled, and annotated the Bp1651 genome and analyzed the sequence using comparative genomic analyses with susceptible strains, keyword searches of the annotation, publicly available antimicrobial resistance prediction tools, and published reports. More than 100 genes in the Bp1651 sequence were identified as potentially contributing to antimicrobial resistance. Most notably, we identified three previously uncharacterized point mutations in penA, which codes for a class A β-lactamase and was previously implicated in resistance to β-lactam antibiotics. The mutations result in amino acid changes T147A, D240G, and V261I. When individually introduced into select agent-excluded B. pseudomallei strain Bp82, D240G was found to contribute to ceftazidime resistance and T147A contributed to amoxicillin-clavulanic acid and imipenem resistance. This study provides the first evidence that mutations in penA may alter susceptibility to carbapenems in B. pseudomallei. Another mutation of interest was a point mutation affecting the dihydrofolate reductase gene folA, which likely explains the trimethoprim resistance of this strain. Bp1651 was susceptible to aminoglycosides likely because of a frameshift in the amrB gene, the transporter subunit of the AmrAB-OprA efflux pump. These findings expand the role of penA to include resistance to carbapenems and may assist in the development of molecular diagnostics that predict antimicrobial resistance and provide guidance for treatment of melioidosis.

scholarly journals Melioidosis- Report of Two Cases

2020 ◽  
pp. 1-3
Author(s):  
Biswabikash Mohanty ◽  
◽  
Amitav Rath ◽  
Sidharth Sankar Sahoo ◽  
Sudhir Pattnaik ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Septic Shock ◽  
Nervous System ◽  
Southeast Asia ◽  
Burkholderia Pseudomallei ◽  
Indian Subcontinent ◽  
Clinical Manifestations ◽  
Stable Condition ◽  
Cerebral Abscess ◽  
Bacteremic Patient

Melioidosis which is caused by burkholderia pseudomallei occurs predominantly in Southeast Asia. Cases are now being reported from india as well. It can present with varying clinical manifestations like pneumonia, septicemia, arthritis, abscess etc. Neurologic meliodiosis, though rare can occur in upto 3-4% cases. Here we present two cases of melioidosis from Indian subcontinent, one involving central nervous system causing cerebral abscess and second one involving multiple splenic and liver abscess with bacteremia. First patient with cerebral abscess was managed with surgical debridement with antibiotics and discharged in a stable condition after 15 days while the bacteremic patient developed septic shock with mutiorgan failure and succumbed to death after 12 days of treatment

scholarly journals Whole-genome comparative analysis of Malaysian Burkholderia pseudomallei clinical isolates

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Ahmad-Kamal Ghazali ◽  
Su-Anne Eng ◽  
Jia-Shiun Khoo ◽  
Seddon Teoh ◽  
Chee-Choong Hoh ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Virulence Factors ◽  
Type Species ◽  
Burkholderia Pseudomallei ◽  
Clinical Manifestations ◽  
Phylogenomic Analysis ◽  
Content Type ◽  
Link Type ◽  
Multiple Organs ◽  
The Difference

Burkholderia pseudomallei , a soil-dwelling Gram-negative bacterium, is the causative agent of the endemic tropical disease melioidosis. Clinical manifestations of B. pseudomallei infection range from acute or chronic localized infection in a single organ to fulminant septicaemia in multiple organs. The diverse clinical manifestations are attributed to various factors, including the genome plasticity across B. pseudomallei strains. We previously characterized B. pseudomallei strains isolated in Malaysia and noted different levels of virulence in model hosts. We hypothesized that the difference in virulence might be a result of variance at the genome level. In this study, we sequenced and assembled four Malaysian clinical B. pseudomallei isolates, UKMR15, UKMPMC2000, UKMD286 and UKMH10. Phylogenomic analysis showed that Malaysian subclades emerged from the Asian subclade, suggesting that the Malaysian strains originated from the Asian region. Interestingly, the low-virulence strain, UKMH10, was the most distantly related compared to the other Malaysian isolates. Genomic island (GI) prediction analysis identified a new island of 23 kb, GI9c, which is present in B. pseudomallei and Burkholderia mallei , but not Burkholderia thailandensis . Genes encoding known B. pseudomallei virulence factors were present across all four genomes, but comparative analysis of the total gene content across the Malaysian strains identified 104 genes that are absent in UKMH10. We propose that these genes may encode novel virulence factors, which may explain the reduced virulence of this strain. Further investigation on the identity and role of these 104 proteins may aid in understanding B. pseudomallei pathogenicity to guide the design of new therapeutics for treating melioidosis.

scholarly journals Perinatal listeriosis patients treated at a maternity hospital in Beijing, China, from 2013-2018

2020 ◽  
Author(s):  
Chunyun Li ◽  
Huihui Zeng ◽  
Xin Ding ◽  
Yi Chen ◽  
Xiaowei Liu ◽  
...  
Keyword(s):  
Large Scale ◽  
Clinical Manifestations ◽  
Positive Culture ◽  
Maternity Hospital ◽  
Health Concern ◽  
Cns Infection ◽  
Perinatal Complications ◽  
Adverse Pregnancy ◽  
Beijing China

Abstract Background: Listeriosis is a rare but severe foodborne infectious disease. Perinatal listeriosis is often associated with septicemia, central nervous system (CNS) infection, and serious adverse pregnancy outcomes (miscarriage and neonate death). Here we report the characteristics and outcomes of perinatal listeriosis cases treated over 6 years at Beijing Obstetrics and Gynecology Hospital (BOGH), the largest maternity hospital in China. Methods: We retrospectively reviewed the records of laboratory-confirmed, pregnancy-associated listeriosis cases treated from January 1, 2013 to December 31, 2018. The clinical manifestations, laboratory results, perinatal complications and outcomes (post-natal follow-up of 6 months) were investigated. Results: In BOGH, 12 perinatal listeriosis cases were diagnosed based on Listeria monocytogenes positive culture, including 10 single pregnancies and 2 twin pregnancies. The corresponding incidence of pregnancy-associated listeriosis was 13.7/100,000 deliveries. Among those cases, four pregnant women and four newborns had septicemia, and two of the neonates with septicemia also suffered CNS infection. All the maternal patients recovered. Two inevitable miscarriages and four fetal stillbirths occurred. Of the eight delivered newborns, six survived, and two died within 2 days from birth. None of the survivors had neurological sequelae during a 6-month follow-up. The overall feto-neonatal fatality rate was 57.1%; notably, this rate was 100% for infections occurring during the second trimester of pregnancy and only 14.3% for those occurring in the third trimester. Conclusions: Perinatal listeriosis is associated with high feto-neonatal mortality, and thus, a public health concern. Additional large-scale studies are needed to strengthen the epidemiological understanding of listeriosis in China.

Abstract 4535: Therapeutic Angiogenesis by Mononuclear Cell Implantation for Critical Digit Ischemia of Patients with Connective Tissue Diseases

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Masafumi Takahashi ◽  
Yoshiaki Ishigatsubo ◽  
Kazuteru Fujimoto ◽  
Masaaki Miyamoto ◽  
Seiji Minota ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Connective Tissue ◽  
Peripheral Blood ◽  
Mononuclear Cells ◽  
Connective Tissue Diseases ◽  
Clinical Manifestations ◽  
Therapeutic Angiogenesis ◽  
Diffuse Fibrosis ◽  
Dramatic Improvement ◽  
Skin Ulcers

Systemic sclerosis (SSc or scleroderma) is an autoimmune connective tissue disease characterized by diffuse fibrosis, degenerative changes, and microvascular abnormalities. The vasculopathy mainly affects small arteries and capillaries and causes insufficient blood flow, which leads to clinical manifestations, such as Raynaud’s syndrome, fingertip ulcers, and gangrene. Recently, implantation of bone marrow-derived mononuclear cells (MNCs) has been successfully used for therapeutic neovascularization in Buerger’s disease that is thought to be an “autoimmune” vasculitis. The purpose of this study is to determine the efficacy of autologous MNC implantation into the ischemic digits of patients with connective tissue diseases. This study was performed as a prospective, non-randamized, and multicenter clinical trial. Thirty-four patients (19 SSc, 5 SLE, 2 CREST, 2 MCTD, 4 APS, 2 PN) who had painful ischemic digits with skin ulcers were enrolled in this study. Autologous MNCs obtained from bone marrow or peripheral blood were implanted into the ischemic digits. Ischemic pain and ulcers improved remarkably after MNC implantation. In particular, SSc patients showed dramatic improvement of these parameters (18 of 19 patients, 94.7%). In patients with other types of connective tissue diseases, pain and ulcers improved in 12 of 15 patients (80.0%). No serious adverse event was observed. These results demonstrate that implantation of autologous MNCs from bone marrow or peripheral blood into ischemic digits is feasible, safe and effective for improvement of pain and skin ulcers in patients with connective tissue diseases including SSc. Thus, larger, randomized and controlled trials for this cell therapy in patients with connective tissue diseases will be warranted.

Gonorrhea in Preadolescent Children: An Inquiry Into Source of Infection and Mode of Transmission

PEDIATRICS ◽  
1977 ◽  
Vol 60 (2) ◽  
pp. 153-156 ◽  
Author(s):  
David S. Folland ◽  
Ralph E. Burke ◽  
Alan R. Hinman ◽  
William Schaffner
Keyword(s):  
Child Neglect ◽  
Sexual Transmission ◽  
Clinical Manifestations ◽  
Positive Culture ◽  
Sexual Contact ◽  
Gonococcal Infection ◽  
Vaginal Infection ◽  
Source Of Infection ◽  
Increased Risk ◽  
History Of

From November 1974 through December 1975 a study was made of all reported cases of gonorrhea in children under 10 years of age in Tennessee. Clinical manifestations of the 73 subjects identified included vaginal infection (48), urethritis (11), conjunctivitis (8), and ophthalmia neonatorum (6). A total of 203 relatives and associates of 54 subjects was cultured. Fifty-four (27%) had gonorrhea; 43 of these were relatives. A history of sexual contact was found in 18 children, including seven where the contact had a positive culture for Neisseria gonorrhoeae. Sexual transmission was common in children with vaginitis or urethritis. In nine cases, sexual abuse or child neglect was suspected. The recognition of a child with gonococcal infection identifies a cluster of family members and associates who are at increased risk of having gonorrhea.

scholarly journals Novel Antibiotic Combinations of Diverse Subclasses for Effective Suppression of Extensively Drug-Resistant Methicillin-Resistant Staphylococcus aureus (MRSA)

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Shumyila Nasir ◽  
Muhammad Sufyan Vohra ◽  
Danish Gul ◽  
Umm E Swaiba ◽  
Maira Aleem ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clavulanic Acid ◽  
Antimicrobial Agents ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Methicillin Resistant ◽  
Development Of Resistance ◽  
Amoxicillin Clavulanic Acid ◽  
Combination Antibiotics ◽  
Time Kill

The emergence of multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), the chief etiological agent for a range of refractory infections, has rendered all β-lactams ineffective against it. The treatment process is further complicated with the development of resistance to glycopeptides, primary antibiotics for treatment of MRSA. Antibiotic combination therapy with existing antimicrobial agents may provide an immediate treatment option. Minimum inhibitory concentrations (MICs) of 18 different commercially available antibiotics were determined along with their 90 possible pairwise combinations and 64 triple combinations to filter out 5 best combinations. Time-Kill kinetics of these combinations were then analyzed to find collateral bactericidal combinations which were then tested on other randomly selected MRSA isolates. Among the top 5 combinations including levofloxacin-ceftazidime; amoxicillin/clavulanic acid-tobramycin; amoxicillin/clavulanic acid-cephradine; amoxicillin/clavulanic acid-ofloxacin; and piperacillin/tazobactam-tobramycin, three combinations were found to be collaterally effective. Levofloxacin-ceftazidime acted synergistically in 80% of the tested clinical MRSA isolates. First-line β-lactams of lower generations can be used effectively against MRSA infection when used in combination. Antibiotics other than glycopeptides may still work in combination.

scholarly journals Neuromelioidosis: a series of seven cases in Hainan province, China

2017 ◽  
Vol 45 (2) ◽  
pp. 856-867 ◽  
Author(s):  
Yuefu Zhan ◽  
Yehua Wu ◽  
Qun Li ◽  
Anle Yu
Keyword(s):  
Burkholderia Pseudomallei ◽  
Imaging Features ◽  
Northern Australia ◽  
Peripheral Blood Leukocytes ◽  
Resonance Imaging ◽  
Blood Leukocytes ◽  
Disease Characteristics ◽  
The Central Nervous System ◽  
Low Incidence ◽  
Tropical Climates

Melioidosis, which is caused by Burkholderia pseudomallei, is predominately a disease of tropical climates and is especially widespread in south-east Asia and northern Australia. Melioidosis affecting the central nervous system has a low incidence but a high mortality. We present seven cases of neuromelioidosis and analyze the disease characteristics and imaging features. Typical clinical features of this disease included high fever and headache. Five patients had an irregular fever with a temperature ≥ 39℃. Peripheral blood leukocytes and the neutrophil ratio were raised in all patients. On computed tomography and magnetic resonance imaging the disease mainly manifested as intracerebral single or multiple nodules, as well as ring and flake-like enhancements with rapid lesion progression. This study demonstrated the importance of imaging examination in the clinical evaluation and diagnosis of neuromelioidosis.

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