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      Clinical, Environmental, and Serologic Surveillance Studies of Melioidosis in Gabon, 2012–2013

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          Abstract

          Burkholderia pseudomallei and B. thailandensis are in the soil; a novel B. pseudomallei sequence type causes lethal septic shock.

          Abstract

          Burkholderia pseudomallei, an environmental gram-negative bacillus, is the causative agent of melioidosis and a bio-threat agent. Reports of B. pseudomallei isolation from soil and animals in East and West Africa suggest that melioidosis might be more widely distributed than previously thought. Because it has been found in equatorial areas with tropical climates, we hypothesized that B. pseudomallei could exist in Gabon. During 2012–2013, we conducted a seroprevalance study in which we set up microbiology facilities at a large clinical referral center and prospectively screened all febrile patients by conducting blood cultures and testing for B. pseudomallei and related species; we also determined whether B. pseudomallei could be isolated from soil. We discovered a novel B. pseudomallei sequence type that caused lethal septic shock and identified B. pseudomallei and B. thailandensis in the environment. Our data suggest that melioidosis is emerging in Central Africa but is unrecognized because of the lack of diagnostic microbiology facilities.

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          The global distribution of Burkholderia pseudomallei and melioidosis: an update.

          While Southeast Asia and northern Australia are well recognized as the major endemic regions for melioidosis, recent reports have expanded the endemic zone. Severe weather events and environmental disasters such as the 2004 Asian tsunami have unmasked locations of sporadic cases and have reconfirmed endemicity in Indonesia. The endemic region now includes the majority of the Indian subcontinent, southern China, Hong Kong and Taiwan. Sporadic cases have occurred in Brazil and elsewhere in the Americas and in island communities such as New Caledonia, in the Pacific Ocean, and Mauritius in the Indian Ocean. Some of the factors that are critical to further elucidating the global distribution of Burkholderia pseudomallei and melioidosis include improved access to diagnostic laboratory facilities and formal confirmation of the identity of bacterial isolates from suspected cases.
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            Burkholderia thailandensis sp. nov., a Burkholderia pseudomallei-like species.

            The presence of a Burkholderia pseudomallei-like species based upon the significant genotypic and phenotypic dissimilarities exhibited between these organisms and true B. pseudomallei strains has been reported previously. In this study, a comprehensive 16S rDNA-based phylogenetic analysis further supports the existence of this newly described Burkholderia species for which the name Burkholderia thailandensis sp. nov. is proposed.
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              Antibiotic susceptibility of Burkholderia pseudomallei from tropical northern Australia and implications for therapy of melioidosis.

              From a prospective melioidosis study commencing in 1989 at Royal Darwin Hospital, 170 initial isolates of Burkholderia pseudomallei were available for susceptibility testing. Of these 163 (96%) were susceptible to meropenem/imipenem, ceftazidime, trimethoprim-sulphamethoxazole (SMX/TMP) and doxycycline. Seven (4%) showed primary resistance; three had low-level resistance to SMX/TMP, one to ceftriaxone and amoxycillin/clavulanate (AMOX/CA) and three to doxycycline. Of 167 patients who survived their initial presentation, seven (4%) had culture positive infections which persisted for greater than 3 months after start of therapy. All ultimately cleared carriage of B. pseudomallei though three required changing to SMX/TMP after development of doxycycline resistance. Nineteen (11%) of the initial survivors clinically relapsed and 17 of these had repeat isolates available for testing. Four of these had acquired resistance: one to doxycycline, one to AMOX/CA and ceftazidime, one to SMX/TMP and one to both SMX/TMP and doxycycline. Molecular typing using randomly amplified polymorphic DNA and pulsed-field gel electrophoresis showed all but one relapse isolate to be the same as the original strain. These data are similar to published data from Thailand. As melioidosis has a high mortality (21% in this series) these results emphasize the need for prolonged eradication therapy and regular clinical and microbiological monitoring so that the emergence of resistance can be detected early and appropriate treatment modifications made.
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                Author and article information

                Journal
                Emerg Infect Dis
                Emerging Infect. Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                January 2015
                : 21
                : 1
                : 40-47
                Affiliations
                [1]University of Amsterdam, Amsterdam, the Netherlands (W.J. Wiersinga, E. Birnie, T.A.F. Weehuizen, M.A.M. Huson, R.A.G. in ’t Veld, C.E. Visser, A. van der Ende, M.P. Grobusch);
                [2]Albert Schweitzer Hospital, Lambaréné, Gabon (A.S. Alabi, H.K. Mabala, G.K. Adzoda, M. Esen, B. Lell, P.G. Kremsner, M.P. Grobusch);
                [3]Ex-Situ Silex Geoarchaeology, Leiden, the Netherlands (Y. Raczynski-Henk);
                [4]University of Tübingen, Tübingen, Germany (M. Esen, B. Lell, P.G. Kremsner, M.P. Grobusch);
                [5]Mahidol University, Bangkok, Thailand (V. Wuthiekanun, D. Limmathurotsakul);
                [6]University of Cambridge, Cambridge, UK (S.J. Peacock)
                Author notes
                Address for correspondence: W. Joost Wiersinga, Center for Infection and Immunity Amsterdam, Dept. of Internal Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room G2-132, 1105 AZ Amsterdam, the Netherlands; email: w.j.wiersinga@ 123456amc.uva.nl
                Article
                14-0762
                10.3201/eid2101.140762
                4285261
                25530077
                577a9276-b59a-4996-925a-0f96a414c95e
                History
                Categories
                Research
                Research
                Clinical, Environmental, and Serologic Surveillance Studies of Melioidosis in Gabon, 2012–2013

                Infectious disease & Microbiology
                burkholderia pseudomallei,burkholderia thailandensis,melioidosis,epidemiology,seroprevalance,africa,gabon,soil,sepsis,bacteria

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