An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis

James B. Geake, David W Reid, Bart Currie, Scott Bell, MelioidCF Investigators

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    Abstract

    Background: Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies.

    Methods: We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested.

    Results: 25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV1 % predicted was 60 %, and mean BMI was 19.5 kg/m2. The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 %) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection.

    Conclusion: Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection. 

    Original languageEnglish
    Article number116
    Pages (from-to)1-10
    Number of pages10
    JournalBMC Pulmonary Medicine
    Volume15
    DOIs
    Publication statusPublished - 9 Oct 2015

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    Burkholderia Infections
    Burkholderia pseudomallei
    Cystic Fibrosis
    Lung Transplantation
    Infection
    South Australia
    Ceftazidime
    Far East
    Sulfamethoxazole Drug Combination Trimethoprim
    Communicable Diseases
    Population

    Cite this

    Geake, James B. ; Reid, David W ; Currie, Bart ; Bell, Scott ; MelioidCF Investigators. / An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis. In: BMC Pulmonary Medicine. 2015 ; Vol. 15. pp. 1-10.
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    title = "An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis",
    abstract = "Background: Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies. Methods: We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested. Results: 25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV1 {\%} predicted was 60 {\%}, and mean BMI was 19.5 kg/m2. The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 {\%}) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection. Conclusion: Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection. ",
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    An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis. / Geake, James B.; Reid, David W; Currie, Bart; Bell, Scott; MelioidCF Investigators.

    In: BMC Pulmonary Medicine, Vol. 15, 116, 09.10.2015, p. 1-10.

    Research output: Contribution to journalArticleResearchpeer-review

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    AB - Background: Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies. Methods: We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested. Results: 25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV1 % predicted was 60 %, and mean BMI was 19.5 kg/m2. The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 %) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection. Conclusion: Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection. 

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