Melioidosis

Epidemiology, pathophysiology, and management

A CHENG, Bart Currie

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease. Copyright � 2005, American Society for Microbiology. All Rights Reserved.
    Original languageEnglish
    Pages (from-to)383-416
    Number of pages34
    JournalClinical Microbiology Reviews
    Volume18
    Issue number2
    Publication statusPublished - 2005

    Fingerprint

    Melioidosis
    Burkholderia pseudomallei
    Epidemiology
    Virulence Factors
    Cellular Immunity
    Sepsis
    Infection
    Southeastern Asia
    Carbapenems
    Ceftazidime
    Economic Development
    Mortality
    Environmental Exposure
    Phagocytes
    Humoral Immunity
    Microbiology
    Routine Diagnostic Tests
    Vaccination
    Neutrophils
    Vaccines

    Cite this

    @article{04402c90e6c2455db2920109aaffbf47,
    title = "Melioidosis: Epidemiology, pathophysiology, and management",
    abstract = "Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease. Copyright � 2005, American Society for Microbiology. All Rights Reserved.",
    keywords = "amikacin, amoxicillin, amoxicillin plus clavulanic acid, ampicillin, antibiotic agent, azithromycin, aztreonam, beta lactamase inhibitor, biapenem, carbapenem, carbenicillin, carumonam, cefalexin, cefalotin, cefamandole, cefazolin, cefepime, cefixime, cefoperazone, cefotaxime, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, cefuzonam, cephalosporin derivative, chloramphenicol, chloramphenicol derivative, ciprofloxacin, cotrimoxazole, cycloserine, doxycycline, enoxacin, erythromycin, fosfomycin, gentamicin, imipenem, kanamycin, latamoxef, lomefloxacin, meropenem, minocycline, nalidixic acid, neomycin, netilmicin, norfleroxacin, novobiocin, ofloxacin, panipenem, piperacillin, piperacillin plus tazobactam, quinolone derivative, rifampicin, sulfamethoxazole, sulperazon, sultamicillin, temafloxacin, tetracycline, tetracycline derivative, ticarcillin, timentin, tosufloxacin, trimethoprim, virulence factor, antibiotic resistance, Burkholderia pseudomallei, cellular immunity, environmental exposure, epidemic, eradication therapy, gene sequence, human, humoral immunity, infection sensitivity, melioidosis, nonhuman, pathophysiology, phagocyte, review, sepsis, vaccination, Animals, Anti-Bacterial Agents, Humans, Melioidosis, Animalia, Burkholderia, Negibacteria, Protea",
    author = "A CHENG and Bart Currie",
    year = "2005",
    language = "English",
    volume = "18",
    pages = "383--416",
    journal = "Clinical Microbiology Reviews",
    issn = "0893-8512",
    publisher = "American Society for Microbiology",
    number = "2",

    }

    Melioidosis : Epidemiology, pathophysiology, and management. / CHENG, A; Currie, Bart.

    In: Clinical Microbiology Reviews, Vol. 18, No. 2, 2005, p. 383-416.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Melioidosis

    T2 - Epidemiology, pathophysiology, and management

    AU - CHENG, A

    AU - Currie, Bart

    PY - 2005

    Y1 - 2005

    N2 - Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease. Copyright � 2005, American Society for Microbiology. All Rights Reserved.

    AB - Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease. Copyright � 2005, American Society for Microbiology. All Rights Reserved.

    KW - amikacin

    KW - amoxicillin

    KW - amoxicillin plus clavulanic acid

    KW - ampicillin

    KW - antibiotic agent

    KW - azithromycin

    KW - aztreonam

    KW - beta lactamase inhibitor

    KW - biapenem

    KW - carbapenem

    KW - carbenicillin

    KW - carumonam

    KW - cefalexin

    KW - cefalotin

    KW - cefamandole

    KW - cefazolin

    KW - cefepime

    KW - cefixime

    KW - cefoperazone

    KW - cefotaxime

    KW - cefoxitin

    KW - ceftazidime

    KW - ceftriaxone

    KW - cefuroxime

    KW - cefuzonam

    KW - cephalosporin derivative

    KW - chloramphenicol

    KW - chloramphenicol derivative

    KW - ciprofloxacin

    KW - cotrimoxazole

    KW - cycloserine

    KW - doxycycline

    KW - enoxacin

    KW - erythromycin

    KW - fosfomycin

    KW - gentamicin

    KW - imipenem

    KW - kanamycin

    KW - latamoxef

    KW - lomefloxacin

    KW - meropenem

    KW - minocycline

    KW - nalidixic acid

    KW - neomycin

    KW - netilmicin

    KW - norfleroxacin

    KW - novobiocin

    KW - ofloxacin

    KW - panipenem

    KW - piperacillin

    KW - piperacillin plus tazobactam

    KW - quinolone derivative

    KW - rifampicin

    KW - sulfamethoxazole

    KW - sulperazon

    KW - sultamicillin

    KW - temafloxacin

    KW - tetracycline

    KW - tetracycline derivative

    KW - ticarcillin

    KW - timentin

    KW - tosufloxacin

    KW - trimethoprim

    KW - virulence factor

    KW - antibiotic resistance

    KW - Burkholderia pseudomallei

    KW - cellular immunity

    KW - environmental exposure

    KW - epidemic

    KW - eradication therapy

    KW - gene sequence

    KW - human

    KW - humoral immunity

    KW - infection sensitivity

    KW - melioidosis

    KW - nonhuman

    KW - pathophysiology

    KW - phagocyte

    KW - review

    KW - sepsis

    KW - vaccination

    KW - Animals

    KW - Anti-Bacterial Agents

    KW - Humans

    KW - Melioidosis

    KW - Animalia

    KW - Burkholderia

    KW - Negibacteria

    KW - Protea

    M3 - Article

    VL - 18

    SP - 383

    EP - 416

    JO - Clinical Microbiology Reviews

    JF - Clinical Microbiology Reviews

    SN - 0893-8512

    IS - 2

    ER -