Burkholderia pseudomallei: Difference between revisions
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Burkholderia pseudomallei
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== |
==Background== |
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=== |
===Microbiology=== |
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* [[Oxidase test::Oxidase-positive]], [[Has indole test::indole-negative]] Stain::Gram-negative]] [[Has cell shape::bacillus]] with "'''safety pin'''" appearance |
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* [[Has hemolysis pattern::Non-hemolytic]] |
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* Colonies are dry and wrinkly |
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*[[Oxidase test::Oxidase-positive]], [[Has indole test::indole-negative]] Stain::Gram-negative]] [[Has cell shape::bacillus]] with "'''safety pin'''" appearance |
|||
=== Epidemiology === |
|||
*[[Has hemolysis pattern::Non-hemolytic]] |
|||
*Colonies are dry and wrinkly |
|||
===Epidemiology=== |
|||
* Humans and animals |
|||
* Important cause of death in SE Asia and northern Australia |
|||
** Up to 80% seroprevalence in Thailand, mostly asymptomatic |
|||
** Sporadic cases elsewhere |
|||
* May have latent disease with reactivation much later |
|||
* Acquired by percutaneous inoculation, inhalation (esp. lab workers), and ingestion |
|||
* Risk factors for clinical disease |
|||
** Diabetes |
|||
** Heavy alcohol use |
|||
** Chronic lung disease |
|||
** Chronic kidney disease |
|||
** Treatment with glucocorticoids |
|||
** Cancer |
|||
** Thalassemia |
|||
*Humans and animals |
|||
== Clinical Manifestations == |
|||
*Important cause of death in south-east Asia and northern Australia |
|||
**Up to 80% seroprevalence in Thailand, mostly asymptomatic |
|||
**More cases during the rainy season |
|||
**Sporadic cases elsewhere, including the Middle East, Africa, and the Americas |
|||
*May have latent disease with reactivation much later |
|||
*Acquired by percutaneous inoculation, inhalation (esp. lab workers), and ingestion |
|||
*Risk factors for clinical disease |
|||
**Diabetes |
|||
**Heavy alcohol use |
|||
**Chronic lung disease |
|||
**Chronic kidney disease |
|||
**Treatment with glucocorticoids |
|||
**Cancer |
|||
**Thalassemia |
|||
==Clinical Manifestations== |
|||
* Incubation period 9 days (range 1 to 21 days) |
|||
* Presentations can vary from asymptomatic, skin ulcers, abscesses, latent infection, chronic pneumonia (similar to TB), or fulminant shock |
|||
** Pneumonia (50%) |
|||
** GU infection (15%) |
|||
** Skin (15%) |
|||
** Primary bacteremia (10%) |
|||
** Septic arthritis/OM (3-5%) |
|||
** Neuro (3-5%) |
|||
* About 20% of clinical cases with develop septic shock |
|||
*Incubation period 9 days (range 1 to 21 days) |
|||
== Diagnosis == |
|||
*Presentations can vary from asymptomatic, skin ulcers, abscesses, latent infection, chronic pneumonia (similar to TB), or fulminant shock |
|||
**Pneumonia (50%) |
|||
**GU infection (15%) |
|||
**Skin (15%) |
|||
**Primary bacteremia (10%) |
|||
**Septic arthritis/OM (3-5%) |
|||
**Neuro (3-5%) |
|||
*About 20% of clinical cases with develop septic shock |
|||
==Diagnosis== |
|||
* Culture |
|||
** Blood, throat, and urine cultures from all patients with suspected melioidosis |
|||
** Grows on blood agar, MacConkey, etc. (i.e. ''not'' a fastidious organism) |
|||
** Can use selective colistin or polymyxin B |
|||
** On sheep blood agar, grows as small, smooth, cream-coloured colony with metallic sheen |
|||
** May develop a dry and '''wrinkled''' appearance after 1 to 2 days of incubation |
|||
* MALDI-ToF is ''not'' reliable for identifying it |
|||
* Other methods |
|||
** PCR |
|||
** Immunofluorescence and latex agglutination |
|||
** Serology (acute/convalescent) |
|||
*Culture |
|||
== Management == |
|||
**Blood, throat, and urine cultures from all patients with suspected melioidosis |
|||
**Grows on blood agar, MacConkey, etc. (i.e. ''not'' a fastidious organism) |
|||
**Can use selective colistin or polymyxin B |
|||
**On sheep blood agar, grows as small, smooth, cream-coloured colony with metallic sheen |
|||
**May develop a dry and '''wrinkled''' appearance after 1 to 2 days of incubation |
|||
*MALDI-ToF is ''not'' reliable for identifying it |
|||
*Other methods |
|||
**PCR |
|||
**Immunofluorescence and latex agglutination |
|||
**Serology (acute/convalescent) |
|||
==Management== |
|||
* Intrinsic resistance to many antibiotics, especially using efflux pumps |
|||
* [[Is treated by::Ceftazidime]] |
|||
* [[Is treated by::Amoxicillin-clavulanic acid]] |
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* [[Is treated by::TMP-SMX]] |
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*Intrinsic resistance to many antibiotics, especially using efflux pumps |
|||
== Biosafety == |
|||
*[[Is treated by::Ceftazidime]] |
|||
*[[Is treated by::Amoxicillin-clavulanic acid]] |
|||
*[[Is treated by::TMP-SMX]] |
|||
==Biosafety== |
|||
* Lab workers can have aerosol exposure |
|||
* May need prophylaxis in high-risk patients |
|||
*Lab workers can have aerosol exposure |
|||
** [[TMP-SMX]] or [[doxycycline]] or [[amoxicillin-clavulanic acid]] |
|||
*May need prophylaxis in high-risk patients |
|||
* Monitor with serology at baseline, weeks 1 2 4 and 6 post-exposure |
|||
**[[TMP-SMX]] or [[doxycycline]] or [[amoxicillin-clavulanic acid]] |
|||
** Needs to be sent to CDC via NML |
|||
*Monitor with serology at baseline, weeks 1 2 4 and 6 post-exposure |
|||
**Needs to be sent to CDC via NML |
|||
{{DISPLAYTITLE:''Burkholderia pseudomallei''}} |
{{DISPLAYTITLE:''Burkholderia pseudomallei''}} |
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Revision as of 02:05, 22 July 2020
Background
Microbiology
- Oxidase-positive, indole-negative Stain::Gram-negative]] bacillus with "safety pin" appearance
- Non-hemolytic
- Colonies are dry and wrinkly
Epidemiology
- Humans and animals
- Important cause of death in south-east Asia and northern Australia
- Up to 80% seroprevalence in Thailand, mostly asymptomatic
- More cases during the rainy season
- Sporadic cases elsewhere, including the Middle East, Africa, and the Americas
- May have latent disease with reactivation much later
- Acquired by percutaneous inoculation, inhalation (esp. lab workers), and ingestion
- Risk factors for clinical disease
- Diabetes
- Heavy alcohol use
- Chronic lung disease
- Chronic kidney disease
- Treatment with glucocorticoids
- Cancer
- Thalassemia
Clinical Manifestations
- Incubation period 9 days (range 1 to 21 days)
- Presentations can vary from asymptomatic, skin ulcers, abscesses, latent infection, chronic pneumonia (similar to TB), or fulminant shock
- Pneumonia (50%)
- GU infection (15%)
- Skin (15%)
- Primary bacteremia (10%)
- Septic arthritis/OM (3-5%)
- Neuro (3-5%)
- About 20% of clinical cases with develop septic shock
Diagnosis
- Culture
- Blood, throat, and urine cultures from all patients with suspected melioidosis
- Grows on blood agar, MacConkey, etc. (i.e. not a fastidious organism)
- Can use selective colistin or polymyxin B
- On sheep blood agar, grows as small, smooth, cream-coloured colony with metallic sheen
- May develop a dry and wrinkled appearance after 1 to 2 days of incubation
- MALDI-ToF is not reliable for identifying it
- Other methods
- PCR
- Immunofluorescence and latex agglutination
- Serology (acute/convalescent)
Management
- Intrinsic resistance to many antibiotics, especially using efflux pumps
- Ceftazidime
- Amoxicillin-clavulanic acid
- TMP-SMX
Biosafety
- Lab workers can have aerosol exposure
- May need prophylaxis in high-risk patients
- Monitor with serology at baseline, weeks 1 2 4 and 6 post-exposure
- Needs to be sent to CDC via NML
References
- ^ Bart J. Currie, Linda Ward, Allen C. Cheng. David Joseph Diemert. The Epidemiology and Clinical Spectrum of Melioidosis: 540 Cases from the 20 Year Darwin Prospective Study. PLoS Neglected Tropical Diseases. 2010;4(11):e900. doi:10.1371/journal.pntd.0000900.
