Burkholderia pseudomallei: Difference between revisions
From IDWiki
Burkholderia pseudomallei
No edit summary |
m (→) |
||
(27 intermediate revisions by the same user not shown) | |||
Line 1: | Line 1: | ||
+ | ==Background== |
||
− | = ''Burkholderia pseudomallei'' (melioidosis) = |
||
+ | *Also called '''melioidosis''' or '''Whitmore's disease''' |
||
− | = Microbiology = |
||
+ | ===Microbiology=== |
||
− | * Oxidase positive, indole-negative Gram-negative rod with "'''safety pin'''" appearance |
||
− | * Non-hemolytic |
||
+ | *Oxidase [[Oxidase::positive]], indole [[Indole::negative]] [[Stain::Gram-negative]] [[Shape::bacillus]] with "'''safety pin'''" appearance (i.e. bipolar staining) |
||
− | = Epidemiology = |
||
+ | *[[Hemolysis::Non-hemolytic]] |
||
+ | *Colonies start small, smooth, cream-coloured with a metallic sheen, but become dry and wrinkly after 1 to 2 days of incubation |
||
+ | *Inherently resistant to [[Polymixin|polymixins]] |
||
+ | ===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 Presentation = |
||
+ | *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 [[Usual incubation period::9 days]] (range [[Incubation period range::1 to 21 days]]) |
||
− | = Diagnosis = |
||
+ | *Presentations can vary from asymptomatic, skin ulcers, abscesses, latent infection, chronic pneumonia (similar to TB), or fulminant shock[[CiteRef::diemert2010th]][[CiteRef::meumann2011cl]] |
||
+ | **[[Pneumonia]] (50%) |
||
+ | **Genitourinary infection (15%) |
||
+ | **Skin infection (15%), with ulcers, nodules, or abscesses |
||
+ | **Primary bacteremia (10%) |
||
+ | **Septic arthritis/OM (3-5%) |
||
+ | **Neuro (3-5%) |
||
+ | **Disseminated infections can involve liver, spleen, lung, and prostate |
||
+ | *About 50% of clinical cases have [[Causes::bacteremia]], and 20% of cases will develop [[Causes::septic shock]] |
||
+ | *Can occasionally lay latent and reactivate decades after exposure |
||
+ | ===Prognosis and Complications=== |
||
− | * 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</ul> |
||
− | * MALDI-ToF is ''not'' reliable for identifying it |
||
− | * Other methods |
||
− | ** PCR |
||
− | ** Immunofluorescence and latex agglutination |
||
− | ** Serology (acute/convalescent) |
||
+ | *50% mortality even with high-quality care |
||
− | = Management = |
||
+ | ==Diagnosis== |
||
− | * Intrinsic resistance to many antibiotics, especially using efflux pumps |
||
− | * Ceftazidime |
||
− | * Amoxicillin-clavulanic acid |
||
− | * TMP-SMX |
||
+ | *Culture |
||
− | = Biosafety = |
||
+ | **Blood, throat, and urine cultures should be taken 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, since it is inherently resistant |
||
+ | **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 may misidentify it as [[Burkholderia thailandensis]], and automated biochemical tests may misidentify it as [[Chromobacterium violaceum]] |
||
+ | *Other methods |
||
+ | **PCR |
||
+ | **Immunofluorescence and latex agglutination |
||
+ | **Serology (acute/convalescent) |
||
+ | ==Management== |
||
− | * Lab workers can have aerosol exposure |
||
− | * May need prophylaxis in high-risk patients |
||
− | ** Septra or doxy or amox/clav</ul> |
||
− | * Monitor with serology at baseline, weeks 1 2 4 and 6 post-exposure |
||
− | ** Needs to be sent to CDC via NML</ul> |
||
+ | *Intrinsic resistance to many antibiotics, including [[colistin]], primarily using efflux pumps |
||
+ | *Treat with induction followed by eradication therapy |
||
+ | **Induction: [[Is treated by::ceftazidime]], [[Is treated by::imipenem]], or [[Is treated by::meropenem]] for 10-14 days |
||
+ | **Eradication: [[Is treated by::TMP-SMX]] for 3+ months |
||
+ | *Others: [[Is treated by::amoxicillin-clavulanic acid]] |
||
+ | |||
+ | ==Prevention== |
||
+ | |||
+ | ===Laboratory Safety=== |
||
+ | |||
+ | *[[Biosafety risk groups|Biosafety risk group 3]] |
||
+ | *Lab workers can have aerosol exposure if aerosol-generating procedure done outside of a BSC, bite/scratch from infected lab animals, or needlestick/percutaneous exposure |
||
+ | **Those at higher risk include: not wearing proper PPE, [[diabetes]], [[chronic liver disease]], [[chronic kidney disease]], [[Alcohol use disorder|alcohol abuse]], chronic [[Corticosteroids|corticosteroid]] use, [[hematologic malignancy]], [[neutropenia]] or neutrophil dysfunction, [[chronic lung disease]], [[thalassemia]], or other [[immunosuppression]] |
||
+ | *May need prophylaxis in high-risk patients |
||
+ | **[[TMP-SMX]] or [[doxycycline]] or [[amoxicillin-clavulanic acid]] |
||
+ | **[[TMP-SMX]] DS 2 tablets (>60 kg) or SS 3 tablets (40-60 kg) or DS 1 tablet (<40 kg) PO bid |
||
+ | **[[Amoxicillin-clavulanic acid]] 20/5 mg/kg/dose PO tid |
||
+ | **Duration: 21 days |
||
+ | *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''}} |
||
[[Category:Gram-negative bacilli]] |
[[Category:Gram-negative bacilli]] |
Latest revision as of 09:36, 25 May 2021
Background
- Also called melioidosis or Whitmore's disease
Microbiology
- Oxidase positive, indole negative Gram-negative bacillus with "safety pin" appearance (i.e. bipolar staining)
- Non-hemolytic
- Colonies start small, smooth, cream-coloured with a metallic sheen, but become dry and wrinkly after 1 to 2 days of incubation
- Inherently resistant to polymixins
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 shock12
- Pneumonia (50%)
- Genitourinary infection (15%)
- Skin infection (15%), with ulcers, nodules, or abscesses
- Primary bacteremia (10%)
- Septic arthritis/OM (3-5%)
- Neuro (3-5%)
- Disseminated infections can involve liver, spleen, lung, and prostate
- About 50% of clinical cases have bacteremia, and 20% of cases will develop septic shock
- Can occasionally lay latent and reactivate decades after exposure
Prognosis and Complications
- 50% mortality even with high-quality care
Diagnosis
- Culture
- Blood, throat, and urine cultures should be taken 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, since it is inherently resistant
- 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 may misidentify it as Burkholderia thailandensis, and automated biochemical tests may misidentify it as Chromobacterium violaceum
- Other methods
- PCR
- Immunofluorescence and latex agglutination
- Serology (acute/convalescent)
Management
- Intrinsic resistance to many antibiotics, including colistin, primarily using efflux pumps
- Treat with induction followed by eradication therapy
- Induction: ceftazidime, imipenem, or meropenem for 10-14 days
- Eradication: TMP-SMX for 3+ months
- Others: amoxicillin-clavulanic acid
Prevention
Laboratory Safety
- Biosafety risk group 3
- Lab workers can have aerosol exposure if aerosol-generating procedure done outside of a BSC, bite/scratch from infected lab animals, or needlestick/percutaneous exposure
- Those at higher risk include: not wearing proper PPE, diabetes, chronic liver disease, chronic kidney disease, alcohol abuse, chronic corticosteroid use, hematologic malignancy, neutropenia or neutrophil dysfunction, chronic lung disease, thalassemia, or other immunosuppression
- May need prophylaxis in high-risk patients
- TMP-SMX or doxycycline or amoxicillin-clavulanic acid
- TMP-SMX DS 2 tablets (>60 kg) or SS 3 tablets (40-60 kg) or DS 1 tablet (<40 kg) PO bid
- Amoxicillin-clavulanic acid 20/5 mg/kg/dose PO tid
- Duration: 21 days
- 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.