Burkholderia pseudomallei: Difference between revisions
From IDWiki
Burkholderia pseudomallei
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− | == |
+ | ==Background== |
− | === |
+ | ===Microbiology=== |
− | * [[Oxidase test::Oxidase-positive]], [[Has indole test::indole-negative]] Stain::Gram-negative]] [[Has cell shape::bacillus]] with "'''safety pin'''" appearance |
||
− | * [[Has hemolysis pattern::Non-hemolytic]] |
||
− | * Colonies are dry and wrinkly |
||
+ | *[[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]] |
||
− | * [[Is treated by::TMP-SMX]] |
||
+ | *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''}} |
Revision as of 22:05, 21 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.
- ^ E. M. Meumann, A. C. Cheng, L. Ward, B. J. Currie. Clinical Features and Epidemiology of Melioidosis Pneumonia: Results From a 21-Year Study and Review of the Literature. Clinical Infectious Diseases. 2011;54(3):362-369. doi:10.1093/cid/cir808.