Burkholderia pseudomallei: Difference between revisions
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Burkholderia pseudomallei
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| + | ==Background== |
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| − | = ''Burkholderia pseudomallei'' (melioidosis) = |
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| + | *Also called '''melioidosis''' or '''Whitmore's disease''' |
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| − | == Microbiology == |
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| + | ===Microbiology=== |
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| − | * Oxidase positive, indole-negative Gram-negative rod with "'''safety pin'''" appearance |
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| − | * Non-hemolytic |
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| + | *Oxidase [[Oxidase::positive]], indole [[Indole::negative]] [[Stain::Gram-negative]] [[Shape::bacillus]] with "'''safety pin'''" appearance (i.e. bipolar staining) |
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| − | == Epidemiology == |
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| + | *[[Hemolysis::Non-hemolytic]] |
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| + | *Colonies start small, smooth, cream-coloured with a metallic sheen, but become dry and wrinkly after 1 to 2 days of incubation |
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| + | *Inherently resistant to [[Polymixin|polymixins]] |
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| + | ===Epidemiology=== |
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| − | * Humans and animals |
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| − | * Important cause of death in SE Asia and northern Australia |
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| − | ** Up to 80% seroprevalence in Thailand, mostly asymptomatic |
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| − | ** Sporadic cases elsewhere |
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| − | * May have latent disease with reactivation much later |
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| − | * Acquired by percutaneous inoculation, inhalation (esp. lab workers), and ingestion |
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| − | * Risk factors for clinical disease |
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| − | ** Diabetes |
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| − | ** Heavy alcohol use |
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| − | ** Chronic lung disease |
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| − | ** Chronic kidney disease |
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| − | ** Treatment with glucocorticoids |
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| − | ** Cancer |
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| − | ** Thalassemia |
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| + | *Humans and animals |
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| − | == Clinical Presentation == |
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| + | *Important cause of death in south-east Asia and northern Australia |
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| + | **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 |
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| + | **Diabetes |
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| + | **Heavy alcohol use |
||
| + | **Chronic lung disease |
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| + | **Chronic kidney disease |
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| + | **Treatment with glucocorticoids |
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| + | **Cancer |
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| + | **Thalassemia |
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| + | ==Clinical Manifestations== |
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| − | * Incubation period 9 days (range 1 to 21 days) |
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| − | * Presentations can vary from asymptomatic, skin ulcers, abscesses, latent infection, chronic pneumonia (similar to TB), or fulminant shock |
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| − | ** Pneumonia (50%) |
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| − | ** GU infection (15%) |
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| − | ** Skin (15%) |
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| − | ** Primary bacteremia (10%) |
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| − | ** Septic arthritis/OM (3-5%) |
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| − | ** Neuro (3-5%) |
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| − | * About 20% of clinical cases with develop septic shock |
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| + | *Incubation period [[Usual incubation period::9 days]] (range [[Incubation period range::1 to 21 days]]) |
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| − | == Diagnosis == |
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| + | *Presentations can vary from asymptomatic, skin ulcers, abscesses, latent infection, chronic pneumonia (similar to TB), or fulminant shock[[CiteRef::diemert2010th]][[CiteRef::meumann2011cl]] |
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| + | **[[Pneumonia]] (50%) |
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| + | **Genitourinary infection (15%) |
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| + | **Skin infection (15%), with ulcers, nodules, or abscesses |
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| + | **Primary bacteremia (10%) |
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| + | **Septic arthritis/OM (3-5%) |
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| + | **Neuro (3-5%) |
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| + | **Disseminated infections can involve liver, spleen, lung, and prostate |
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| + | *About 50% of clinical cases have [[Causes::bacteremia]], and 20% of cases will develop [[Causes::septic shock]] |
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| + | *Can occasionally lay latent and reactivate decades after exposure |
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| + | ===Prognosis and Complications=== |
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| − | <ul> |
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| − | <li><p>Culture</p> |
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| − | <ul> |
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| − | <li>Blood, throat, and urine cultures from all patients with suspected melioidosis</li> |
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| − | <li>Grows on blood agar, MacConkey, etc. (i.e. ''not'' a fastidious organism) |
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| − | <ul> |
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| − | <li>Can use selective colistin or polymyxin B</li></ul> |
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| − | </li> |
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| − | <li>On sheep blood agar, grows as small, smooth, cream-coloured colony with metallic sheen |
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| − | <ul> |
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| − | <li>May develop a dry and '''wrinkled''' appearance after 1 to 2 days of incubation</li></ul> |
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| − | </li></ul> |
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| − | </li> |
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| − | <li><p>MALDI-ToF is ''not'' reliable for identifying it</p></li> |
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| − | <li><p>Other methods</p> |
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| − | <ul> |
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| − | <li>PCR</li> |
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| − | <li>Immunofluorescence and latex agglutination</li> |
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| − | <li>Serology (acute/convalescent)</li></ul> |
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| + | *50% mortality even with high-quality care |
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| − | == Management == |
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| + | ==Diagnosis== |
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| − | <ul> |
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| − | <li>Intrinsic resistance to many antibiotics, especially using efflux pumps</li> |
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| − | <li>Ceftazidime</li> |
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| − | <li>Amoxicillin-clavulanic acid</li> |
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| − | <li>TMP-SMX</li></ul> |
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| + | *Culture |
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| − | == Biosafety == |
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| + | **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 |
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| + | **PCR |
||
| + | **Immunofluorescence and latex agglutination |
||
| + | **Serology (acute/convalescent) |
||
| + | ==Management== |
||
| − | <ul> |
||
| + | |||
| − | <li>Lab workers can have aerosol exposure</li> |
||
| + | *Intrinsic resistance to many antibiotics, including [[colistin]], primarily using efflux pumps |
||
| − | <li>May need prophylaxis in high-risk patients |
||
| + | *Treat with induction followed by eradication therapy |
||
| − | <ul> |
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| + | **Induction: [[Is treated by::ceftazidime]], [[Is treated by::imipenem]], or [[Is treated by::meropenem]] for 10-14 days |
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| − | <li>Septra or doxy or amox/clav</li></ul> |
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| + | **Eradication: [[Is treated by::TMP-SMX]] for 3+ months |
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| − | </li> |
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| + | *Others: [[Is treated by::amoxicillin-clavulanic acid]] |
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| − | <li>Monitor with serology at baseline, weeks 1 2 4 and 6 post-exposure |
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| + | |||
| − | <ul> |
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| + | ==Prevention== |
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| − | <li>Needs to be sent to CDC via NML</li></ul> |
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| + | |||
| − | </li></ul> |
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| + | ===Laboratory Safety=== |
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| − | </li></ul> |
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| + | |||
| + | *[[Biosafety risk groups|Biosafety risk group 3]] |
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| + | *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 |
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| + | **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]] |
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| + | *May need prophylaxis in high-risk patients |
||
| + | **[[TMP-SMX]] or [[doxycycline]] or [[amoxicillin-clavulanic acid]] |
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| + | **[[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 |
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| + | *Monitor with serology at baseline, weeks 1 2 4 and 6 post-exposure |
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| + | **Needs to be sent to CDC via NML |
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| + | {{DISPLAYTITLE:''Burkholderia pseudomallei''}} |
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| + | [[Category:Gram-negative bacilli]] |
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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.
