• 1.

    Cheng AC, Currie BJ, 2005. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 18: 383416.

  • 2.

    Wiersinga WJ, Currie BJ, Peacock SJ, 2012. Melioidosis. N Engl J Med 367: 10351044.

  • 3.

    Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, Limmathurotsakul D, 2018. Melioidosis. Nat Rev Dis Primers 4: 17107.

  • 4.

    Currie BJ, 2015. Melioidosis: evolving concepts in epidemiology pathogenesis and treatment. Semin Respir Crit Care Med 36: 111125.

  • 5.

    Cousins S, 2016. India is at high risk from surge in cases of melioidosis, warn researchers. BMJ 352: i275.

  • 6.

    Limmathurotsakul D 2016. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 1: 15008.

  • 7.

    Tipre M, Kingsley PV, Smith T, Leader M, Sathiakumar N, 2018. Melioidosis in India and Bangladesh: a review of case reports. Asian Pac J Trop Med 11: 320329.

    • Search Google Scholar
    • Export Citation
  • 8.

    Kingsley PV, Arunkumar G, Tipre M, Leader M, Sathiakumar N, 2016. Pitfalls and optimal approaches to diagnose melioidosis. Asian Pac J Trop Med 9: 515524.

    • Search Google Scholar
    • Export Citation
  • 9.

    Gassiep I, Armstrong M, Norton R, 2020. Human melioidosis. Clin Microbiol Rev 33: e00006e00019.

  • 10.

    Churuangsuk C, Chusri S, Hortiwakul T, Charernmak B, Silpapojakul K, 2016. Characteristics, clinical outcomes and factors influencing mortality of patients with melioidosis in southern Thailand: a 10-year retrospective study. Asian Pac J Trop Med 9: 256260.

    • Search Google Scholar
    • Export Citation
  • 11.

    Tellapragada C, Shaw T, D’Souza A, Eshwara VK, Mukhopadhyay C, 2017. Improved detection of Burkholderia pseudomallei from non-blood clinical specimens using enrichment culture and PCR: narrowing diagnostic gap in resource-constrained settings. Trop Med Intl Health 22: 866870.

    • Search Google Scholar
    • Export Citation
  • 12.

    Koshy M, Jagannati M, Ralph R, Victor P, David T, Sathyendra S, Veeraraghavan B, Varghese GM, 2019. Clinical manifestations, antimicrobial drug susceptibility patterns, and outcomes in melioidosis cases, India. Emerg Infect Dis 25: 316320.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mukhopadhyay C, Shaw T, Varghese GM, Dance DAB, 2018. Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan). Trop Med Infect Dis 3: 51.

    • Search Google Scholar
    • Export Citation
  • 14.

    Vidyalakshmi K, Lipika S, Vishal S, Damodar S, Chakrapani M, 2012. Emerging clinico-epidemiological trends in melioidosis: analysis of 95 cases from western coastal India. Int J Infect Dis 16: e491e497.

    • Search Google Scholar
    • Export Citation
  • 15.

    Chrispal A, Rajan SJ, Sathyendra S, 2010. The clinical profile and predictors of mortality in patients with melioidosis in South India. Trop Doct 40: 3638.

    • Search Google Scholar
    • Export Citation
  • 16.

    Tille PM, ed., 2017. Bailey & Scott’s Diagnostic Microbiology, 14th edition. St. Louis, MO: Elsevier Inc.

  • 17.

    Collee JG, Miles RS, Watt B, 1996. Test for the identification of bacteria. Collee JG, Fraser AG, Marmion BP, Simmons A, eds. Mackie and McCartney. Practical Medical Microbiology. 14th edition. London, United Kingdom: Churchill Livingstone, 131145.

    • Search Google Scholar
    • Export Citation
  • 18.

    Pitt TL, Dance DA, 2005. Burkholderia spp. and related genera. Borriello SP, Murray PR, Funke G, eds. Topley & Wilsons Microbiology & Microbial Infections. Bacteriology Vol. 2. 10th edition. Chichester, West Sussex, United Kingdom: Wiley, 16071648.

    • Search Google Scholar
    • Export Citation
  • 19.

    Suppiah J, Thimma JS, Cheah SH, Vadivelu J, 2010. Development and evaluation of polymerase chain reaction assay to detect Burkholderia genus and to differentiate the species in clinical specimens. FEMS Microbiol Lett 306: 914.

    • Search Google Scholar
    • Export Citation
  • 20.

    CLSI, 2018. Performance Standards for Antimicrobial Susceptibility Testing. CLSI Supplement M100, 28th edition. Wayne, PA: Clinical and Laboratory Standards Institute.

    • Search Google Scholar
    • Export Citation
  • 21.

    CLSI, 2015. Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. CLSI Guideline M45, 3rd edition. Wayne, PA: Clinical and Laboratory Standards Institute.

    • Search Google Scholar
    • Export Citation
  • 22.

    Mohanty S, Kapil A, Dhawan B, Das BK, 2004. Bacteriological and antimicrobial susceptibility profile of soft tissue infections from Northern India. Indian J Med Sci 58: 1015.

    • Search Google Scholar
    • Export Citation
  • 23.

    Agrawal SK, Panigrahy A, Perumalla S, Kapil A, Dhawan B, 2018. Microbiological profile and antibiotic resistance pattern of skin and soft-tissue infections: a study from Northern India. J Lab Physicians 10: 471472.

    • Search Google Scholar
    • Export Citation
  • 24.

    Sudhaharan S, Kanne P, Chavali P, Vemu L, 2018. Aerobic bacteriological profile and antimicrobial susceptibility pattern of pus isolates from tertiary care hospital in India. J Infect Dev Ctries 12: 842848.

    • Search Google Scholar
    • Export Citation
  • 25.

    Behera B 2019. Melioidosis in Odisha: a clinico-microbiological and epidemiological description of culture-confirmed cases over a 2-year period. Indian J Med Microbiol 37: 430432.

    • Search Google Scholar
    • Export Citation
  • 26.

    Kingsley PV, Leader M, Nagodawithana NS, Tipre M, Sathiakumar N, 2016. Melioidosis in Malaysia: a review of case reports. PLoS Negl Trop Dis 10: e0005182.

    • Search Google Scholar
    • Export Citation
  • 27.

    Currie BJ, Ward L, Cheng AC, 2010. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis 4: e900.

    • Search Google Scholar
    • Export Citation
  • 28.

    Mathew S, Perakath B, Mathew G, Sitaram V, Nair A, Lalitha MK, John TJ, 1999. Surgical presentation of melioidosis in India. Natl Med J India 12: 5961.

  • 29.

    Lath R, Rajshekhar V, George V, 1998. Brain abscess as the presenting feature of melioidosis. Br J Neurosurg 12: 170172.

  • 30.

    Navaneethan U, Ramesh Kumar AC, Ravi G, 2006. Multiple visceral abscess in a case of melioidosis. Indian J Med Sci 60: 6870.

  • 31.

    Mukhopadhya A, Balaji V, Jesudason MV, Amte A, Jeyamani R, Kurian G, 2007. Isolated liver abscesses in melioidosis. Indian J Med Microbiol 25: 150151.

    • Search Google Scholar
    • Export Citation
  • 32.

    Vidyalakshmi K, Shrikala B, Bharathi B, Suchitra U, 2007. Melioidosis: an under-diagnosed entity in western coastal India: a clinico-microbiological analysis. Indian J Med Microbiol 25: 245248.

    • Search Google Scholar
    • Export Citation
  • 33.

    Gopalakrishnan R, Sureshkumar D, Thirunarayan MA, Ramasubramanian V, 2013. Melioidosis: an emerging infection in India. J Assoc Physicians India 61: 612614.

    • Search Google Scholar
    • Export Citation
  • 34.

    Vishnu Prasad NR, Balasubramaniam G, Karthikeyan VS, Ramesh CK, Srinivasan K, 2012. Melioidosis of chest wall masquerading as a tubercular cold abscess. J Surg Tech Case Rep 4: 115117.

    • Search Google Scholar
    • Export Citation
  • 35.

    Kundangar RS, Bhat SN, Mohanty SP, 2017. Melioidosis mimicking tubercular cold abscess. BMJ Case Rep 2017: bcr2017221787.

  • 36.

    Sulaiman H, Ponnampalavanar S, Mun KS, Italiano CM, 2013. Cervical abscesses due to co-infection with Burkholderia pseudomallei, Salmonella enterica serovar Stanley and Mycobacterium tuberculosis in a patient with diabetes mellitus. BMC Infect Dis 13: 527.

    • Search Google Scholar
    • Export Citation
  • 37.

    Shenoy V, Kamath MP, Hegde MC, D’Souza T, Mammen SS, 2009. Melioidosis and tuberculosis: dual pathogens in a neck abscess. J Laryngol Otol 123: 12851287.

    • Search Google Scholar
    • Export Citation
  • 38.

    Perumal R, Livingston A, Samuel S, Govindaraju SK, 2020. Melioidosis of the musculoskeletal system. Med Princ Pract 29: 121127.

  • 39.

    Chowdhury FR 2018. Melioidosis in Bangladesh: a clinical and epidemiological analysis of culture-confirmed cases. Trop Med Infect Dis 3: 40.

    • Search Google Scholar
    • Export Citation
  • 40.

    Pagnarith Y, Kumar V, Thaipadungpanit J, Wuthiekanun V, Amornchai P, Sin L, Day NP, Peacock SJ, 2010. Emergence of pediatric melioidosis in Siem Reap, Cambodia. Am J Trop Med Hyg 82: 11061112.

    • Search Google Scholar
    • Export Citation
  • 41.

    Raja NS, Scarbrook C, 2016. Burkholderia pseudomallei causing bone and joint infections: a clinical update. Infect Dis Ther 5: 1729.

  • 42.

    Gibney KB, Cheng AC, Currie BJ, 2008. Cutaneous melioidosis in the tropical top end of Australia: a prospective study and review of the literature. Clin Infect Dis 47: 603609.

    • Search Google Scholar
    • Export Citation
  • 43.

    Ahmad N, Hashim R, Mohd Noor A, 2013. The in vitro antibiotic susceptibility of Malaysian isolates of Burkholderia pseudomallei. Int J Microbiol 2013: 121845.

    • Search Google Scholar
    • Export Citation
  • 44.

    Schweizer HP, 2012. Mechanisms of antibiotic resistance in Burkholderia pseudomallei: implications for treatment of melioidosis. Future Microbiol 7: 13891399.

    • Search Google Scholar
    • Export Citation
  • 45.

    Khosravi Y, Vellasamy KM, Mariappan V, Ng SL, Vadivelu J, 2014. Antimicrobial susceptibility and genetic characterisation of Burkholderia pseudomallei isolated from Malaysian patients. ScientificWorldJournal 2014: 132971.

    • Search Google Scholar
    • Export Citation

 

 

 

 

Identification and Characterization of Burkholderia pseudomallei from Localized Pyogenic Infections in Eastern India: A Clinico-Microbiological Study

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  • 1 Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India;
  • 2 Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, India;
  • 3 Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India

ABSTRACT

Melioidosis, caused by Burkholderia pseudomallei, is increasingly recognized in several regions of the globe. The present study was performed to identify and determine the frequency of B. pseudomallei infection in localized pyogenic lesions in eastern India and describe their clinico-microbiological profile. Pus samples were subjected to standard microbiological techniques for isolation and identification of various bacteria, including B. pseudomallei, which were confirmed by PCR. The clinical and demographic details of patients with melioidosis and antimicrobial susceptibility pattern of B. pseudomallei isolates were analyzed. Of 245 samples, 126 (51.4%) were culture positive, yielding 137 isolates. Staphylococcus aureus was the predominant pathogen accounting for 54 (39.4%) isolates, followed by B. pseudomallei accounting for 34 (24.8%) isolates. The mean age of the patients with melioidosis was 39.1 years, with males (24/34; 70.6%) being affected more than females (10/34; 29.4%). A majority of the patients were laborers (12/34; 35.3), followed by homemakers (8/34; 23.5%). Head and neck abscesses (35.3%) were the most common presentation followed by pyogenic lesions of the musculoskeletal system (32.3%) and deep organ abscesses (23.5%). Clinical resolution of infection was observed in 31 (91.2%) patients, relapse in two (5.9%) patients, and death in one (2.9%) patient, respectively. Susceptibility testing revealed all B. pseudomallei isolates to be completely susceptible to the following antimicrobials: ceftazidime, trimethoprim–sulfamethoxazole, imipenem, and doxycycline, with one (2.9%) resistant to amoxicillin–clavulanic acid. Burkholderia pseudomallei is an emerging etiological agent of localized pyogenic infections in eastern India, affecting a mainly adult male population. An increased vigilance along with appropriate diagnostic techniques helps in accurate diagnosis facilitating appropriate therapy.

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Author Notes

Address correspondence to Srujana Mohanty, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar -751019, India. E-mail: srujana_micro@yahoo.co.in

Financial support: The study was partially funded by the Indian Council of Medical Research (ICMR) under MD thesis grant (reference no-3/2/March-2019/PG-Thesis-HRD[35]).

Authors’ addresses: Prashanth Purushotham, Srujana Mohanty, and Ashoka Mahapatra, Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, India, E-mails: dr.prashanth.pdk@gmail.com, srujana_micro@yahoo.co.in, and meetasoka@yahoo.co.in. Preetam Chappity, Department of ENT, All India Institute of Medical Sciences, Bhubaneswar, India, E-mail: preetam82@gmail.com. Tushar Subhadarshan Mishra, Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, India, E-mail: tusharmishra@aiimsbhubaneswar.edu.in.

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