• 1.

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

  • 2.

    Jenjaroen K et al., 2015. T-cell responses are associated with survival in acute melioidosis patients. PLoS Negl Trop Dis 9: e0004152.

  • 3.

    Cheng AC, Jacups SP, Anstey NM, Currie BJ, 2003. A proposed scoring system for predicting mortality in melioidosis. Trans R Soc Trop Med Hyg 97: 577581.

    • Search Google Scholar
    • Export Citation
  • 4.

    Chaowagul W, White NJ, Dance DAB, Wattanagoon Y, Naigowit P, Davis TME, Looareesuwan S, Pitakwatchara N, 1989. Melioidosis: a major cause of community-acquired septicemia in northeastern Thailand. J Infect Dis 159: 890899.

    • Search Google Scholar
    • Export Citation
  • 5.

    Domthong P, Chaisuksant S, Sawanyawisuth K, 2016. What clinical factors are associated with mortality in septicemic melioidosis? A report from an endemic area. J Infect Dev Ctries 10: 404409.

    • Search Google Scholar
    • Export Citation
  • 6.

    Tiangpitayakorn C, Songsivilai S, Piyasangthong N, Dharakul T, 1997. Speed of detection of Burkholderia pseudomallei in blood cultures and its correlation with the clinical outcome. Am J Trop Med Hyg 57: 9699.

    • Search Google Scholar
    • Export Citation
  • 7.

    Harris PN, Ketheesan N, Owens L, Norton RE, 2009. Clinical features that affect indirect-hemagglutination-assay responses to Burkholderia pseudomallei. Clin Vaccine Immunol 16: 924930.

    • Search Google Scholar
    • Export Citation
  • 8.

    Australian Bureau of Statistics , 2016. 2016 Census. Available at: https://www.abs.gov.au/census. Accessed March 9, 2021.

  • 9.

    Australian Research Council and Universities Australia , 2020. Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Commonwealth of Australia, Canberra: National Health and Medical Research Council.

    • Search Google Scholar
    • Export Citation
  • 10.

    Inker LA, Astor BC, Fox CH, Isakova T, Lash JP, Peralta CA, Kurella Tamura M, Feldman HI, 2014. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis 63: 713735.

    • Search Google Scholar
    • Export Citation
  • 11.

    Singer M et al., 2016. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 315: 801810.

  • 12.

    Ashdown LR, Johnson RW, Koehler JM, Cooney CA, 1989. Enzyme-linked immunosorbent assay for the diagnosis of clinical and subclinical melioidosis. J Infect Dis 160: 253260.

    • Search Google Scholar
    • Export Citation
  • 13.

    Ramsay S, Ketheesan N, Norton R, Watson AM, LaBrooy J, 2002. Peripheral blood lymphocyte subsets in acute human melioidosis. Eur J Clin Microbiol Infect Dis 21: 566568.

    • Search Google Scholar
    • Export Citation
  • 14.

    Buddhisa S, Rinchai D, Ato M, Bancroft GJ, Lertmemongkolchai G, 2015. Programmed death ligand 1 on Burkholderia pseudomallei–infected human polymorphonuclear neutrophils impairs T cell functions. J Immunol 194: 44134421.

    • Search Google Scholar
    • Export Citation
  • 15.

    Kirby P, Smith S, Ward L, Hanson J, Currie BJ, 2019. Clinical utility of platelet count as a prognostic marker for melioidosis. Am J Trop Med Hyg 100: 10851087.

    • Search Google Scholar
    • Export Citation
  • 16.

    Birnie E et al., 2019. Thrombocytopenia impairs host defense against Burkholderia pseudomallei (Melioidosis). J Infect Dis 219: 648659.

  • 17.

    Walsh AL, Smith MD, Wuthiekanun V, Suputtamongkol Y, Chaowagul W, Dance DA, Angus B, White NJ, 1995. Prognostic significance of quantitative bacteremia in septicemic melioidosis. Clin Infect Dis 21: 14981500.

    • Search Google Scholar
    • Export Citation
  • 18.

    Russell CD, Parajuli A, Gale HJ, Bulteel NS, Schuetz P, de Jager CPC, Loonen AJM, Merekoulias GI, Baillie JK, 2019. The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: a systematic review and meta-analysis. J Infect 78: 339348.

    • Search Google Scholar
    • Export Citation
  • 19.

    Kunakorn M, Boonma P, Khupulsup K, Petchclai B, 1990. Enzyme-linked immunosorbent assay for immunoglobulin M specific antibody for the diagnosis of melioidosis. J Clin Microbiol 28: 12491253.

    • Search Google Scholar
    • Export Citation
 
 

 

 

 

 

 

 

Melioidosis: Laboratory Investigations and Association with Patient Outcomes

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  • 1 University of Queensland Centre for Clinical Research, Royal Brisbane and Woman’s Hospital, Herston, Queensland, Australia;
  • | 2 Department of Infectious Diseases, Mater Hospital Brisbane, South Brisbane, Queensland, Australia;
  • | 3 Department of Medicine, Townsville University Hospital, Queensland, Australia;
  • | 4 Pathology Queensland, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia;
  • | 5 Pathology Queensland, Townsville University Hospital, Townsville, Queensland, Australia;
  • | 6 Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia

ABSTRACT.

Melioidosis is an infection caused by the bacterium Burkholderia pseudomallei. The most common presentation is bacteremia occurring in 38–73% of all patients, and the mortality rate ranges from 9% to 42%. Although there is abundant data representing risk factors for infection and patient outcomes, there is limited information regarding laboratory investigations associated with bacteremia and mortality. We assessed a range of baseline and diagnostic investigations and their association with patient outcomes in a retrospective cohort study in Townsville, Australia. 124 patients’ medical and laboratory records were reviewed between January 1, 1997 and December 31, 2020. Twenty-seven patients died and 87 patients were bacteremic. The presence of lymphopenia (< 1.5 × 109 cells/L) was the highest risk for bacteremia (relative risk [RR] 2.2; 95% CI: 1.3–3.7, P < 0.001). Factors associated with mortality included lymphopenia, (RR: 1.4; 95% CI: 1.2–1.6, P = 0.004); uremia (RR: 1.7; 95% CI: 1.1–2.5, P = 0.03); and an elevated international normalized ratio (RR: 1.5; 95% CI: 1.2–2.0, P = 0.006). Median incubation to positive blood culture result was 28 hours with 15/82 (18%) positive in ≤ 24 hours. For serological testing during admission only 53/121 (44%) were indirect hemagglutination assay positive, 67/120 (56%) enzyme immunoassay IgG positive, and 23/89 (26%) IgM positive. Simple baseline investigations at time of presentation may be used to stratify patients at high risk for both bacteremia and mortality. This information can be used as a decision aid for early intensive management.

Author Notes

Address correspondence to Ian Gassiep, Department of Infectious Diseases, Mater Hospital Brisbane, South Brisbane, Queensland, 4101, Australia. E-mail: i.gassiep@uq.edu.au

Authors’ addresses: Ian Gassiep, University of Queensland Centre for Clinical Research, Royal Brisbane and Woman’s Hospital, Herston, Queensland, Australia, and Department of Infectious Diseases, Mater Hospital Brisbane, South Brisbane, Queensland, Australia, E-mail: i.gassiep@uq.edu.au. Vibooshini Ganeshalingam, Department of Medicine, Townsville University Hospital, Townsville, Queensland, Australia, E-mail: vibooshini.ganeshalingam@health.qld.gov.au. Mark D. Chatfield, University of Queensland Centre for Clinical Research, Royal Brisbane and Woman’s Hospital, Herston, Queensland, Australia, E-mail: m.chatfield@uq.edu.au. Patrick N. A. Harris, University of Queensland Centre for Clinical Research, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia, and Pathology Queensland, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia, E-mail: p.harris@uq.edu.au. Robert E. Norton, Pathology Queensland, Townsville University Hospital, Townsville, Queensland, Australia, and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia, E-mail: robert.norton@health.qld.gov.au.

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