Article Category:
Case Report

A Novel Virulent Clinical Isolate of Burkholderia pseudomallei Imported from Thailand Exhibiting Resistance to Trimethoprim-Sulfamethoxazole

Sharon Amit Clinical Microbiology, Sheba Medical Center, Ramat-Gan, Israel;
Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel;

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David Gur Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Moshe Aftalion Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Asaf Biber Infectious Diseases Unit, The Center for Geographic Medicine and Tropical Diseases, Sheba Medical Center, Ramat-Gan, Israel;

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Paula David Department of Internal Medicine, Sheba Medical Center, Ramat-Gan, Israel;

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Inbar Cohen-Gihon Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Hila Cohen Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Ron Alcalay Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Galia Zaide Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Ofir Israeli Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Raphael Ber Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Shahar Rotem Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Ma’ayan Israeli Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Shirley Lazar Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Anat Zvi Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Adi Beth-Din Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Erez Bar-Haim Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Uri Elia Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Shay Weiss Department of Infectious Diseases, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Ofer Cohen Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Emanuelle Mamroud Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;

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Theodor Chitlaru Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel;
Faculty of Digital Technologies in Medicine, Holon Institute of Technology, Holon, Israel

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DOI:
https://doi.org/10.4269/ajtmh.24-0231
Volume/Issue:
Volume 112: Issue 1
Page(s):
116–123
Restricted access
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ABSTRACT.

We present the investigation of a Burkholderia pseudomallei strain isolated from the urine of a 56-year-old male returning from a recreational trip to Thailand. The patient initially presented with fever and chills, and lobar as well as bladder and prostate involvement was demonstrated on imaging. Treatment first involved trimethoprim-sulfamethoxazole, the backbone of melioidosis therapy, but was discontinued upon the discovery of resistance to the drug through antimicrobial sensitivity testing via broth microdilution. Further analysis included genomic sequencing, immunotyping, and phenotypic assessment, including virulence testing in an animal model. Results indicated that this strain is a distinct, novel variant with antigenic similarity to other Thai strains displaying high virulence, with a significantly low murine intranasal lethal dose 50% inoculum. The emergence of such a strain, particularly if prevalent in tourist destinations in Thailand, could pose a substantial public health risk, highlighting the need for ongoing vigilance among infectious disease specialists and clinical microbiologists.

    • Supplemental Materials (PDF 1724.9 KB)

Author Notes

Disclosure: Animal studies were approved by the local ethical committee on animal experiments (protocol number Rb-10-18).

Current contact information: Sharon Amit, Clinical Microbiology, Sheba Hospital, Tel Aviv, Israel, E-mail: sharon.amit@sheba.health.gov.il. David Gur, Moshe Aftalion, Inbar Cohen-Gihon, Hila Cohen, Ron Alcalay, Galia Zaide, Ofir Israeli, Raphael Ber, Shahar Rotem, Ma’ayan Israeli, Shirley Lazar, Anat Zvi, Adi Beth-Din, Erez Bar-Haim, Uri Elia, Shay Weiss, Ofer Cohen, Emanuelle Mamroud, and Theodor Chitlaru, Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness Ziona, Israel, E-mails: gurd@iibr.gov.il, moshea@iibr.gov.il, inbarg@iibr.gov.il, hilac@iibr.gov.il, rona@iibr.gov.il, galiaz@iibr.gov.il, ofiri@iibr.gov.il, raphaelb@iibr.gov.il, shaharr@iibr.gov.il, maayani@iibr.gov.il, shirleyl@iibr.gov.il, anatZ@iibr.gov.il, adib@iibr.gov.il, erezb@iibr.gov.il, urie@iibr.gov.il, shayw@iibr.gov.il, oferc@iibr.gov.il, emmym@iibr.gov.il, and theodorc@iibr.gov.il. Asaf Biber, The Center for Geographic Medicine and Tropical Diseases, The Chaim Sheba Medical Center, Tel Aviv, Israel, E-mail: asafbib@gmail.com. Paula David, Department of Internal Medicine, Sheba Medical Center, Tel Aviv, Israel, E-mail: paula.david@sheba.health.gov.il.

Address correspondence to Theodor Chitlaru, Department of Biochemistry and Molecular Genetics, Israel Institute for Biological Research, Ness-Ziona, Israel. E-mail: theodorc@iibr.gov.il
Copyright:
© American Society of Tropical Medicine and Hygiene 2025
Received:
10 Apr 2024
|
Accepted:
28 Jun 2024
|
Published Online:
22 Oct 2024
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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