Melioidosis; Epidemiology, Pathophysiology, And Management

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Text of Melioidosis; Epidemiology, Pathophysiology, And Management

  • CLINICAL MICROBIOLOGY REVIEWS, Apr. 2005, p. 383416 Vol. 18, No. 20893-8512/05/$08.000 doi:10.1128/CMR.18.2.383416.2005Copyright 2005, American Society for Microbiology. All Rights Reserved.

    Melioidosis: Epidemiology, Pathophysiology, and ManagementAllen C. Cheng1,2 and Bart J. Currie1,2,3*

    Menzies School of Health Research, Charles Darwin University,1 Northern Territory Clinical School,Flinders University,2 and Department of Medicine, Royal Darwin Hospital,3 Darwin, Australia

    INTRODUCTION .......................................................................................................................................................384Background and History........................................................................................................................................384

    EPIDEMIOLOGY.......................................................................................................................................................384Melioidosis in the Australia-Pacific Region........................................................................................................384Distribution of Melioidosis in Asia ......................................................................................................................385Thailand ...............................................................................................................................................................385PDR Laos .............................................................................................................................................................386Vietnam ................................................................................................................................................................386Malaysia and Indonesia.....................................................................................................................................386Singapore .............................................................................................................................................................387China, Hong Kong Special Administrative Region, and Taiwan .................................................................387Other parts of Asia.............................................................................................................................................387

    Areas outside Asia ..................................................................................................................................................389Animals and Melioidosis .......................................................................................................................................389

    BACTERIOLOGY AND PATHOGENESIS.............................................................................................................389General Bacteriology ..............................................................................................................................................389Environmental Microbiology and Epidemiology ................................................................................................389Bacterial Virulence Factors ...................................................................................................................................390Secretory antigens...............................................................................................................................................390Cell-associated antigens.....................................................................................................................................391

    Molecular Epidemiology ........................................................................................................................................392Genome Sequence of B. pseudomallei and Comparison with That of B. mallei ..............................................392Role of Host Immune Responses..........................................................................................................................393Innate immunity..................................................................................................................................................393Role of macrophages in immunity....................................................................................................................393Role of T cells in immunity ...............................................................................................................................394Antibody responses .............................................................................................................................................394Other host factors...............................................................................................................................................394

    Prospects for Vaccine .............................................................................................................................................394CLINICAL FEATURES .............................................................................................................................................395Risk Factors.............................................................................................................................................................395Clinical Syndromes.................................................................................................................................................396Modes of Acquisition and Incubation Period .....................................................................................................397Melioidosis as a Potential Bioweapon .................................................................................................................398

    DIAGNOSIS AND MANAGEMENT OF MELIOIDOSIS ....................................................................................399Diagnosis..................................................................................................................................................................399Culture-based methods ......................................................................................................................................400Antigen detection ................................................................................................................................................400Antibody detection ..............................................................................................................................................400Molecular methods .............................................................................................................................................401

    Antibiotic Resistance ..............................................................................................................................................401Antibiotic Treatment ..............................................................................................................................................403Management of Sepsis Syndrome.........................................................................................................................405

    CONCLUSIONS .........................................................................................................................................................406ACKNOWLEDGMENTS ...........................................................................................................................................406REFERENCES ............................................................................................................................................................406

    * Corresponding author. Mailing address: Menzies School of HealthResearch, P.O. Box 41096, Casuarina, NT 0811, Darwin, Australia.Phone: 61 8 8922 8196. Fax: 61 8 8927 5187. E-mail: bart@menzies.edu.au.

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  • INTRODUCTION

    Background and History

    The pathologist Alfred Whitmore and his assistant C. S.Krishnaswami first described melioidosis as a glanders-likedisease among morphia addicts in Rangoon, Burma, in 1911(474, 475). They recognized a new organism that fulfilledKochs postulates for causation of disease. This bacterium,which could be isolated from autopsy specimens on peptoneagar and potato slopes, could be distinguished from the organ-ism causing glanders by its relatively rapid growth, its motility,and the lack of the Strauss reaction when it was injected intoguinea pigs. Based on these characteristics, . . . sufficientlypeculiar to distinguish it from all pathogenic bacteria previ-ously known to us (475), they correctly surmised that this newbacterium was closely related to that which caused glanders, afinding that has only recently been confirmed by molecularstudies (170, 197, 313).

    This disease, now termed melioidosis, was named from theGreek melis (distemper of asses) and eidos (resemblance)by Stanton and Fletcher in 1932 (405). During the last centurythis gram-negative environmental bacterium has been vari-ously known as Bacillus pseudomallei, Bacillus whitmorii (orBacille de Whitmore), Malleomyces pseudomallei, Pseudomonaspseudomallei, and, since 1992, Burkholderia pseudomallei (496).

    In the latter half of the 20th century, melioidosis emerged asan infectious disease of major public health importance insoutheast Asia and northern Australia. In Ubon Ratchathani,Thailand, B. pseudomallei accounts for up to approximately20% of community-acquired bacteremias (74). At the RoyalDarwin Hospital, Australia, it has been the most commoncause of fatal community-acquired bacteremic pneumonia(112, 147).

    Largely due to clinical trials in Thailand, significant improve-ments have been made in defining the optimal