A simple laboratory algorithm for diagnosis of melioidosis in resource-constrained areas: a study from north-central Vietnam

Trung, Trịnh Thành; Hoang, Thi Sim; Tran, D.; Trinh, Van-Long; Göhler, André; Nguyen, Tinh; Hoang, S.N.; Krumkamp, Ralf; Nguyen, Lien Thi; May, Jürgen; Doan, Phuong Mai; Do, CD; Que, Tram A.; Steinmetz, Ivo

doi:10.1016/j.cmi.2017.07.029

Cited by 42 publications

(40 citation statements)

References 15 publications

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“…While highly sensitive, rapid, and specific, the use of B. pseudomallei -specific latex agglutination assay is too costly for public hospitals. Although antibiotic susceptibility tests for amoxicillin-clavulanate, colistin, and gentamicin are not done routinely, this diagnostic algorithm is certainly worth adopting in Malaysia as it has been shown to be useful in resource-limited laboratories in north-central Vietnam [ 56 ]. However, gentamicin-susceptible isolates need to be assessed with extra care due to the discovery of gentamicin-susceptible strains that are predominantly found in Central Sarawak [ 26 ].…”

Section: Laboratory Diagnosis Of Melioidosis In the Malaysian Healmentioning

confidence: 99%

Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis

et al. 2018

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Malaysia is an endemic hot spot for melioidosis; however, a comprehensive picture of the burden of disease, clinical presentations, and challenges faced in diagnosis and treatment of melioidosis is not available. This review provides a nonexhaustive overview of epidemiological data, clinical studies, risk factors, and mortality rates from available literature and case reports. Clinical patterns of melioidosis are generally consistent with those from South and Southeast Asia in terms of common primary presentations with diabetes as a major risk factor. Early diagnosis and appropriate management of Malaysian patients is a key limiting factor, which needs to be addressed to reduce serious complications and high mortality and recurrence rates. Promoting awareness among the local healthcare personnel is crucial to improving diagnostics and early treatment, as well as educating the Malaysian public on disease symptoms and risk factors. A further matter of urgency is the need to make this a notifiable disease and the establishment of a national melioidosis registry. We also highlight local studies on the causative agent, Burkholderia pseudomallei, with regards to bacteriology and identification of virulence factors as well as findings from host–pathogen interaction studies. Collectively, these studies have uncovered new correlations and insights for further understanding of the disease.

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Section: Laboratory Diagnosis Of Melioidosis In the Malaysian Healmentioning

confidence: 99%

Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis

et al. 2018

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“…should include a note that the organism was tested and confirmed not to be B. pseudomallei . A simple three-disc susceptibility testing method (demonstrating resistance to gentamicin and colistin but sensitivity to amoxicillin/clavulanic acid [ 67 , 68 ]) should be used in areas where resources are limited and secondary diagnostic tests (such as API 20NE and latex agglutination specific for B. pseudomallei ) are not available. All uncertain isolates should be sent for confirmation to the Department of Medical Science, MoPH, Thailand, university hospital laboratories, or any research organizations in the area willing to receive bacterial isolates for confirmation of identity.…”

Section: Current and Future Challengesmentioning

confidence: 99%

Melioidosis in Thailand: Present and Future

et al. 2018

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A recent modelling study estimated that there are 2800 deaths due to melioidosis in Thailand yearly. The Thailand Melioidosis Network (formed in 2012) has been working closely with the Ministry of Public Health (MoPH) to investigate and reduce the burden of this disease. Based on updated data, the incidence of melioidosis is still high in Northeast Thailand. More than 2000 culture-confirmed cases of melioidosis are diagnosed in general hospitals with microbiology laboratories in this region each year. The mortality rate is around 35%. Melioidosis is endemic throughout Thailand, but it is still not uncommon that microbiological facilities misidentify Burkholderia pseudomallei as a contaminant or another organism. Disease awareness is low, and people in rural areas neither wear boots nor boil water before drinking to protect themselves from acquiring B. pseudomallei. Previously, about 10 melioidosis deaths were formally reported to the National Notifiable Disease Surveillance System (Report 506) each year, thus limiting priority setting by the MoPH. In 2015, the formally reported number of melioidosis deaths rose to 112, solely because Sunpasithiprasong Hospital, Ubon Ratchathani province, reported its own data (n = 107). Melioidosis is truly an important cause of death in Thailand, and currently reported cases (Report 506) and cases diagnosed at research centers reflect the tip of the iceberg. Laboratory training and communication between clinicians and laboratory personnel are required to improve diagnosis and treatment of melioidosis countrywide. Implementation of rapid diagnostic tests, such as a lateral flow antigen detection assay, with high accuracy even in melioidosis-endemic countries such as Thailand, is critically needed. Reporting of all culture-confirmed melioidosis cases from every hospital with a microbiology laboratory, together with final outcome data, is mandated under the Communicable Diseases Act B.E.2558. By enforcing this legislation, the MoPH could raise the priority of this disease, and should consider implementing a campaign to raise awareness and melioidosis prevention countrywide.

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“…Secondly, a simple and easy-to-perform laboratory algorithm for the identification of B. pseudomallei from clinical samples, such as that described by Trinh et al [ 27 ], should be implemented in all microbiological laboratories in Indonesia. Future plans include the delivery of a workshop on how to prepare Ashdown agar, identification of B. pseudomallei , antibiotic susceptibility testing, and biosafety issues at a national meeting for laboratory staff.…”

Section: Current Recommendations and Availability Of Measures Agaimentioning

confidence: 99%

Emergence of Melioidosis in Indonesia and Today’s Challenges

Tauran

Wahyunie²,

Saad³

et al. 2018

TropicalMed

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A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.

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A simple laboratory algorithm for diagnosis of melioidosis in resource-constrained areas: a study from north-central Vietnam

Cited by 42 publications

References 15 publications

Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis

Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis

Melioidosis in Thailand: Present and Future

Emergence of Melioidosis in Indonesia and Today’s Challenges

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