Application of Indirect Hemagglutination Test and Indirect Fluorescent Antibody Test for IgM Antibody for Diagnosis of Melioidosis in Thailand

Khupulsup, Kalayanee; Petchclai, B

doi:10.4269/ajtmh.1986.35.366

Cited by 49 publications

(34 citation statements)

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“…The use of the IHA is problematic in areas of endemicity, particularly in Thailand, where rates of background seropositivity may be up to 30 to 47% in various populations (238), presumably due to subclinical exposure to B. thailandensis or B. pseudomallei early in life (12,230). Background seropositivity appears to be less common in Australia, except in immigrants from southeast Asia (24); the lower cutoff titer in Australia reflects this (1:40, compared to 1:160 in Thailand) (265,308).…”

Section: Diagnosis and Management Of Melioidosis Diagnosismentioning

confidence: 99%

“…Background seropositivity appears to be less common in Australia, except in immigrants from southeast Asia (24); the lower cutoff titer in Australia reflects this (1:40, compared to 1:160 in Thailand) (265,308). Although IgM antibodies should be more specific (21,238), field tests of IgM antibody detection have not reflected this promise (142).…”

Section: Diagnosis and Management Of Melioidosis Diagnosismentioning

confidence: 99%

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Melioidosis: Epidemiology, Pathophysiology, and Management

2005

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Melioidosis, caused by the gram-negative saprophyte Burkholderia pseudomallei, is a disease of public health importance in southeast Asia and northern Australia that is associated with high case-fatality rates in animals and humans. It has the potential for epidemic spread to areas where it is not endemic, and sporadic case reports elsewhere in the world suggest that as-yet-unrecognized foci of infection may exist. Environmental determinants of this infection, apart from a close association with rainfall, are yet to be elucidated. The sequencing of the genome of a strain of B. pseudomallei has recently been completed and will help in the further identification of virulence factors. The presence of specific risk factors for infection, such as diabetes, suggests that functional neutrophil defects are important in the pathogenesis of melioidosis; other studies have defined virulence factors (including a type III secretion system) that allow evasion of killing mechanisms by phagocytes. There is a possible role for cell-mediated immunity, but repeated environmental exposure does not elicit protective humoral or cellular immunity. A vaccine is under development, but economic constraints may make vaccination an unrealistic option for many regions of endemicity. Disease manifestations are protean, and no inexpensive, practical, and accurate rapid diagnostic tests are commercially available; diagnosis relies on culture of the organism. Despite the introduction of ceftazidime- and carbapenem-based intravenous treatments, melioidosis is still associated with a significant mortality attributable to severe sepsis and its complications. A long course of oral eradication therapy is required to prevent relapse. Studies exploring the role of preventative measures, earlier clinical identification, and better management of severe sepsis are required to reduce the burden of this disease

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Section: Diagnosis and Management Of Melioidosis Diagnosismentioning

confidence: 99%

Section: Diagnosis and Management Of Melioidosis Diagnosismentioning

confidence: 99%

Melioidosis: Epidemiology, Pathophysiology, and Management

2005

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“…However, since it is the rural poor within endemic areas who are most likely to come into contact with P. pseudomallei in soil and water, but who are least likely to have access to sophisticated laboratory facilities, it is probable that active clinical melioidosis is underdiagnosed in many countries. Furthermore, seroprevalence data (6,10,42,54,83,112,139) indicate that many more individuals may have latent melioidosis (7) and be at risk of subsequent relapse (132,134). It is possible that the spread of the human immunodeficiency viruses through melioidosis endemic areas may unmask large numbers of such cases (155).…”

Section: Discussionmentioning

confidence: 99%

“…While useful as an indicator of exposure to P. pseudomallei, this test lacks diagnostic specificity in areas of high melioidosis prevalence (27) and is also of unreliable sensitivity (10). Tests to detect specific immunoglobulin M antibodies to P. pseudomallei, either by indirect immunofluorescence (6,83) or ELISA (enzyme-linked immunosorbent assay) (10,87) have shown better correlation with disease activity. Assays for the detection of P. pseudomallei antigens (174) or exotoxin (69) offer the possibility of rapid diagnostic tests but await validation in clinical use.…”

Section: Serodiagnosismentioning

confidence: 99%

Melioidosis: the tip of the iceberg?

1991

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For nearly 80 years clinical melioidosis has been considered a rare disease. This bacterial infection is caused by Pseudomonas pseudomallei, a saprophyte found in soil and surface water of endemic areas. Consequently, those who have most contact with soil, the rural poor, are likely to be at greatest risk of infection. Since the diversity of clinical manifestations necessitates the isolation and identification of the causative organism for a definitive diagnosis of melioidosis and the population at greatest risk within endemic areas rarely have access to an appropriate level of health care, the disease has probably been underrecognized. Melioidosis is now known to be an important cause of human morbidity and mortality in Thailand, and this may be true throughout Southeast Asia, which is usually regarded as the main endemic area for the disease. In Australia, melioidosis causes a smaller number of human infections, while disease among livestock has important economic and possible public health implications. Sporadic reports of the infection indicate its presence in several other tropical regions: in the Indian subcontinent, Africa, and Central and South America. Clinical melioidosis may be highly prevalent in these areas, but underdiagnosed as a result of a lack of awareness of the clinical and microbiological features of the disease, or simply because of a lack of health care facilities. Furthermore, during the last two decades the importation and transmission of melioidosis within nontropical zones have been documented. The causative organism is not difficult to grow, and modern antibiotics have improved disease prognosis. Further studies are needed to determine the true worldwide distribution and prevalence of melioidosis so that improved therapeutic and preventive measures can be developed and applied.

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“…In parts of northeastern Thailand, melioidosis accounts for nearly 20% of cases of and 40% of deaths caused by community-acquired septicemia (5). P. pseudomallei may also cause localized infections in almost any body site (7,18), while asymptomatic seroconversion is found in up to 50% of the population in endemic areas (17). The organism may remain latent for many years, causing recrudescent melioidosis at subsequent times of intercurrent stress (7,18).…”

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confidence: 99%

Pseudomonas pseudomallei resistance to beta-lactam antibiotics due to alterations in the chromosomally encoded beta-lactamase

Godfrey

Wong

Dance

et al. 1991

Antimicrob Agents Chemother

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Pseudomonas pseudomallei, the causative agent of melioidosis, is generally susceptible to some of the newer extended-spectrum cephalosporins or to combinations of a ,-lactam and clavulanic acid, a ,-lactamase inhibitor. Resistance to these agents may, however, emerge during treatment. We report on alterations in the chromosomal D-lactamase associated with the development of resistance. Three resistance patterns resulted from three different mechanisms in the strains investigated. Derepression of the chromosomal enzyme resulted in a general increase in the MICs of all of the f8-lactams tested. The second mechanism observed was an insensitivity to inhibition of the D-lactamase by clavulanic acid. In this case, the level of susceptibility to ,I-lactams as independent entities remained unchanged. The final "resistance" pattern occurred in a patient treated with ceftazidime and resulted in a I8-lactamase that was capable of hydrolyzing this antibiotic at detectable levels, but with reduced efficacy against other I-lactams. The net result was a strain that was generally susceptible to all of the I8-lactams tested except ceftazidime. In all cases, the level of susceptibility to antibiotics other than P-lactams remained unchanged. Such variability found within one genus over a relatively short time course suggests that treatment of infections caused by this organism should be carefully monitored to detect susceptibility alterations to the chosen therapy.

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Application of Indirect Hemagglutination Test and Indirect Fluorescent Antibody Test for IgM Antibody for Diagnosis of Melioidosis in Thailand

Cited by 49 publications

References 0 publications

Melioidosis: Epidemiology, Pathophysiology, and Management

Melioidosis: Epidemiology, Pathophysiology, and Management

Melioidosis: the tip of the iceberg?

Pseudomonas pseudomallei resistance to beta-lactam antibiotics due to alterations in the chromosomally encoded beta-lactamase

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