Melioidosis in Tsunami Survivors

Athan, Eugene; Allworth, Anthony; Engler, Catherine; Bastian, Ivan; Cheng, Allen

doi:10.3201/eid1110.050740

Cited by 52 publications

(33 citation statements)

References 8 publications

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“…Melioidosis occurs primarily in Southeast Asia and Northern Australia, but it has increasingly been found in other tropical and subtropical regions of the world (12), in visitors returning from regions where it is endemic (11,20), or in tourists affected by natural disasters (2,8,10,37). However, B. pseudomallei has received attention in the Western Hemisphere in recent years due to its potential for use as a biological weapon (13).…”

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confidence: 99%

A Burkholderia pseudomallei Δ purM Mutant Is Avirulent in Immunocompetent and Immunodeficient Animals: Candidate Strain for Exclusion from Select-Agent Lists

et al. 2010

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Burkholderia pseudomallei causes the disease melioidosis in humans and is classified as a category B select agent. Research utilizing this pathogen is highly regulated in the United States, and even basic studies must be conducted in biosafety level 3 (BSL-3) facilities. There is currently no attenuated B. pseudomallei strain available that is excluded from select-agent regulations and can be safely handled at BSL-2 facilities. To address this need, we created Bp82 and Bp190, which are ⌬purM derivatives of B. pseudomallei strains 1026b and K96243 that are deficient in adenine and thiamine biosynthesis but replication competent in vitro in rich medium. A series of animal challenge studies was conducted to ensure that these strains were fully attenuated. Whereas the parental strains 1026b and K96243 and the complemented mutants Bp410 and Bp454 were virulent in BALB/c mice following intranasal inoculation, the ⌬purM mutants Bp82 and Bp190 were avirulent even when they were administered at doses 4 logs higher than the doses used for the parental strains. Animals challenged with high doses of the ⌬purM mutants rapidly cleared the bacterium from tissues (lung, liver, and spleen) and remained free of culturable bacteria for the duration of the experiments (up to 60 days postinfection). Moreover, highly susceptible 129/SvEv mice and immune incompetent mice (IFN-␥ ؊/؊ , SCID) were resistant to challenges with ⌬purM mutant Bp82. This strain was also avirulent in the Syrian hamster challenge model. We concluded that ⌬purM mutant Bp82 is fully attenuated and safe for use under BSL-2 laboratory conditions and thus is a candidate for exclusion from the select-agent list.

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confidence: 99%

A Burkholderia pseudomallei Δ purM Mutant Is Avirulent in Immunocompetent and Immunodeficient Animals: Candidate Strain for Exclusion from Select-Agent Lists

et al. 2010

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“…The reported incidence of melioidosis has been increasing within this region, and new foci and outbreaks of melioidosis are being described within this region and in distant locations such as Brazil (3) and New Caledonia (4). It remains unclear how much of this expansion of the global distribution boundaries is from recent spread of the causative bacterium, Burkholderia pseudomallei, and how much is from unmasking of disease after events such as the 2004 Asian tsunami (5,6). Molecular studies have shown considerable genetic diversity within B. pseudomallei (1,2,7).…”

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Identification of Melioidosis Outbreak by Multilocus Variable Number Tandem Repeat Analysis

Currie¹,

Haslem²,

Pearson³

et al. 2009

Emerg. Infect. Dis.

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Endemic melioidosis is caused by genetically diverse Burkholderia pseudomallei strains. However, clonal outbreaks (multiple cases caused by 1 strain) have occurred, such as from contaminated potable water. B. pseudomallei is designated a group B bioterrorism agent, which necessitates rapidly recognizing point-source outbreaks. Pulsedfi eld gel electrophoresis (PFGE) and multilocus sequence typing (MLST) can identify genetically related isolates, but results take several days to obtain. We developed a simplifi ed 4-locus multilocus variable number tandem repeat analysis (MLVA-4) for rapid typing and compared results with PFGE and MLST for a large number of well-characterized B. pseudomallei isolates. MLVA-4 compared favorably with MLST and PFGE for the same isolates; it discriminated between 65 multilocus sequence types and showed relatedness between epidemiologically linked isolates from outbreak clusters and between isolates from individual patients. MLVA-4 can establish or refute that a clonal outbreak of melioidosis has occurred within 8 hours of receipt of bacterial strains.

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“…The case reported here was a combined infection of Legionella and E. coli, and she developed necrotizing pneumonia, which meets the abovementioned accepted notion. In the reported tsunami victims of the Sumatra-Andaman earthquake in 2004, 7 of 16 pulmonary infection cases with microbiological examination were polymicrobial, and 8 of 13 patients with a detailed description had empyema or cavity formation (2)(3)(4)(5). Reported microbes involved in the Sumatra-Andaman earthquake of 2004 were combinations of Burkholderia pseudomallei, a Gram-negative bacterium which causes melioidosis in endemic areas such as in Thailand and northern Australia, Klebsiella species, Pseudomonas species, E. coli, Enterobacter species, Acinetobacter baumannii, Staphylococcus aureus, Nocardia species, Salmonella typhi, Mycobacterium tuberculosis, and Candida species (2-5).…”

Section: Discussionmentioning

confidence: 99%

Combined Legionella and Escherichia Coli Lung Infection after a Tsunami Disaster

et al. 2011

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Pulmonary infection after a tsunami is often polymicrobial and tends to form chronic pyogenic lung disease, necrotizing pneumonia, and empyemas. We report a combined pulmonary infection of Legionella and multiple antibiotic-resistant Escherichia coli in a previously well 75-year-old woman following immersion in tsunami waters 1 km inland from the Pacific coastline following the Tohoku Region Pacific Coast Earthquake of 2011. She needed drainage several times and the long-term use of multiple antibiotics according to the type of bacteria found and antibiotic susceptibility. We should be mindful of infections caused by multiple pathogens in the environment in Japan as a consequence of a tsunami disaster.

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Melioidosis in Tsunami Survivors

Cited by 52 publications

References 8 publications

A Burkholderia pseudomallei Δ purM Mutant Is Avirulent in Immunocompetent and Immunodeficient Animals: Candidate Strain for Exclusion from Select-Agent Lists

A Burkholderia pseudomallei Δ purM Mutant Is Avirulent in Immunocompetent and Immunodeficient Animals: Candidate Strain for Exclusion from Select-Agent Lists

Identification of Melioidosis Outbreak by Multilocus Variable Number Tandem Repeat Analysis

Combined Legionella and Escherichia Coli Lung Infection after a Tsunami Disaster

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