Septicemia and Suppuration in a Vietnam Veteran

Chodimella, Ushasree; Hoppes, William L.; Whalen, Scott; Ognibene, André J.; Rutecki, Gregory W.

doi:10.1080/21548331.1997.11443493

Cited by 46 publications

(37 citation statements)

References 4 publications

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“…In case of immunosuppression, melioidosis may be reactivated, with reports of latency periods lasting up to 26 years, as seen in US veterans returning from Vietnam, earning it the name the ‘Vietnamese time bomb’ [2,4,8]. …”

Section: Discussionmentioning

confidence: 99%

Melioidosis: the great mimicker

Singh

Mahmood

2017

Journal of Community Hospital Internal Medicine Perspectives

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Melioidosis is an infectious disease endemic in Northern Australia and South East Asia. It is associated with high degrees of morbidity and mortality. On average, around five cases are diagnosed annually in the USA. Diagnosis remains a challenge, as it mimics many other conditions, especially tuberculosis, hence its other name, the ‘great mimicker.’ The present case involves a recent traveler to the Philippines, who presented with episodic fevers and weight loss to his primary care physician. Blood cultures ordered grew Burkholderia pseudomallei. Primary care physicians should suspect melioidosis in symptomatic patients with travel history to endemic areas.

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Section: Discussionmentioning

confidence: 99%

Melioidosis: the great mimicker

Singh

Mahmood

2017

Journal of Community Hospital Internal Medicine Perspectives

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“…Latent periods from exposure to B. pseudomallei in an endemic region to onset of melioidosis in a nonendemic region have been documented to be as long as 29 yrs [56]. However, documented cases of re-activated B. pseudomallei are very uncommon.…”

Section: The Natural History Of Infection Withmentioning

confidence: 99%

“…Concerns of re-activation of latent infection in soldiers returned from Vietnam, with estimates from serology studies of y225,000 potential cases, resulted in melioidosis being called the ''Vietnamese time bomb'' [53,54]. However, while occasional cases of re-activation of B. pseudomallei still occur in Vietnam veterans [55,56], it is rare in comparison to the numbers exposed.…”

Section: Melioidosis In Travellers To and Returned From Endemic Regionsmentioning

confidence: 99%

Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions

Currie¹

2003

Eur Respir J

166

171

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Melioidosis is endemic in South East Asia, Asia and northern Australia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium,Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. While 20–36% of melioidosis cases have no evident predisposing risk factor, the vast majority of fatal cases have an identified risk factor, the most important of which are diabetes, alcoholism and chronic renal disease.Half of all cases present with pneumonia, but there is great clinical diversity, from localised skin ulcers or abscesses without systemic illness to fulminant septic shock with multiple abscesses in the lungs, liver, spleen and kidneys. At least 10% of cases present with a chronic respiratory illness (sick >2 months) mimicking tuberculosis and often with upper lobe infiltrates and/or cavities on chest radiography. As with tuberculosis, latency with reactivation decades after infection can also occur, although this is rare.Confirmation of diagnosis is by culture ofB. pseudomalleifrom blood, sputum, throat swab or other samples. Microbiology laboratories need to be informed of the possibility of melioidosis, as those not familiar with it can misidentify the organism. Antibiotic therapy is initial intensive therapy withi.v.ceftazidime or meropenem or imipenem +/− cotrimoxazole for ≥10 days, followed by eradication therapy with cotrimoxazole +/− doxycycline +/− chloramphenicol (first 4 weeks only) for ≥3 months.Melioidosis has been increasingly recognised in returning travellers in Europe and recently melioidosis and colonisation withB. pseudomalleihave been documented in cystic fibrosis patients visiting or resident in endemic areas.

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“…The clinical manifestations of melioidosis are extremely varied, ranging from asymptomatic seroconversion, acute and chronic infection, and localized infection involving one organ to disseminated septicemia or septic shock (15). In addition, latency of as long as 24-29 y before disease manifestation in ex-servicemen who were in Papua New Guinea and Vietnam have been described previously (16)(17)(18). The factors and mechanisms contributing to these diverse disease outcomes are unknown.…”

mentioning

confidence: 99%

Suppression of Host Innate Immune Response by Burkholderia pseudomallei through the Virulence Factor TssM

Tan

Chen²,

Lim

et al. 2010

The Journal of Immunology

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Burkholderia pseudomallei is a Gram-negative saprophyte that is the causative agent of melioidosis, a severe infectious disease endemic in Northern Australia and Southeast Asia. This organism has sparked much scientific interest in the West because of its classification as a potential bioterrorism agent by the U.S. Centers for Disease Control and Prevention. However, relatively little is known about its pathogenesis. We demonstrate that B. pseudomallei actively inhibits NF-κB and type I IFN pathway activation, thereby downregulating host inflammatory responses. We found the virulence factor TssM to be responsible for this activity. TssM interferes with the ubiquitination of critical signaling intermediates, including TNFR-associated factor-3, TNFR-associated factor-6, and IκBα. The expression but not secretion of TssM is regulated by the type III secretion system. We demonstrate that TssM is important for B. pseudomallei infection in vivo as inflammation in the tssM mutant-infected mice is more severe and corresponds to a more rapid death compared with wild-type bacteria-infected mice. Abs to TssM can be detected in the sera of melioidosis patients, indicating that TssM is functionally expressed in vivo and thus could contribute to bacterial pathogenesis in human melioidosis.

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Septicemia and Suppuration in a Vietnam Veteran

Cited by 46 publications

References 4 publications

Melioidosis: the great mimicker

Melioidosis: the great mimicker

Melioidosis: an important cause of pneumonia in residents of and travellers returned from endemic regions

Suppression of Host Innate Immune Response by Burkholderia pseudomallei through the Virulence Factor TssM

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