The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation

Currie, Bart J.; Mayo, Mark; Ward, Linda; Kaestli, Mirjam; Meumann, Ella M.; Webb, Jessica R.; Woerle, Celeste; Baird, Robert W.; Price, Ric N.; Marshall, Catherine; Ralph, Anna P.; Spencer, Emma; Davies, Jane; Huffam, Sarah; Janson, Sonja; Lynar, Sarah; Markey, Peter; Krause, Vicki; Anstey, Nicholas M.

doi:10.1016/s1473-3099(21)00022-0

Cited by 97 publications

(135 citation statements)

References 42 publications

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“…We then from these data compared AMD results directly with culture results from the same patient for each of serum, urine, sputum, skin swabs, joint fluid, and other pus/tissue. Epidemiological, clinical, and laboratory data for these patients were collected as part of the Darwin Prospective Melioidosis Study, based at Royal Darwin Hospital, a 350-bed tertiary referral center in the tropical north of the Northern Territory of Australia [ 17 ]. In addition, we prospectively tested serial samples on 3 selected patients who had prolonged culture positivity for B. pseudomallei using AMD.…”

Section: Methodsmentioning

confidence: 99%

What is the Role of Lateral Flow Immunoassay for the Diagnosis of Melioidosis?

Currie

Woerle

Mayo

et al. 2022

Open Forum Infectious Diseases

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Background Culture of Burkholderia pseudomallei remains the gold standard for diagnosis of melioidosis but is not possible in many resource-limited settings where melioidosis is endemic. Direct identification of B. pseudomallei antigen in clinical samples has been developed using a lateral flow immunoassay (LFA) targeting B. pseudomallei capsular polysaccharide. Methods We summarized the findings from the 8 studies to date of the Active Melioidosis Detect (AMD) LFA and compared these with our results from 232 patients with culture-confirmed melioidosis. We have also optimized the methodology for testing different clinical samples. Results Sensitivity and specificity for different samples were broadly similar in our study to those published from Thailand, India, Laos, and Malaysia. One hundred thirty of 232 (56%) of our melioidosis patients were positive on 1 or more AMD tests: 27% for serum (rising to 39% in those with bacteremic melioidosis and 68% in those with septic shock), 63% for urine (72% in bacteremic melioidosis and 90% in septic shock), 85% in sputum that was culture positive, and 83% in pus that was culture positive. Heating sputum and pus samples increased sensitivity. Faint false-positive urine bands seen on earlier AMD versions were not seen when retested using the most recent version, AMD-Plus. Conclusions While the sensitivity of melioidosis LFA is low overall for blood samples, there is potential for use as a rapid diagnostic: testing serum and urine from those with severe sepsis who may have melioidosis and testing sputum and pus samples from clinically relevant scenarios. Prospective studies of patients with sepsis and other clinical presentations resembling melioidosis are required to ascertain if the specificity of AMD-PLUS is adequate to enable diagnosis of melioidosis with a high positive predictive value.

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Section: Methodsmentioning

confidence: 99%

What is the Role of Lateral Flow Immunoassay for the Diagnosis of Melioidosis?

Currie

Woerle

Mayo

et al. 2022

Open Forum Infectious Diseases

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“…The first human case was reported in Australia in 1950. So far, more than 1500 human cases have been reported and most patients were from the Northern Australia [1,4,40]. The reported CFR was 12% (n = 133) during 1989-2019 in Australia [40].…”

Section: Geographical Distribution Of Melioidosismentioning

confidence: 99%

“…So far, more than 1500 human cases have been reported and most patients were from the Northern Australia [1,4,40]. The reported CFR was 12% (n = 133) during 1989-2019 in Australia [40]. Cambodia, Laos and Malaysia reported more than 1000 cases of melioidosis in humans separately [4].…”

Section: Geographical Distribution Of Melioidosismentioning

confidence: 99%

“…It was perceived that farmers were more exposed to B. pseudomallei contaminated soil and flood water while working in the paddy fields during the monsoon [46]. Excessive alcohol consumption was observed to increase the risk of contracting melioidosis in Australia, Thailand, Cambodia, and India [15,31,40,89,90,99]. S2).…”

Section: Risk Factors Associated With Melioidosismentioning

confidence: 99%

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The Epidemiology of Melioidosis and Its Association with Diabetes Mellitus: A Systematic Review and Meta-Analysis

et al. 2022

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Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium Burkholderia pseudomallei. Globally, more than 35,000 human melioidosis cases have been reported since 1911. Soil acts as the natural reservoir of B. pseudomallei. Humans may become infected by this pathogen through direct contact with contaminated soil and/or water. Melioidosis commonly occurs in patients with diabetes mellitus, who increase the occurrence of melioidosis in a population. We carried out a systematic review and meta-analysis to investigate to what extent diabetes mellitus affects the patient in getting melioidosis. We selected 39 articles for meta-analysis. This extensive review also provided the latest updates on the global distribution, clinical manifestation, preexisting underlying diseases, and risk factors of melioidosis. Diabetes mellitus was identified as the predominant predisposing factor for melioidosis in humans. The overall proportion of melioidosis cases having diabetes was 45.68% (95% CI: 44.8–46.57, p < 0.001). Patients with diabetes mellitus were three times more likely to develop melioidosis than patients with no diabetes (RR 3.40, 95% CI: 2.92–3.87, p < 0.001). The other potential risk factors included old age, exposure to soil and water, preexisting underlying diseases (chronic kidney disease, lung disease, heart disease, and thalassemia), and agricultural activities. Evidence-based clinical practice guidelines for melioidosis in patients with diabetes mellitus may be developed and shared with healthcare professionals of melioidosis endemic countries to reduce morbidity.

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“…The most common clinical presentation of melioidosis is pneumonia [1]. In a study of over 7000 patients in Thailand, 38 % were diagnosed with a pulmonary infection, and in an Australian study of over 1000 patients the rate was 52 % [4,5]. The most common microbiological diagnosis is bacteraemia, which is present in up to 73 % of patients [6].…”

Section: Introductionmentioning

confidence: 99%

Comparative evaluation of Panther Fusion and real-time PCR for detection of Burkholderia pseudomallei in spiked human blood

Gassiep

Bauer

Page

et al. 2022

Access Microbiology

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Introduction. Melioidosis is an infection that most commonly presents with bacteraemia. Culture-based laboratory methods can result in a significant delay to organism identification. Molecular diagnostic techniques have a high sensitivity and rapid time to diagnosis. A decreased time to diagnosis is likely to improve patient outcomes. Aim. To compare the Panther Fusion automated molecular instrument to an in-house method for the detection of Burkholderia pseudomallei directly from spiked human whole-blood samples. Results. The in-house method detected 11/12 (92 %) samples with a B. pseudomallei concentration of 2.5–4.5×102 c.f.u. ml−1. The Panther was less reliable, detecting only 8/14 (75 %) samples with a similar bacterial concentration. The Panther was able to detect 12/12 (100 %) spiked blood culture-positive samples. Conclusion. The direct detection of B. pseudomallei from patient blood on presentation to a healthcare facility will significantly decrease time to diagnosis. We describe an in-house real-time PCR method with the lowest reported limit of detection to date. Due to lower sensitivity, the Panther Fusion would be best used as a diagnostic method directly from a positive blood culture.

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The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation

Cited by 97 publications

References 42 publications

What is the Role of Lateral Flow Immunoassay for the Diagnosis of Melioidosis?

What is the Role of Lateral Flow Immunoassay for the Diagnosis of Melioidosis?

The Epidemiology of Melioidosis and Its Association with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Comparative evaluation of Panther Fusion and real-time PCR for detection of Burkholderia pseudomallei in spiked human blood

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