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Melioidosis. Burkholderia pseudomallei

Melioidosis. Burkholderia pseudomallei



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Melioidosis Melioidosis Presentation Transcript

  • BURKHOLDERIA PSEUDOMALLEI MELIOIDOSIS.• Burkholderia pseudomallei causes an infectious disease called Melioidosis. This bacteria is most commonly found in Southeast Asia, especially in Thailand and in Northern Australia. It was first discovered in Australia in far northern Queensland in 1962, but has now spread progressively to the west and south.DR.T.V.RAO MD 2
  • WHAT IS MELIOIDOSIS?• Melioidosis, also called Whitmores disease, is an infectious disease caused by the bacterium Burkholderia pseudomallei. Melioidosis is clinically and pathologically similar to glanders disease, but the ecology and epidemiology of melioidosis are different from glanders.DR.T.V.RAO MD 3
  • AN ENVIRONMENTAL BACTERIA• Burkholderia pseudomallei is found in the soil, rice paddies, and muddy waters of these areas.• Polluted and contaminate atmosphere contributes for spread DR.T.V.RAO MD 4
  • DR.T.V.RAO MD 5
  • SPREAD OF PSEUDOMALLEI INFECTIONS• B.pseudomallei is a facultative intracellular pathogen. It is pathogenic because of its ability to invade, resist factors in serum, and survive intracellularly. It is easily contracted by inhaling dust containing the bacteria or by having contact between contaminated soil and cuts or scrapes of the skinDR.T.V.RAO MD 6
  • HOW MELIDIOSIS IS SPREAD• Humans and animals, like sheep, goats and horses are believed to acquire the infection by inhalation of dust, ingestion of contaminated water and contact with contaminated soil especially through skin abrasions. Melioidosis can also spread from person to person by contact with the body fluids of an infected person.DR.T.V.RAO MD 7
  • HUMAN INFECTIONS INITIATED• Human infections are initiated with contamination of skin abrasions.• By Ingestion• By inhalation. DR.T.V.RAO MD 8
  • CAN BE EPIZOOTIC INFECTION• Sheep, horses, Goats, swine, can harbor the infection• However animals are unlikely to be primary reservoirs of infectionDR.T.V.RAO MD 9
  • GROWTH ON STANDARD MEDIUM• Grows on Standard Bacteriological media, colonies become rough and wrinkled on prolonged incubation DR.T.V.RAO MD 11
  • COLONIES OF B.PSEUDOMALLEI ON ASHDOWN MEDIA• Ashdowns medium is a selective culture medium for the isolation and characterisation of Burkholderia pseudomallei. the medium contains crystal violet and Gentamycin as selective agents to suppress the growth of other bacteria. Colonies of B. pseudomallei also take up neutral red which is present in the medium, Ashdowns agar needs to be incubated for a minimum of 96 hours instead of 48 hours. MD DR.T.V.RAO 12
  • PATHOGENESIS• The disease can manifest as Acute, Sub acute, and Chronic disease• Incubation may be as short as 2 – 3 days• Latent infections can occurs after months to years• The infection starts with non specific lesion at the inoculum, where there can be break in the skin.• Lead to septicemia• Most common form is pulmonary infection• Can lead to suppurative infection and bacteremia DR.T.V.RAO MD 13
  • CLINICAL MANIFESTATION• Asymptomatic seroconversion• Acute form: septicaemia and is associated with very high mortality• Chronic form: long-standing suppurative focal abscesses with or without fever and is associated with a good prognosis• Fever • >95% of patients • a few days to months• White blood cell counts: • Increased:55.6% • low :3.7% DR.T.V.RAO MD 14
  • PULMONARY MELIOIDOSIS• Fever• Cough • purulent sputum • Haemoptysis is rare in acute disease but may be present in up to 31% of patients with chronic disease• Acute fulminant pneumonia with septicaemia which commonly requires mechanical ventilation and intensive care, mortality exceeding 80%• Chest radiograph • Acute: localised patch or bilateral diffuse patchy alveolar infiltration or multiple nodular lesions which may coalesce, cavitate and form abscesses. • Chronic: mimic pulmonary tuberculosis• Rarely pleural effusion, empyema, pyopericardium and hilar lymphadenopathy DR.T.V.RAO MD 15
  • RESPIRATORY INFECTION• The most dangerous infection can be associated with respiratory infection• Can lead to suppurative lesions.• Consolidations of upper lobe of the lung• Can mimic tuberculosis.• Progressive illness can produce cavities DR.T.V.RAO MD 16
  • SKIN AND SUBCUTANEOUS INVOLVEMENT• Skin and subcutaneous involvement is the second commonest presentation• Blisters, superficial erythematous pustules, clusters of violaceous skin abscesses, cellulitis and subcutaneous abscesses• Lymphadenitis or lymph node abscessDR.T.V.RAO MD 17
  • SPREADING LESIONS• Systemic infections spread from the primary lesions on the skin.• Can spread to lungs, Myocardium, Liver and Bone.• Can present with unexplained systemic disease. DR.T.V.RAO MD 18
  • UROGENITAL TRACT INFECTION• Prostatic abscess • 18% of adult males with melioidosis in Australia• Pyonephrosis, pyelonephritis, perinephric abscess and scrotal abscess 1-5DR.T.V.RAO MD 19
  • MELIOIDOSIS IN CHILDREN• Acute septicaemia with foci of infection in the lungs (the most frequently involved organ), liver, spleen or other organs• Localised infection is common • Unilateral suppurative parotitis has been reported to account for 40% of localised melioidosis in Thailand • unilateral parotid swelling with abscess formation • facial nerve paralysis • periorbital cellulitis • conjunctivitis • purulent discharges at the opening of Stensen’s duct and the ear • Pharyngocervical melioidosis: fever and sore throat with or without cervical lymphadenopathy. DR.T.V.RAO MD 20
  • LATENT INFECTION IN MELIOIDOSIS• The latent infection can reactivate as result of immuno suppression• A high level of suscipicion in endemic areas is gratifying.• Any unexplained clinical symptoms and signs should be explored for infections.DR.T.V.RAO MD 21
  • WHO ARE AT RISK• Individuals with diabetes are at a higher risk for contracting melioidosis. About 40% of melioidosis patients are diabetic. Other factors that may increase the risk of contracting melioidosis are excessive alcohol consumption, chronic renal disease, and chronic lung disease. However, even though these factors do increase the risk of contracting melioidosis, cases of infection can still occur in healthy adults and children occasionally. DR.T.V.RAO MD 22
  • CLUES TO RESPIRATORY INFECTION• Pulmonary infection: This form of the disease can produce a clinical picture of mild bronchitis to severe pneumonia. The onset of pulmonary melioidosis is typically accompanied by a high fever, headache, anorexia, and general muscle soreness. Chest pain is common, but a non- productive or productive cough with normal sputum is the hallmark of this form of melioidosis.DR.T.V.RAO MD 23
  • IMMUNE SUPPRESSION CAN BE LEADING CAUSE• Acute bloodstream infection: Patients with underlying illness such as HIV, renal failure, and diabetes are affected by this type of the disease, which usually results in septic shock. The symptoms of the bloodstream infection vary depending on the site of original infection, but they generally include respiratory distress, severe headache, fever, diarrheal, development of pus- filled lesions on the skin, muscle tenderness, and disorientation. This is typically an infection of short duration, and abscesses will be found throughout the body. DR.T.V.RAO MD 24
  • DIAGNOSIS• Melioidosis is diagnosed by isolating Burkholderia pseudomallei from the blood, urine, sputum, or skin lesions. Detecting and measuring antibodies to the bacteria in the blood is another means of diagnosis DR.T.V.RAO MD 25
  • BACTERIOLOGICAL DIAGNOSIS• Gram stain of the material from skin lesions, sputum.• Small gram-ve bacilli with specific Bipolar staining can be leading clue.• In all suspected cases staining with Wrights stain and methylene blue DR.T.V.RAO MD 26
  • LABORATORY DIAGNOSIS• Ashdown /Francis medium that contains aminoglycoside to which this organism is resistant: non- sterile specimens• Blood agar and chocolate media: sterile specimens• Throat swab has been shown to have 100% specificity with 38% and 47% sensitivity in adult and paediatric patients, respectively • J Clin Microbiology 2001; 39:3901-2 , J Infect Dis 1993; 167: 230-33 DR.T.V.RAO MD 27
  • LABORATORY DIAGNOSIS• Serology • a high background of positive serology in the general population • acute seroconversion in a clinically septic patient strongly suggests melioidosis.• Monoclonal antibody and polymerase chain reaction• Chest radiograph• Ultrasound examination• Abdominal and pelvic CT scan DR.T.V.RAO MD 28
  • SEROLOGY • Strains of B.pseudomallei are identified serologically by agglutination tests, rapid slide or tube agglutination • Recently ELISA based on monoclonal antitoxin is available for rapid diagnosis in endemic areas of melioidosis.DR.T.V.RAO MD 29
  • EPIDEMIOLOGY• Farming has been shown to be strongly associated with incidences of melioidosis4. In Thailand, 81% of Melioidosis patients were rice-farmers and their family members• Mode of transmission • direct entry of the organism into the blood stream via very minor wounds • inhalation of contaminated dust • drowning • motor vehicle accident • breast milk • perinatal transmission • human-to-human transmission DR.T.V.RAO MD 30
  • TREATMENT• As the disease carries high mortality, a prompt and effective treatment is highly essential• A surgical drainage of organized surgical lesions.• Tetracyclines, Sulfonamides, Trimethoprim-Sulphmethoxazole are effective.• Ceftazidime is highly effective• The duration of treatment should lost at least 8 weeks.• The treatment lasting 6moths to 1 year are considered in immunosuppressive conditions.• No Vaccines are available DR.T.V.RAO MD 31
  • BIO HAZARD AND B.PSEUDOMALLEI• Human laboratory acquired infection with, B.pseudomallei and P.mallei is a hazard• Both organisms are included in category A pathogen.• Included in category 3 and to be handled with greatest care and strict and designated isolation conditions. DR.T.V.RAO MD 32