An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis

BMC Pulmonary Medicine

Scott C. Bell³  Bart J. Currie²  David W. Reid³  James B. Geake¹ 

[1] Department of Respiratory Medicine, The Lyell-McEwin Hospital, Haydown Road, Elizabeth Vale 5112, South Australia, Australia;Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia;QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane 4006, Australia

关键词: Therapeutics;    Patient outcome assessment;    Melioidosis;    Cystic fibrosis;    Burkholderia pseudomallei;   

Others  :  1229492
DOI  :  10.1186/s12890-015-0109-9

 received in 2015-06-30, accepted in 2015-09-23,  发布年份 2015

【 摘 要 】

Background

Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies.

Methods

We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested.

Results

25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV ₁% predicted was 60 %, and mean BMI was 19.5 kg/m ² . The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 %) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection.

Conclusion

Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection.

【 授权许可】

   
2015 Geake et al.

【 参考文献 】

• [1]Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med. 2012; 367(11):1035-44.
• [2]Currie BJ. Melioidosis: evolving concepts in epidemiology, pathogenesis and treatment. Semin Respir Crit Care Med. 2015; 36:111-25.
• [3]Currie BJ, Fisher DA, Howard DM, Burrow JN, Selvanayagam S, Snelling PL et al.. The epidemiology of melioidosis in Australia and Papua New Guinea. Acta Trop. 2000; 74(2–3):121-7.
• [4]Meumann EM, Cheng AC, Ward L, Currie BJ. Clinical features and epidemiology of melioidosis pneumonia: results from a 21-year study and review of the literature. Clin Infect Dis. 2012; 54(3):362-9.
• [5]Sarovich DS, Ward L, Price EP, Mayo M, Pitman MC, Baird RW et al.. Recurrent melioidosis in the Darwin prospective melioidosis study: improving therapies mean that relapse cases are now rare. J Clin Microbiol. 2014; 52(2):650-3.
• [6]Currie BJ, Ward L, Cheng AC. The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study. PLoS Negl Trop Dis. 2010; 4(11):e900.
• [7]Price EP, Sarovich DS, Mayo M, Tuanyok A, Drees KP, Kaestli M et al. Within-host evolution of Burkholderia pseudomallei over a twelve-year chronic carriage infection. MBio. 2013;4(4). doi:10.1128/mBio.00388-13.
• [8]Asiah K, Hanifah YA, Norzila MZ, Hasniah L, Rusanida A. Unrecognised infection in a cystic fibrosis patient. J Paediatr Child Health. 2006; 42(4):217-8.
• [9]Barth AL, de Abreu E, Silva FA, Hoffmann A, Vieira MI, Zavascki AP et al.. Cystic fibrosis patient with Burkholderia pseudomallei infection acquired in Brazil. J Clin Microbiol. 2007; 45(12):4077-80.
• [10]Corral DM, Coates AL, Yau YCW, Tellier R, Glass M, Jones SM et al.. Burkholderia pseudomallei infection in a cystic fibrosis patient from the Caribbean: a case report. Can Respir J. 2008; 15(5):237-9.
• [11]Dance DA, Smith MD, Aucken HM, Pitt TL. Imported melioidosis in England and Wales. Lancet. 1999; 353(9148):208.
• [12]O’Carroll MR, Kidd TJ, Coulter C, Smith HV, Rose BR, Harbour C et al.. Burkholderia pseudomallei: another emerging pathogen in cystic fibrosis. Thorax. 2003; 58(12):1087-91.
• [13]O’Sullivan BP, Torres B, Conidi G, Smole S, Gauthier C, Stauffer KE et al.. Burkholderia pseudomallei infection in a child with cystic fibrosis: acquisition in the Western Hemisphere. Chest. 2011; 140(1):239-42.
• [14]Schülin T, Steinmetz I. Chronic melioidosis in a patient with cystic fibrosis. J Clin Microbiol. 2001; 39(4):1676-7.
• [15]Visca P, Cazzola G, Petrucca A, Braggion C. Travel-associated Burkholderia pseudomallei infection (Melioidosis) in a patient with cystic fibrosis: a case report. Clin Infect Dis. 2001; 32(1):E15-6.
• [16]Holland DJ, Wesley A, Drinkovic D, Currie BJ. Cystic fibrosis and Burkholderia pseudomallei infection: an emerging problem? Clin Infect Dis. 2002; 35(12):e138-40.
• [17]Radhakrishna N, Morton J. Burkholderia pseudomallei in cystic fibrosis and treatment complications. Respirol Case Rep. 2014. doi:10.1002/rcr2.86.
• [18]Lezana JL, Novoa O, Lezana MA. Epidemiology of Pseudomonas in Mexican CF patients [abstract]. Pediatric Pulmonolgy. 1989; 4 Supplement:138.
• [19]Lipsitz R, Garges S, Aurigemma R, Baccam P, Blaney DD, Cheng AC et al.. Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010. Emerg Infect Dis. 2012; 18(12):e2.
• [20]Melioidosis. Centre for Disease Control, Darwin. 2012. http://health.nt.gov.au/library/scripts/objectifyMedia.aspx?file=pdf/43/46.pdf&siteID=1&str_title=Melioidosis.pdf. Accessed December 2 2014 2104.