Search Results (103)

Background: Melioidosis is a severe infectious disease caused by Burkholderia pseudomallei, with high mortality rates, particularly in severe cases complicated by acute kidney injury (AKI). Objective: The objective of this study was to systematically review and quantitatively synthesize the impact of AKI on mortality and other clinical outcomes—including ICU admission and the need for renal replacement therapy (RRT)—in patients with melioidosis. Methods: A systematic search was conducted in PubMed, Scopus, and Embase up to 16 May 2025. Studies reporting mortality, ICU admission, or RRT use in patients with AKI were included. A random-effects meta-analysis was performed to estimate the odds ratio (OR) for mortality associated with AKI. Results: Twenty-nine studies (380 patients) were included. AKI occurred in 123 patients (32.4%). The pooled analysis revealed that AKI patients had a significantly higher mortality risk than non-AKI patients (OR = 23.37; 95% CI: 13.97–39.10; p = 0.0082), with no significant heterogeneity (I² = 0%). Sensitivity analysis confirmed the robustness of this association. ICU admission and RRT data were frequently reported but were not suitable for meta-analysis due to insufficient data. Conclusions: AKI is a serious complication in melioidosis, significantly increasing the risk of mortality. Early recognition and aggressive management of AKI in melioidosis may be critical to improving clinical outcomes. Full article

Background: Burkholderia pseudomallei, the causative agent of melioidosis, is intrinsically resistant to multiple antibiotics, posing substantial challenges for treatment. Reports of acquired resistance are increasing, underscoring the need for global surveillance. Objective: This systematic review and meta-analysis aimed to determine the global prevalence of antibiotic-resistant B. pseudomallei isolated from human clinical cases, with a focus on regional differences and variations in antimicrobial susceptibility testing methods. Methods: We systematically searched PubMed, Scopus, and Embase for studies reporting resistance in clinical B. pseudomallei isolates, following PRISMA guidelines. Pooled resistance rates to 11 antibiotics were calculated using a random-effect model. Subgroup analyses were performed based on geographical region and testing methodology (MIC vs. disk diffusion). Results: Twelve studies comprising 10,391 isolates were included. Resistance rates varied across antibiotics, with the highest pooled resistance observed for tigecycline (46.3%) and ciprofloxacin (38.3%). Ceftazidime (CAZ) and trimethoprim–sulfamethoxazole (SXT), commonly used first-line agents, showed resistance rates of 5.3% and 4.2%, respectively. Subgroup analyses of CAZ and SXT revealed significantly higher resistance in studies from Asia compared to Australia and America (p value < 0.0001). Disk diffusion methods tended to overestimate resistance compared to MIC-based approaches, which revealed non-significant differences for CAZ (p value = 0.5343) but significant differences for SXT (p value < 0.0001). Conclusions: Antibiotic resistance in B. pseudomallei exhibits regional variation and is influenced by the susceptibility testing method used. Surveillance programs and standardized antimicrobial susceptibility testing protocols are essential to guide effective treatment strategies and ensure accurate resistance reporting. Full article

Biofilms formation by the Burkholderia cepacia complex (Bcc) poses a considerable risk to hospital environments, particularly for immunocompromised individuals. These bacteria exhibit notable resistance to disinfectants and antibiotics, mainly due to their ability to adhere to biotic and abiotic surfaces, forming highly persistent biofilms, contamination, and pharmaceutical solutions. These microbial structures function as protective shields, impeding the effective action of antimicrobial compounds and facilitating the occurrence of chronic infections and outbreaks in healthcare settings. The high genetic plasticity of the Bcc, evidenced by the presence of multiple chromosomes and the ease of horizontal gene transfer, further enhances its capacity for adaptation and treatment resistance. Moreover, the ability of the Bcc to survive in aquatic environments and withstand unfavorable conditions heightens concerns regarding the contamination of pharmaceutical products. This study examines the molecular mechanisms underlying Bcc biofilm formation, its impact on hospital infections, and the challenges associated with its eradication. It also discusses the current detection techniques available and innovative approaches to mitigating contamination in pharmaceutical products. In summary, a thorough understanding of the mechanisms underlying Bcc biofilm formation and maintenance is crucial for implementing more effective preventive measures and minimizing the risks associated with hospital infections. Full article

Melioidosis, caused by Burkholderia pseudomallei, is a potentially fatal infection, particularly affecting individuals with chronic conditions such as diabetes or kidney or liver diseases. This review examines melioidosis in India over the past two decades, focusing on its prevalence, risk factors and clinical manifestations. A PubMed search (2000–2024) identified a rise in melioidosis publications, with most from Southern India, followed by Eastern India, and an increase post-2019. Eight studies from 2010–2022 identified fever (86%), cough (26%) and joint pain (23%) as the most common symptoms, while diabetes (75%), alcohol abuse (19%) and cancer (6%) were primary predisposing factors. Severe clinical manifestations were also observed, including bacteremia (50%), pneumonia (37%) and splenic abscess (18%). Although environmental exposure risks were not significantly high, individuals with diabetes or chronic kidney disease, particularly those working in high-risk environments, were more likely to contract melioidosis. Cryptic environmental factors that might bridge known epidemiological risk factors are also addressed. The review emphasizes the increasing awareness and research in clinical epidemiology and also highlights a gap in studies on antimicrobial treatments, vaccines and environmental surveillance. Targeted interventions in diabetes and poverty hotspots could help control the disease more effectively. Full article

Objectives: This study aimed to evaluate the prognostic impact of coinfections and other clinical factors on mortality in melioidosis patients, providing a comprehensive analysis through systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Embase, Scopus, and other sources for studies published from their inception to August 2023. Studies reporting mortality outcomes in melioidosis patients with and without coinfections were included. Mixed-effects logistic regression models were used to estimate the causal association of each prognostic factor on the outcome. Directed acyclic graphs (DAGs) were used to guide confounding adjustment, and missing data were handled using multiple imputations. Results: A total of 346 studies involving 509 patients were analyzed. Coinfections were observed in 10.8% of patients with tuberculosis and Leptospira spp. being the most common. Disseminated disease significantly increased the odds of death (OR 4.93, 95% CI: 2.14–11.37, p < 0.001). Coinfections were associated with a higher mortality rate, but the association was not statistically significant (OR 2.70, 95% CI: 0.53–13.90, p = 0.172). Sensitivity analyses confirmed the robustness of the findings. Other factors, including diabetes mellitus and agricultural occupation, were evaluated for their associations with mortality. Conclusions: Disseminated melioidosis remains a significant factor influencing prognosis. Although less common, coinfections may contribute to worsen patient outcomes, emphasizing the importance of immediate and accurate diagnosis and comprehensive management. Full article

Melioidosis is an endemic tropical disease caused by Burkholderia pseudomallei. It typically causes pulmonary disease and bacteraemia but can disseminate to cause multi-organ disease. 18-F FDG PET/CT has an evolving role in diagnosing other infectious diseases, especially where the pathogen or extent of infection is challenging to elucidate clinically and with conventional imaging (CT, US and MRI). We present a case series of patients diagnosed with melioidosis who also underwent 18-F FDG PET/CT from December 18th 2018 to September 30th 2022. Indications for imaging were categorised and analysed as to whether 18-F FDG PET/CT changed management over conventional imaging. Twenty-one 18-F FDG PET/CT scans were performed for sixteen patients. Two scans (9.5%) performed for pyrexia of unknown origin changed management in both cases. Twelve scans (57.1%) performed to ascertain the extent of dissemination of melioidosis changed management in only three (25%) cases. Five scans (23.8%) performed to monitor the response to treatment of known foci changed management in all five cases. Five scans (23.8%) performed for suspected or known malignancy changed management in three (60%) cases. 18-F FDG PET/CT is an emerging tool which improves diagnosis and changes the management of melioidosis when applied judiciously and for well-selected indications. Full article

Melioidosis, an infection with the bacterium Burkholderia pseudomallei, is highly endemic in the Top End of the Northern Territory of Australia. The indirect haemagglutination assay (IHA) is the most widely used serology test globally, but it is not standardised among the limited number of laboratories that perform it. While concerns have been raised about the sensitivity of IHA early in melioidosis infections, the advantage of IHA over more recently developed ELISAs is that testing serial dilutions allows a titre to be recorded. While in Australia a titre of 1:40 or higher is considered positive, the specificity at these low positive titres remains uncertain. However, a high titre is considered to represent recent or past true infection with B. pseudomallei, rather than cross-rection with other environmental Burkholderia species. Also, the natural history of IHA titres over time, in both asymptomatic infection and melioidosis has been little studied. We have assessed the clinical status and serology time courses of all 534 patients who had an IHA titre of 1:640 or higher, over a 20-year period. Of these, 324 (60.7%) were diagnosed with culture-confirmed melioidosis, with varying time courses of diagnosis of melioidosis in relation to the high serology. Of the 210 without confirmed melioidosis, 22 (10.5%) were considered highly likely to be melioidosis despite being culture-negative, and these were all treated as melioidosis. In the remainder, titres mostly gradually decreased over time, but the majority remained seropositive. A small number who had not been treated for melioidosis continued to have high IHA titres over years and activation from latency with a new diagnosis of melioidosis was occasionally documented. This study highlights the importance of a full clinical workup in those found to have high titre melioidosis serology as well as subsequent close clinical surveillance and where resources allow, yearly IHA in those not confirmed or treated as melioidosis. Full article

Melioidosis is a zoonotic disease that is caused by Burkholderia pseudomallei, which is a serious public health and safety risk. In order to explore the global animal melioidosis risk distribution and its dynamic response to future climate scenarios, we collected global data about reported animal incidence sites. Data regarding the density of Burkholderia pseudomallei in the environment were created by collecting and sorting information about the Burkholderia pseudomallei occurrence sites in contaminated air, soil, and water. Combined with bioclimatic variables, the maximum entropy (MaxEnt) niche was modeled for global animal melioidosis. The findings indicate that under current bioclimatic conditions, global animal melioidosis risk regions are concentrated between 30° S and 30° N, with high-risk areas being mainly in Central America, the northern part of South America, and eastern and southern India, among others. Most countries will expand their risk regions under future climatic scenarios. Melioidosis risk expanding towards higher northern latitudes has led to new epidemic areas. In addition, the melioidosis risk area will contract in some areas. Therefore, we have provided a basis for global melioidosis surveillance and propose feasible strategies for prevention and control in high-risk regions, which will help countries to carry out targeted surveillance and prevention to reduce risks and losses. Full article

Multiple blood pathogen infections are increasingly found in many areas, particularly in tropical regions. This study aimed to investigate the effectiveness and safety of using doxycycline monotherapy to treat triple blood pathogen infection in sheltered dogs. A total of 375 sheltered dogs were screened for blood pathogen using polymerase chain reaction technique (PCR). There were 34 dogs with triple infection (Babesia vogeli, Ehrlichia canis, and Anaplasma platys), and most dogs displayed anemia and thrombocytopenia. These dogs were treated with doxycycline (10 mg/kg/day) orally for four weeks, and their blood profiles were monitored. Almost all pathogens were undetectable by PCR by day 14 and pathogens were all cleared by day 28. Most blood profiles significantly improved after 14 days. The improvement continued after 28 days. The red blood cell and platelet count (PLT) were increased in similar trends between mild-to-moderate and severe thrombocytopenia groups. The average PLT in the mild-to-moderate thrombocytopenia group raised to normal level by day 14, whereas in the severe group, it was gradually increased to normal level by day 70. We propose using doxycycline monotherapy for 28 days to eliminate all pathogens, and facilitate recovery and welfare in dogs suffering with triple blood pathogen infections. Full article

Food contamination with non-typhoidal Salmonella (NTS) presents a significant public health risk, underscoring the critical need for rigorous food safety measures throughout the production, distribution, preparation, and consumption stages. Conventional diagnostic strategies are time-consuming and labor-intensive and are thus sub-optimal for throughput NTS detection. Bacteriophages (phages) are highly specialized bacterial viruses and exhibit extreme specificity for their hosts. This organic phage/bacterial interaction provides an invaluable tool that can potentially replace or complement existing S. enterica detection methods. Here, we explored work in this area and reviewed data from PubMed/MEDLINE, Embase, and ScienceDirect up to 4 November 2024. Thirty-five studies were selected from 607 retrieved articles using the JBI Critical Appraisal Checklist to ensure quality. Salmonella enrichment, rapid detection, and effective recovery in diverse food sources for various NTS serovars were targeted. Utilizing phages as bio-probes alongside lateral flow immunoassays, surface-enhanced Raman spectroscopy, fluorescence, and electrochemistry assays enabled rapid and highly sensitive detection of NTS, achieving limits as low as 7 to 8 CFU/mL within 30 min. Balancing detection sensitivity with rapid analysis time is essential. Further research and development will be pivotal to overcoming challenges and maximizing the efficiency of NTS phage-based detection to ensure optimal food safety. Full article

Endemic in over 45 countries globally, recent reports of locally acquired melioidosis in novel geographical areas, such as the Southern US, have highlighted the expanding geographical range of Burkholderia pseudomallei. Climate change and severe weather events have been linked to an increase in cases of melioidosis, which follows environmental exposure to the bacterium. Healthcare professionals should be aware of the possibility of the disease, with its diverse and often delayed presentations, even in areas not previously known to have risk. Over 200 cases of travel-associated melioidosis have been reported in the literature, highlighting the need to consider this disease in non-endemic areas, as diagnostic delays of up to 18 months have been identified. The review updates the global epidemiology of melioidosis, focusing on new geographical areas where cases have been diagnosed and imported cases, unusual clinical presentations and co-infections, and less frequent modes of transmission (laboratory exposures and the risk of acquisition due to imported infected animals and contaminated products). Full article

This study investigated species diversity and seasonal abundance of Stomoxyinae and tabanid flies, which are significant pests and vectors of animal pathogens, on a beef cattle and a buffalo farm in Nakhon Si Thammarat province, southern Thailand. During a one-year period from December 2020 to November 2021, flies were collected using Nzi traps from 6 a.m. to 6 p.m. over three consecutive days each month, resulting in the capture of 1912 biting flies, representing seven Stomoxyinae and nine tabanid species. The five most prevalent species were Tabanus megalops, Haematobia irritans exigua, Stomoxys calcitrans, Stomoxys indicus, and Stomoxys uruma. Fly density was notably higher on the beef cattle farm compared to the buffalo farm, with most species peaking during the rainy season, except for H. i. exigua, which was more abundant during the dry season. This study also examined the influence of temperature, relative humidity, and rainfall on fly density, revealing species-specific patterns. These findings offer updated insights into species diversity and seasonal trends, providing critical baseline data essential for the development of effective control strategies aimed at mitigating the impact of these flies on livestock health. Full article

Leishmaniasis is a tropical infectious disease caused by Leishmania parasites. The disease can be spread by the bite of an infected sand fly. Currently, five chemotherapeutic drugs are available in leishmaniasis treatment. However, these drugs exhibit toxicity and serious adverse effects on infected individuals, necessitating alternative treatment strategies. One such strategy involves using combinations of existing antileishmanial drugs. In this study, we evaluated the interaction between artesunate (AS) and three antileishmanial drugs—amphotericin B (AmB), miltefosine (MF), and paromomycin (PM) against Leishmania infantum. This evaluation marks the first time such an assessment has been conducted. The Chou–Talalay combination index method was employed to analyze the drug interaction. The findings revealed that the interaction between AS and AmB ranged from antagonistic to synergistic, while the interaction between AS and MF showed moderate to strong synergism. In contrast, the interaction between AS and PM resulted in an antagonistic interaction, which differs from the combinations with AmB or MF. This study provides valuable insights for developing novel drug regimens for leishmaniasis treatment, emphasizing the potential of AS and its combination with existing antileishmanial drugs. Further research is necessary to optimize drug combinations and minimize adverse effects, leading to more effective therapeutic outcomes. Full article

Background: Burkholderia pseudomallei, the causative agent of melioidosis, is highly genetically recombinant, resulting in significant genomic diversity. Multiple virulence factors have been associated with specific disease presentations. To date, there are limited data relating to genomic diversity and virulence factors associated with melioidosis cases in North Queensland, Australia. Aim: To describe the genetic diversity of B. pseudomallei and identify virulence factors associated with clinical risk factors and patient outcomes. Methods: Whole genome sequencing of clinical isolates was performed and analysed with clinical data obtained from a retrospective melioidosis cohort study. Results: Fifty-nine distinct sequence types (STs) were identified from the 128 clinical isolates. Six STs comprised 64/128 (50%) isolates. Novel STs accounted for 38/59 (64%) STs, with ST TSV-13 as the most prevalent (n = 7), and were less likely to possess an LPS A genotype or YLF gene cluster (p < 0.001). These isolates were most likely to be found outside the inner city (aOR: 4.0, 95% CI: 1.7–9.0, p = 0.001). ST TSV-13 was associated with increased mortality (aOR: 6.1, 95% CI: 1.2–30.9, p = 0.03). Patients with a history of alcohol excess were less likely to be infected by fhaB3 (aOR 0.2, 95% CI: 0.1–0.7, p = 0.01) or YLF (aOR: 0.4, 95% CI: 0.2–0.9, p = 0.04) positive isolates. Conclusions: There are a significant number of novel sequence types in Townsville, Australia. An emerging novel ST appears to have an association with geographic location and mortality. Ongoing investigation is required to further understand the impact of this ST on the Townsville region. Full article

Background: Melioidosis, a disease induced by Burkholderia pseudomallei, poses a significant health threat in tropical areas where it is endemic. Despite the availability of effective treatments, mortality rates remain notably elevated. Many risk factors are associated with mortality. This study aims to develop a scoring system for predicting the in-hospital mortality from melioidosis using readily available clinical data. Methods: The data were collected from Surin Hospital, Surin, Thailand, during the period from April 2014 to March 2017. We included patients aged 15 years and above who had cultures that tested positive for Burkholderia pseudomallei. The clinical prediction rules were developed using significant risk factors from the multivariable analysis. Results: A total of 282 patients with melioidosis were included in this study. In the final analysis model, 251 patients were used for identifying the significant risk factors of in-hospital fatal melioidosis. Five factors were identified and used for developing the clinical prediction rules, and the factors were as follows: qSOFA ≥ 2 (odds ratio [OR] = 2.39, p= 0.025), abnormal chest X-ray findings (OR = 5.86, p < 0.001), creatinine ≥ 1.5 mg/dL (OR = 2.80, p = 0.004), aspartate aminotransferase ≥50 U/L (OR = 4.032, p < 0.001), and bicarbonate ≤ 20 mEq/L (OR = 2.96, p = 0.002). The prediction scores ranged from 0 to 7. Patients with high scores (4–7) exhibited a significantly elevated mortality rate exceeding 65.0% (likelihood ratio [LR+] 2.18, p < 0.001) compared to the low-risk group (scores 0–3) with a lower mortality rate (LR + 0.18, p < 0.001). The area under the receiver operating characteristic curve (AUC) was 0.84, indicating good model performance. Conclusions: This study presents a simple scoring system based on easily obtainable clinical parameters to predict in-hospital mortality in melioidosis patients. This tool may facilitate the early identification of high-risk patients who could benefit from more aggressive treatment strategies, potentially improving clinical decision-making and patient outcomes. Full article