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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Human melioidosis caused by Burkholderia pseudomallei is a severe septic disease that is associated with high mortality, even under appropriate antibiotic treatment. The therapeutic effects of low-dose hydrocortisone plus ceftazidime, and of ceftazidime alone, have recently been investigated in the treatment of acute, severe sepsis caused by B. pseudomallei, both in normal BALB/c mice and in BALB/c mice with streptozotocin-induced diabetes. The mice were infected and then treated intravenously, from day 1 or day 2 post-infection, with saline (as a control, given twice daily for 10 days), low-dose hydrocortisone (given in twice-daily doses of 5 mg/kg, for 5 days) plus ceftazidime (given in twice-daily doses of 1200 mg/kg, for 10 days), or the same doses of ceftazidime alone. Although the infected, untreated mice all died within 14 days, almost all of the treated animals were still alive at the end of the follow-up, 30 days post-infection. The addition of the steroid appeared to have no benefit, with bacterial loads and plasma concentrations of tumour necrosis factor, aspartate aminotransferase, alanine aminotransferase and creatinine decreasing similarly in all the treated groups. The infected diabetic mice given hydrocortisone-ceftazidime from day 1 (but not those given just ceftazidime from day 1) showed an increase in their blood glucose concentrations. When infected mice were treated with the low-dose steroid and lower doses of the antibiotic (in twice-daily doses of 120-600 mg/kg), the steroid not only offered no apparent benefit but seemed to reduce survival. It therefore appears that low-dose hydrocortisone, as an adjunct to antibiotic treatment, does not provide benefit in the treatment of murine melioidosis and may have negative effects on human cases of the disease who have diabetes mellitus.
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PMID:Use of a low-dose steroid as an adjunct in the treatment, in mice, of severe sepsis caused by Burkholderia pseudomallei. 1982 85

Melioidosis is an underdiagnosed and underreported disease in India with protean clinical manifestations. Mortality in this study population was 17%. The predominant risk factor for melioidosis was diabetes mellitus. Multifocal disease was present in 66% and pulmonary involvement in 61% of patients. In a country like India where the conditions are conducive for endemic melioidosis and due to the clinical similarity of melioidosis to diseases like tuberculosis, it is essential for clinicians to have a high degree of suspicion and pursue suitable diagnostic strategies for melioidosis in the appropriate clinical setting.
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PMID:The clinical profile and predictors of mortality in patients with melioidosis in South India. 1985 Jun 5

In 2008, melioidosis was diagnosed in an agricultural worker from Thailand in the southern Jordan Valley in Israel. He had newly diagnosed diabetes mellitus, fever, multiple abscesses, and osteomyelitis. Burkholderia pseudomallei was isolated from urine and blood. Four of 10 laboratory staff members exposed to the organism received chemoprophylaxis, 3 of whom had adverse events.
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PMID:Imported melioidosis, Israel, 2008. 1989 71

Melioidosis, an infection due to gram negative Burkholderia pseudomallei, is an important cause of sepsis in east Asia especially Thailand and northern Australia. It usually causes abscesses in lung, liver, spleen, skeletal muscle and parotids especially in patients with diabetes, chronic renal failure and thalassemia. Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. During a two-year-period, we had five patients with musculoskeletal melioidosis. All patients presented with multifocal osteomyelitis, recurrent osteomyelitis or septic arthritis. One patient died early because of septicemia and multi-organ failure. All patients were diagnosed on the basis of positive pus culture. All patients were treated by surgical debridement followed by a combination of antibiotics; (ceftazidime, amoxy-clavulanic acid, co-trimoxazole and doxycycline) for six months except for one who died due to fulminant septicemia. All other patients recovered completely with no recurrences. With increasing awareness and better diagnostic facilities, probably musculoskeletal melioidosis will be increasingly diagnosed in future.
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PMID:Burkholderia pseudomallei musculoskeletal infections (melioidosis) in India. 2041 12

Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative environmental bacterium Burkholderia pseudomallei. A prospective cohort study identified 2,243 patients admitted to Sappasithiprasong Hospital in northeast Thailand with culture-confirmed melioidosis between 1997 and 2006. These data were used to calculate an average incidence rate for the province of 12.7 cases of melioidosis per 100,000 people per year. Incidence increased incrementally from 8.0 (95% confidence interval [CI] = 7.2-10.0) in 2000 to 21.3 (95% CI = 19.2-23.6) in 2006 (P < 0.001; chi(2) test for trend). Male sex, age >/= 45 years, and either known or undiagnosed diabetes were independent risk factors for melioidosis. The average mortality rate from melioidosis over the study period was 42.6%. The minimum estimated population mortality rate from melioidosis in 2006 was 8.63 per 100,000 people (95% CI = 7.33-10.11), the third most common cause of death from infectious diseases in northeast Thailand after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis.
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PMID:Increasing incidence of human melioidosis in Northeast Thailand. 2051 9

Melioidosis is an emerging infection in India. Seventeen cases of culture proven melioidosis are reported in this study. The isolation rate was high during the rainy season. Except one case, all the patients had diabetes mellitus as an underlying disease. Eleven patients improved with ceftazidime or combination therapy and maintenance therapy with doxycycline and Cotrimoxazole. The high prevalence of B. pseudomallei in this region is a matter for serious concern.
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PMID:Spectrum of melioidosis in the suburbs of Mangalore, S West Coast of India. 2057 96

Melioidosis, which is mainly prevalent in Thailand and Australia, has shown an increasing trend in India in the last few years. We carried out a retrospective study of 25 culture-proven adult cases of melioidosis who were admitted to a tertiary care hospital in southern India during June 2001 to September 2007. There was a six-fold increase in the number of cases in 2006 and 2007 as compared to 2001. Diabetes mellitus was the predisposing factor in 68% of cases, followed by alcoholism (28%). The clinical presentations were fever (80%), pneumonia and/or pleural effusion (48%), hepatomegaly (56%), joint involvement, and/or osteomyelitis (48%), splenomegaly (40%), splenic abscess (24%) and septicemia (28%). The organism, Burkholderia pseudomallei, was sensitive to co-amoxiclav, cotrimoxazole, ceftazidime, and carbapenem. The study suggests that melioidosis is an emerging infectious disease in the southwestern coastal belt of India, and it is likely to happen at much higher incidence.
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PMID:Melioidosis in southern India: epidemiological and clinical profile. 2057 24

Melioidosis is an important cause of sepsis in the tropics, is caused by an environmental saprophyte--B. pseudomallei. It affects mainly adults with underlying predisposing condition such as diabetes. The range of symptoms varies from benign and localized abscesses, to severe community-acquired pneumonia to acute fulminating septicaemia with multiple abscesses often leading to death. B. pseudomallei is an intracellular pathogen and some of the virulence mechanisms that govern the complex interaction between the organism and the host have been elucidated. Isolation of B. pseudomallei from bodily fluids of patients remains the "gold standard" in diagnosis but a sensitive and specific serological test can lend support to the diagnosis of melioidosis. Ceftazidime is the treatment of choice for severe melioidosis, but the response is slow. Maintenance or eradication therapy for a prolonged period is necessary to prevent relapse and recurrence. Monitoring IgG antibody levels may be useful as a guideline to determine the duration of eradication therapy.
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PMID:Melioidosis in Malaysia. 2095 49

Diabetes mellitus is a documented risk factor for melioidosis, a tropical infection caused by Burkholderia pseudomallei. The increased susceptibility of diabetic individuals to infections with other pathogens has been associated with immune dysregulation. However, the impact of diabetes on the functional responses of dendritic cells (DC) and macrophages during B. pseudomallei infection has not been investigated. This study compared the responses of macrophages and DC towards B. pseudomallei using bone marrow-derived DC (BMDC) and peritoneal elicited macrophages (PEM) isolated from streptozotocin-induced diabetic C57BL/6 mice exhibiting hyperglycaemia for 9 days (acute) or 70 days (chronic) and age-matched nondiabetic C57BL/6 mice. Following coincubation of BMDC and PEM with a highly virulent B. pseudomallei isolate, maturation, bacterial internalization plus intracellular survival and cytokine gene expression profiles were assessed. No significant differences in functional responses of BMDC or PEM isolated from acute diabetic and nondiabetic mice were observed. However, significant differences in BMDC and PEM function were observed when chronic diabetic and nondiabetic mice were compared. This study demonstrates that diabetic mice with extended periods of uncontrolled hyperglycaemia have impaired DC and macrophage function towards B. pseudomallei, which may contribute to the high susceptibility observed in clinical practice.
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PMID:Impact of streptozotocin-induced diabetes on functional responses of dendritic cells and macrophages towards Burkholderia pseudomallei. 2120 99

There were 176 culture-confirmed cases of melioidosis in north Queensland over the 10 years, 2000-2009. Most (nearly 80%) occurred in the first 4 months of the year. The overall case fatality was 21%, but was 14% in 2005-2009. Of the 173 adult cases, 45% were in Indigenous adults. Both diabetes and alcohol abuse were more prevalent among Indigenous adults with melioidosis than among non-Indigenous adults. The incidences in Indigenous adults were particularly high in the Torres Strait and Northern Peninsula Area, Cape York and Mornington Island, whereas for non-indigenous adults there appears to be a higher risk within Townsville city.
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PMID:Melioidosis in north Queensland, 2000-2009. 2141 30


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