Short report: Disease severity and outcome of melioidosis in HIV coinfected individuals

Charles Darwin University, Palmerston, Northern Territory, Australia
The American journal of tropical medicine and hygiene (Impact Factor: 2.7). 01/2006; 73(6):1165-6.
Source: PubMed


This study examined whether coinfection with HIV and Burkholderia pseudomallei leads to altered disease severity or outcome associated with melioidosis. Coinfection was detected in only 8 of 524 (1.5%) adults with melioidosis in northeast Thailand. Clinical presentation and acute outcome were similar in HIV-positive and HIV-negative patients.

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    • "HIV patients are more susceptible to infection from opportunistic lung pathogens such as M. tuberculosis, Pneumocystis carinii, and Streptococcus pneumoniae, and this increased risk is inversely proportional to the circulating CD4+ T cell count (Phair et al., 1990; Hoover et al., 1993; Gilks et al., 1996; Dworkin et al., 2001; Sharma et al., 2005). Surprisingly, the loss of CD4+ T cells during HIV infection does not appear to be a risk factor for melioidosis (Chierakul et al., 2005), questioning the importance of these cells in protection in human disease despite the clear evidence of their presence in exposed individuals and their role in protection in mouse models. It should also be noted that whilst current literature indicates a role for the Th1 arm of the adaptive immune response, at present the function of other T cell subsets such as T reg and Th17 cells during B. pseudomallei infection are unknown. "
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    ABSTRACT: Burkholderia pseudomallei is a Gram-negative bacterium which is the causative agent of melioidosis, a disease which carries a high mortality and morbidity rate in endemic areas of South East Asia and Northern Australia. At present there is no available human vaccine that protects against B. pseudomallei, and with the current limitations of antibiotic treatment, the development of new preventative and therapeutic interventions is crucial. This review considers the multiple elements of melioidosis vaccine research including: (i) the immune responses required for protective immunity, (ii) animal models available for preclinical testing of potential candidates, (iii) the different experimental vaccine strategies which are being pursued, and (iv) the obstacles and opportunities for eventual registration of a licensed vaccine in humans.
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    ABSTRACT: Burkholderia pseudomallei is a potential bioterror agent and the causative agent of melioidosis, a severe disease that is endemic in areas of Southeast Asia and Northern Australia. Infection is often associated with bacterial dissemination to distant sites, and there are many possible disease manifestations, with melioidosis septic shock being the most severe. Eradication of the organism following infection is difficult, with a slow fever-clearance time, the need for prolonged antibiotic therapy and a high rate of relapse if therapy is not completed. Mortality from melioidosis septic shock remains high despite appropriate antimicrobial therapy. Prevention of disease and a reduction in mortality and the rate of relapse are priority areas for future research efforts. Studying how the disease is acquired and the host-pathogen interactions involved will underpin these efforts; this review presents an overview of current knowledge in these areas, highlighting key topics for evaluation.
    Full-text · Article · May 2006 · Nature Reviews Microbiology
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    ABSTRACT: A 67-year-old male, with a history of stable lower urinary tract symptoms, diabetes mellitus, benign prostatic hyperplasia, gonococcal urethritis, and excessive alcohol consumption, presented to the emergency room with sepsis and acute bacterial prostatitis. He had recently returned from a visit to Indonesia, where he had been a first-hand witness to the 2004 tsunami. Complete blood cell count, urine analysis, blood, urine, and prostatic abscess cultures, chest X-ray, contrasted CT of the abdomen and pelvis, and (18)F-fluorodeoxyglucose PET. Melioidosis. Broad-spectrum empiric antibiotics were administered initially; therapy was then changed to intravenous imipenem plus cilastatin with slow initial clinical improvement. (18)F-fluorodeoxyglucose PET localized the prostate as the only nidus of infection. Ultrasound-guided fine needle aspiration of a small fluid collection of the prostate also grew Burkholderia pseudomallei. The patient improved clinically and was discharged to complete a 2-week course of intravenous imipenem plus cilastatin followed by a 3-month course of oral trimethoprim plus sulfamethoxazole. This medication was switched to co-amoxiclav and doxycycline to complete the 3-month course. The patient was well at his last follow-up, 3 months following hospital discharge.
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