viernes, 23 de enero de 2015

Melioidosis Diagnostic Workshop, 20131 - Volume 21, Number 2—February 2015 - Emerging Infectious Disease journal - CDC


Melioidosis Diagnostic Workshop, 20131 - Volume 21, Number 2—February 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 2—February 2015

Online Report

Melioidosis Diagnostic Workshop, 20131

Alex R. HoffmasterComments to Author , David AuCoin, Prasith Baccam, Henry C. Baggett, Rob Baird, Saithip Bhengsri, David D. Blaney, Paul J. Brett, Timothy J.G. Brooks, Katherine A. Brown, Narisara Chantratita, Allen C. Cheng, David A.B. Dance, Saskia Decuypere, Dawn Defenbaugh, Jay E. Gee, Raymond Houghton, Possawat Jorakate, Ganjana Lertmemongkolchai, Direk Limmathurotsakul, Toby L. Merlin, Chiranjay Mukhopadhyay, Robert Norton, Sharon J. Peacock, Dionne B. Rolim, Andrew J. Simpson, Ivo Steinmetz, Robyn A. Stoddard, Martha M. Stokes, David Sue, Apichai Tuanyok, Toni Whistler, Vanaporn Wuthiekanun, and Henry T. Walke
Author affiliations: US Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A.R. Hoffmaster, D.D. Blaney, J.E. Gee, T.L. Merlin, R.A. Stoddard, D. Sue, H.T. Walke)University of Nevada School of Medicine, Reno, Nevada, USA (D. AuCoin)IEM, Research Triangle Park, North Carolina, USA (P. Baccam)Royal Darwin Hospital, Darwin, Northern Territory, Australia (R. Baird)US Centers for Disease Control and Prevention, Nonthaburi, Thailand (H.C. Baggett, S. Bhengsri, P. Jorakate, T. Whistler)University of South Alabama, Mobile, Alabama, USA (P.J. Brett)Public Health England, Salisbury, UK (T.J.G. Brooks, A.J. Simpson)University of Texas, Austin, Texas, USA (K.A. Brown)University of Cambridge, Cambridge, UK (K.A. Brown, S.J. Peacock)Mahidol University, Bangkok, Thailand (N. Chantratita, D. Limmathurotsakul, V. Wuthiekanun)Alfred Health, Monash University, Melbourne, Victoria, Australia (A. C. Cheng)Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Vientiane, Laos, and University of Oxford, Oxford, UK (D.A.B. Dance)University of Western Australia, Perth, Western Australia, Australia (S. Decuypere)Defense Threat Reduction Agency, Fort Belvoir, Virginia, USA (D. Defenbaugh, M.M. Stokes)InBios International, Seattle, Washington, USA (R. Houghton)Khon Kaen University, Khon Kaen, Thailand (G. Lertmemogkolchai)Kasturba Medical College, Manipal, India (C. Mukhopadhyay);Townsville Hospital, Townsville, Queensland, Australia (R. Norton)Universidade de Fortaleza, Fortaleza, Brazil (D. B. Rolim)University of Greifswald, Greifswald, Germany (I. Steinmetz)University of Hawaii at Manoa, Honolulu, Hawaii, USA (A. Tuanyok)


Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions.
Melioidosis is a frequently fatal infection caused by the gram-negative bacillus Burkholderia pseudomallei (1). It is highly endemic to northeastern Thailand and northern Australia, where the causative organism is commonly found in soil and fresh water. Melioidosis also occurs in those who travel to disease-endemic regions of the world, which include tropical regions of Asia and South America, Central America, various Pacific and Indian Ocean islands, and some countries in Africa (1). B. pseudomallei can also cause latent infection; the longest documented interval between exposure and clinical melioidosis is 62 years (2). The crude case- fatality rate for melioidosis ranges from 14% to 40% and may be as high as 80% if effective antimicrobial drugs are not given.
Clinical diagnosis of melioidosis is difficult because the disease has no pathognomonic clinical manifestations (1). The current diagnostic standard is culture; however, B. pseudomallei can be misidentified as a culture contaminant or as another species (e.g., Burkholderia cepaciaBacillus spp., orPseudomonas spp.), especially by laboratory staff unfamiliar with this organism (1,35). In addition, B. pseudomallei is categorized as a Tier 1 select agent by the US government, and special precautions are recommended to reduce the possibility of exposure while conducting bacterial culture. There are currently no commercially available and reliable rapid diagnostic tests for melioidosis. Serologic tests, such as indirect hemagglutination assay (IHA), have been widely used, but these are neither sensitive nor specific.
With the goal of improving timely and accurate diagnosis of melioidosis, a workshop sponsored by the US Centers for Disease Control and Prevention was held in Bangkok, Thailand, on September 14–15, 2013, to discuss current recommendations and future research directions. International subject matter experts representing academia, government, and the private sector attended the workshop to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. The workshop consisted of multiple sessions focused on specific diagnostic topics (e.g., culture, PCR, serology, and new methods). Each session included short presentations followed by extensive group discussions. Notes from these group discussions along with correspondence exchanged shortly after the workshop were used to clarify points and reach consensus. This article provides a workshop summary as an informative diagnostic guide for clinicians and laboratory staff.

Dr Hoffmaster is the team lead of the Zoonoses and Select Agent Laboratory in the Bacterial Special Pathogens Branch, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention. His research interests include diagnostics and molecular epidemiology of numerous pathogens, including B. pseudomallei.


We thank Bart Currie, Mindy Glass Elrod, Rebecca Lipsitz, Rosemarie Aurigemma, Alec Ritchie, and Maureen Beanan for helpful discussions on this workshop’s agenda and speaker selection; Dennis Dixon, Suman Mukhopadhyay, and Thames Pickett for contributing to discussions during the workshop; and Yolanda Gaines and Kimberly Tutt for assistance with organizing this workshop.
The workshop was funded by the US Centers for Disease Control and Prevention. Names of vendors or manufacturers are provided as examples of available product sources; inclusion does not imply endorsement of the vendors, manufacturers, or products by the US Centers for Disease Control and Prevention or the US Department of Health and Human Services.
D.A. and R.H. are principal investigators and receive funding from Phase 1 US Department of Health and Human Services Small Business Technology Transfer award no. R41AI102482-02. R.H. is an employee of InBios International but does not have a stake in the company.


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Suggested citation for this article: Hoffmaster AR, AuCoin D, Baccam P, Baggett HC, Baird R, Bhengsri S, et al. Melioidosis Diagnostic Workshop, 2013. Emerg Infect Dis. 2015 Feb [date cited].
DOI: 10.3201/eid2102.141045
1Held September 14, 2013, in Bangkok, Thailand.

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