LABORATORY / PROSPECITIVE EVALUATION OF DIAGNOSTIC TESTS  

1 ** An immunofluorescent (IF) method that detects Burkholderia pseudomallei in clinical specimens within 10 min was devised.

2, 3 ** Serology tests (IHA, ELISA, and cassette tests) lacks clinical utility as a result of high background rates of positive Burkholderia pseudomallei serology in this population. Low sensitivity and specificity of clinical rules is consistent with the protean manifestations of melioidosis and clinical difficulty in identifying patients with melioidosis

4 ** Tsunami increased recent exposure in both tsunami survivors and uninjured bystanders. Survivors of the Thailand tsunami may be at increased risk of melioidosis.

5 ** Rate of cotrimoxazole resistant in strains of B. pseudomallei is around 13%, much less than previous understanding.

Major clinical studies based from Ubon Ratchathani unit.

PARENTERAL TREATMENT IN ACUTE PHASE

6 *** Ceftazidime decreased the mortality rate from 74% to 37% compared to the previous standard treatment with four parenteral drug combination of chloramphenicol, doxycycline, and trimethoprim/sulfamethoxazole

7 * There was no difference in overall mortality but the treatment failure is significantly higher with amoxicillin/clavulanate treatment (5% versus 25%)

8 * There was no difference in overall mortality but the treatment failure after 48 hours was more common with ceftazidime. Study was early terminated due to lack of drug supply.

9 * There was no difference in overall mortality but the duration of survival is longer with adjuvant therapy with G-CSF. Survival in this setting is more likely to be improved by management of associated metabolic abnormalities and organ dysfunction associated with severe sepsis.


ORAL TREATMENT IN ERADICATIVE PHASE

10 * Oral amoxicillin/clavulanic acid was also effective and is an alternative treatment for melioidosis

11 * Doxycycline alone was not effective as a oral eradicative regimen

12 * Fluoroquinolone was not effective as a oral eradicative regimen

13 ** Three drug combination has the same efficacy but less side effect (19% vs 36%). Treatment with oral cotrimoxazole plus doxycyline is recommended as a standard treatment of melioidosis for eradicative phase.


Reference List

1. Wuthiekanun,V. et al. Rapid immunofluorescence microscopy for diagnosis of melioidosis. Clin. Diagn. Lab Immunol. 12, 555-556 (2005).

2. Walsh,A.L. et al. Immunofluorescence microscopy for the rapid diagnosis of melioidosis. J Clin. Pathol 47, 377-379 (1994).

3. Cheng,A.C. et al. Prospective evaluation of a rapid immunochromogenic cassette test for the diagnosis of melioidosis in northeast Thailand. Trans. R. Soc. Trop. Med. Hyg. 100, 64-67 (2006).

4. Wuthiekanun,V. et al. Serological evidence for increased human exposure to Burkholderia pseudomallei following the tsunami in southern Thailand. J Clin. Microbiol. 44, 239-240 (2006).

5. Wuthiekanun,V. et al. Trimethoprim/sulfamethoxazole resistance in clinical isolates of Burkholderia pseudomallei. J Antimicrob. Chemother. 55, 1029-1031 (2005).

6. White,N.J. et al. Halving of mortality of severe melioidosis by ceftazidime. Lancet 2, 697-701 (1989).

7. Suputtamongkol,Y. et al. Ceftazidime vs. amoxicillin/clavulanate in the treatment of severe melioidosis. Clin. Infect. Dis. 19, 846-853 (1994).

8. Simpson,A.J. et al. Comparison of imipenem and ceftazidime as therapy for severe melioidosis. Clin. Infect. Dis. 29, 381-387 (1999).

9. Chierakul,W. et al. Two randomized controlled trials of ceftazidime alone versus ceftazidime in combination with trimethoprim-sulfamethoxazole for the treatment of severe melioidosis. Clin. Infect. Dis. 41, 1105-1113 (2005).

10. Suputtamongkol,Y. et al. Amoxycillin-clavulanic acid treatment of melioidosis. Trans. R. Soc. Trop. Med. Hyg. 85, 672-675 (1991).

11. Chaowagul,W. et al. A comparison of chloramphenicol, trimethoprim-sulfamethoxazole, and doxycycline with doxycycline alone as maintenance therapy for melioidosis. Clin. Infect. Dis. 29, 375-380 (1999).

12. Chaowagul,W., Suputtamongkul,Y., Smith,M.D. & White,N.J. Oral fluoroquinolones for maintenance treatment of melioidosis. Trans. R. Soc. Trop. Med. Hyg. 91, 599-601 (1997).

13. Chaowagul,W. et al. Open-label randomized trial of oral trimethoprim-sulfamethoxazole, doxycycline, and chloramphenicol compared with trimethoprim-sulfamethoxazole and doxycycline for maintenance therapy of melioidosis. Antimicrob. Agents Chemother. 49, 4020-4025 (2005).