A simple laboratory algorithm for diagnosis of melioidosis in resource-constrained areas: a study from north-central Vietnam

作者：Trinh T T^*; Hoang T S; Tran D A; Trinh V T; Goehler A; Nguyen T T; Hoang S N; Krumkamp R; Nguyen L T N; May J; Doan P M; Do C D; Que T A; Steinmetz I

来源：Clinical Microbiology and Infection, 2018, 24(1): 84.e1-84.e4.

DOI：10.1016/j.cmi.2017.07.029

• Burkholderia pseudomallei
• Diagnosis
• Epidemiology
• Melioidosis
• North-central Vietnam

Objectives: Melioidosis may be endemic in many tropical developing countries, but diagnosis of the disease is currently unreliable in resource-limited areas. We aimed to validate a simple and cheap laboratory algorithm for the identification of Burkholderia pseudomallei from clinical specimens in parts of Vietnam where the disease has not previously been reported.
Methods: In June 2015, we conducted training courses at five general hospitals in north-central provinces in order to raise awareness of the disease and to introduce a simple and cheap laboratory identification algorithm for B. pseudomallei including the three-antibiotic disc test.
Results: Until the end of the year (7 months later), 94 suspected B. pseudomallei strains resistant to gentamicin and colistin but sensitive to amoxicillin/clavulanic acid were detected in clinical specimens from 70 patients. All strains were further confirmed as B. pseudomallei by using a specific TTSS1 real-time PCR assay and recA sequencing analysis. Among positive blood cultures, positive rates with B. pseudomallei ranged from 3.4% (5/147) to 10.2% (32/312) in the various clinics. A total of 82.8% (58/70) patients were bacteraemic, with a mortality of 50% (18/36) among patients with known outcome. No death occurred in nonbacteraemic patients.
Conclusions: Our results demonstrate that the introduction of a simple and easy-to-perform laboratory algorithm for the identification of B. pseudomallei from clinical samples, together with clinical awareness raising, can lead to the diagnosis of a significant number of melioidosis cases in resource-limited clinical laboratories which previously did not identify the pathogen.

• 出版日期2018-1
• 单位河北医科大学