Red Book 28e
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Burkholderia Infections

Clinical Manifestations

Burkholderia cepacia complex has been associated with severe pulmonary infections in patients with cystic fibrosis, with significant bacteremia in preterm infants after prolonged hospitalization, and with infection in children with chronic granulomatous disease, hemoglobinopathies, or malignant neoplasms. Health care-associated infections include wound and urinary tract infections and pneumonia. Pulmonary infections in people with cystic fibrosis occur late in the course of disease, usually after respiratory epithelial damage caused by infection with Pseudomonas aeruginosa has been established. Patients with positive culture results can experience no change in the rate of pulmonary decompensation, become chronically infected and exhibit a more rapid decline in pulmonary function, or experience an unexpectedly rapid deterioration in clinical status that results in death. In patients with chronic granulomatous disease, pneumonia is the most common manifestation of B cepacia complex infection; lymphadenitis also occurs. Disease onset is insidious, with low-grade fever early in the course and systemic effects occurring 3 to 4 weeks later. Pleural effusion is common, and lung abscess can occur.

Burkholderia pseudomallei is the cause of melioidosis, which is endemic in southeast Asia and northern Australia but also found in other tropical and subtropical areas. Melioidosis can occur in the United States, usually among travelers returning from areas with endemic disease. Melioidosis can manifest as a localized infection or as fulminant septicemia. Localized infection usually is nonfatal and most commonly manifests as pneumonia, but skin, soft tissue, and skeletal infections also occur. In severe cutaneous infection, necrotizing fasciitis has been reported. In disseminated infection, hepatic and splenic abscesses can occur, and relapses are common without prolonged therapy.

Burkholderia Infections has been found in Red Book 28e

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