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Contact investigation of melioidosis cases reveals regional endemicity in Puerto Rico.
Clin Infect Dis. 2015 Jan 15; 60(2):243-50.CI

Abstract

BACKGROUND

Melioidosis results from infection with Burkholderia pseudomallei and is associated with case-fatality rates up to 40%. Early diagnosis and treatment with appropriate antimicrobials can improve survival rates. Fatal and nonfatal melioidosis cases were identified in Puerto Rico in 2010 and 2012, respectively, which prompted contact investigations to identify risk factors for infection and evaluate endemicity.

METHODS

Questionnaires were administered and serum specimens were collected from coworkers, neighborhood contacts within 250 m of both patients' residences, and injection drug user (IDU) contacts of the 2012 patient. Serum specimens were tested for evidence of prior exposure to B. pseudomallei by indirect hemagglutination assay. Neighborhood seropositivity results guided soil sampling to isolate B. pseudomallei.

RESULTS

Serum specimens were collected from contacts of the 2010 (n = 51) and 2012 (n = 60) patients, respectively. No coworkers had detectable anti-B. pseudomallei antibody, whereas seropositive results among neighborhood contacts was 5% (n = 2) for the 2010 patient and 23% (n = 12) for the 2012 patient, as well as 2 of 3 IDU contacts for the 2012 case. Factors significantly associated with seropositivity were having skin wounds, sores, or ulcers (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.2-17.8) and IDU (OR, 18.0; 95% CI, 1.6-194.0). Burkholderia pseudomallei was isolated from soil collected in the neighborhood of the 2012 patient.

CONCLUSIONS

Taken together, isolation of B. pseudomallei from a soil sample and high seropositivity among patient contacts suggest at least regional endemicity of melioidosis in Puerto Rico. Increased awareness of melioidosis is needed to enable early case identification and early initiation of appropriate antimicrobial therapy.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Doker TJ
Epidemic Intelligence Service Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Sharp TM
Dengue Branch, Centers for Disease Control and Prevention.
Rivera-Garcia B
Puerto Rico Department of Health, San Juan.
Perez-Padilla J
Dengue Branch, Centers for Disease Control and Prevention.
Benoit TJ
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Ellis EM
Epidemic Intelligence Service Dengue Branch, Centers for Disease Control and Prevention.
Elrod MG
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Gee JE
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Shieh WJ
Infectious Diseases Pathology Branch.
Beesley CA
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Ryff KR
Puerto Rico Department of Health, San Juan.
Traxler RM
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Galloway RL
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Haberling DL
Prion and Public Health Office, Centers for Disease Control and Prevention.
Waller LA
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Shadomy SV
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Bower WA
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Hoffmaster AR
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Walke HT
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Blaney DD
Bacterial Special Pathogens Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.

MeSH

AdolescentAdultAgedAged, 80 and overAntibodies, BacterialBurkholderia pseudomalleiChildChild, PreschoolContact TracingEndemic DiseasesFemaleHemagglutination TestsHumansMaleMelioidosisMiddle AgedPuerto RicoRisk FactorsSoil MicrobiologySurveys and QuestionnairesYoung Adult

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

25270646

Citation

Doker, Thomas J., et al. "Contact Investigation of Melioidosis Cases Reveals Regional Endemicity in Puerto Rico." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 60, no. 2, 2015, pp. 243-50.
Doker TJ, Sharp TM, Rivera-Garcia B, et al. Contact investigation of melioidosis cases reveals regional endemicity in Puerto Rico. Clin Infect Dis. 2015;60(2):243-50.
Doker, T. J., Sharp, T. M., Rivera-Garcia, B., Perez-Padilla, J., Benoit, T. J., Ellis, E. M., Elrod, M. G., Gee, J. E., Shieh, W. J., Beesley, C. A., Ryff, K. R., Traxler, R. M., Galloway, R. L., Haberling, D. L., Waller, L. A., Shadomy, S. V., Bower, W. A., Hoffmaster, A. R., Walke, H. T., & Blaney, D. D. (2015). Contact investigation of melioidosis cases reveals regional endemicity in Puerto Rico. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 60(2), 243-50. https://doi.org/10.1093/cid/ciu764
Doker TJ, et al. Contact Investigation of Melioidosis Cases Reveals Regional Endemicity in Puerto Rico. Clin Infect Dis. 2015 Jan 15;60(2):243-50. PubMed PMID: 25270646.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Contact investigation of melioidosis cases reveals regional endemicity in Puerto Rico. AU - Doker,Thomas J, AU - Sharp,Tyler M, AU - Rivera-Garcia,Brenda, AU - Perez-Padilla,Janice, AU - Benoit,Tina J, AU - Ellis,Esther M, AU - Elrod,Mindy G, AU - Gee,Jay E, AU - Shieh,Wun-Ju, AU - Beesley,Cari A, AU - Ryff,Kyle R, AU - Traxler,Rita M, AU - Galloway,Renee L, AU - Haberling,Dana L, AU - Waller,Lance A, AU - Shadomy,Sean V, AU - Bower,William A, AU - Hoffmaster,Alex R, AU - Walke,Henry T, AU - Blaney,David D, Y1 - 2014/09/30/ PY - 2014/10/2/entrez PY - 2014/10/2/pubmed PY - 2015/9/4/medline KW - Burkholderia pseudomallei KW - Puerto Rico KW - emerging infectious disease KW - melioidosis SP - 243 EP - 50 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 60 IS - 2 N2 - BACKGROUND: Melioidosis results from infection with Burkholderia pseudomallei and is associated with case-fatality rates up to 40%. Early diagnosis and treatment with appropriate antimicrobials can improve survival rates. Fatal and nonfatal melioidosis cases were identified in Puerto Rico in 2010 and 2012, respectively, which prompted contact investigations to identify risk factors for infection and evaluate endemicity. METHODS: Questionnaires were administered and serum specimens were collected from coworkers, neighborhood contacts within 250 m of both patients' residences, and injection drug user (IDU) contacts of the 2012 patient. Serum specimens were tested for evidence of prior exposure to B. pseudomallei by indirect hemagglutination assay. Neighborhood seropositivity results guided soil sampling to isolate B. pseudomallei. RESULTS: Serum specimens were collected from contacts of the 2010 (n = 51) and 2012 (n = 60) patients, respectively. No coworkers had detectable anti-B. pseudomallei antibody, whereas seropositive results among neighborhood contacts was 5% (n = 2) for the 2010 patient and 23% (n = 12) for the 2012 patient, as well as 2 of 3 IDU contacts for the 2012 case. Factors significantly associated with seropositivity were having skin wounds, sores, or ulcers (odds ratio [OR], 4.6; 95% confidence interval [CI], 1.2-17.8) and IDU (OR, 18.0; 95% CI, 1.6-194.0). Burkholderia pseudomallei was isolated from soil collected in the neighborhood of the 2012 patient. CONCLUSIONS: Taken together, isolation of B. pseudomallei from a soil sample and high seropositivity among patient contacts suggest at least regional endemicity of melioidosis in Puerto Rico. Increased awareness of melioidosis is needed to enable early case identification and early initiation of appropriate antimicrobial therapy. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/25270646/full_citation DB - PRIME DP - Unbound Medicine ER -