An international, multicentre evaluation and description of Burkholderia pseudomallei infection in cystic fibrosis

BMC Pulm Med. 2015 Oct 9;15:116. doi: 10.1186/s12890-015-0109-9.

Abstract

Background: Several cases of Burkholderia pseudomallei infection in CF have been previously reported. We aimed to identify all cases globally, risk factors for acquisition, clinical consequences, and optimal treatment strategies.

Methods: We performed a literature search to identify all published cases of B. pseudomallei infection in CF. In addition we hand-searched respiratory journals, and contacted experts in infectious diseases and CF around the world. Supervising clinicians for identified cases were contacted and contemporaneous clinical data was requested.

Results: 25 culture-confirmed cases were identified. The median age at acquisition was 21 years, mean FEV1 % predicted was 60 %, and mean BMI was 19.5 kg/m(2). The location of acquisition was northern Australia or south-east Asia for most. 19 patients (76 %) developed chronic infection, which was usually associated with clinical decline. Successful eradication strategies included a minimum of two weeks of intravenous ceftazidime, followed by a consolidation phase with trimethoprim/sulfamethoxazole, and this resulted in a higher chance of success when instituted early. Three cases of lung transplantation have been recorded in the setting of chronic B. pseudomallei infection.

Conclusion: Chronic carriage of B. pseudomallei in patients with CF appears common after infection, in contrast to the non-CF population. This is often associated with an accelerated clinical decline. Lung transplantation has been performed in select cases of chronic B. pseudomallei infection.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Australasia / epidemiology
  • Burkholderia pseudomallei*
  • Ceftazidime / therapeutic use
  • Child
  • Cystic Fibrosis / epidemiology*
  • Cystic Fibrosis / physiopathology
  • Europe / epidemiology
  • Female
  • Forced Expiratory Volume
  • Humans
  • Male
  • Melioidosis / drug therapy
  • Melioidosis / epidemiology*
  • North America / epidemiology
  • Retrospective Studies
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Ceftazidime