5 years ago

A Simple Laboratory Algorithm for Diagnosis of Melioidosis in Resource-Constrained Areas: A Study from North Central Vietnam

Melioidosis may be endemic in many tropical developing countries but diagnosis of the disease is currently unreliable in resource-limited areas. Here 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 been reported before. 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 Disk 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 from clinical specimens of 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. 82.8% (58/70) of patients were bacteraemic, with a mortality of 50% (18/36) among patients with known outcome. No death occurred in non-bacteraemic patients. Conclusion 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.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304135

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