Townsville is in the dry tropics in Northern Australia and an endemic region for melioidosis. Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a soil dwelling organism. The ...incidence of melioidosis is associated with high levels of rainfall and has been linked to multiple weather variables in other melioidosis endemic regions such as in Darwin. In contrast to Townsville, Darwin is in the wet-dry tropics in Northern Australia and receives 40% more rainfall. We assessed the relationship between melioidosis incidence and weather conditions in Townsville and compared the patterns to the findings in Darwin and other melioidosis endemic regions.
Performing a time series analysis from 1996 to 2020, we applied a negative binomial regression model to evaluate the link between the incidence of melioidosis in Townsville and various weather variables. Akaike's information criterion was used to assess the most parsimonious model with best predictive performance. Fourier terms and lagged deviance residuals were included to control long term seasonal trends and temporal autocorrelation.
Humidity is the strongest predictor for melioidosis incidence in Townsville. Furthermore, the incidence of melioidosis showed a three-times rise in the Townsville region when >200 mm of rain fell within the fortnight. Prolonged rainfall had more impact than a heavy downpour on the overall melioidosis incident rate. There was no statistically significant increase in incidence with cloud cover in the multivariable model.
Consistent with other reports, melioidosis incidence can be attributed to humidity and rainfall in Townsville. In contrast to Darwin, there was no strong link between melioidosis cases and cloud cover and nor single large rainfall events.
Stefan George (1868–1933) was one of the most important and influential poets to have written in German. His work, in its originality and impact, easily ranks with that of Goethe, Holderlin, or ...Rilke. Yet George's reach extended far beyond the sphere of literature. Particularly during his last three decades, George gathered around himself a group of men who subscribed to his homoerotic and idiosyncratic vision of life and sought to transform that vision into reality. George considered his circle to be the embodiment and defender of the real but secret Germany, opposed to the false values of contemporary bourgeois society. Some of his disciples, friends, and admirers were themselves historians, philosophers, and poets. Their works profoundly affected the intellectual and cultural attitudes of Germany's elite during the critical postwar years of the Weimar Republic. Essentially conservative in temperament and outlook, George and his circle occupy a central, but problematic, place in the rise of proto-fascism in Germany. Their own surrogate state offered a miniature model of a future German state: enthusiastic followers submitting themselves without question to the figure and will of a charismatic leader believed to be in possession of mysterious, even quasi-divine, powers. When he died several months after the Nazi takeover, George was one of the most famous and revered figures in Germany. Today the importance of George and his circle has largely been forgotten. In this, the first full biography of George to appear in any language, Robert E. Norton traces the poet's life and rise to fame.
Melioidosis is an infection caused by the bacterium Burkholderia pseudomallei. The most common presentation is bacteremia occurring in 38-73% of all patients, and the mortality rate ranges from 9% to ...42%. Although there is abundant data representing risk factors for infection and patient outcomes, there is limited information regarding laboratory investigations associated with bacteremia and mortality. We assessed a range of baseline and diagnostic investigations and their association with patient outcomes in a retrospective cohort study in Townsville, Australia. 124 patients' medical and laboratory records were reviewed between January 1, 1997 and December 31, 2020. Twenty-seven patients died and 87 patients were bacteremic. The presence of lymphopenia (< 1.5 × 109 cells/L) was the highest risk for bacteremia (relative risk RR 2.2; 95% CI: 1.3-3.7, P < 0.001). Factors associated with mortality included lymphopenia, (RR: 1.4; 95% CI: 1.2-1.6, P = 0.004); uremia (RR: 1.7; 95% CI: 1.1-2.5, P = 0.03); and an elevated international normalized ratio (RR: 1.5; 95% CI: 1.2-2.0, P = 0.006). Median incubation to positive blood culture result was 28 hours with 15/82 (18%) positive in ≤ 24 hours. For serological testing during admission only 53/121 (44%) were indirect hemagglutination assay positive, 67/120 (56%) enzyme immunoassay IgG positive, and 23/89 (26%) IgM positive. Simple baseline investigations at time of presentation may be used to stratify patients at high risk for both bacteremia and mortality. This information can be used as a decision aid for early intensive management.
Prokaryotic cell transcriptomics has been limited to mixed or sub-population dynamics and individual cells within heterogeneous populations, which has hampered further understanding of spatiotemporal ...and stage-specific processes of prokaryotic cells within complex environments. Here we develop a 'TRANSITomic' approach to profile transcriptomes of single Burkholderia pseudomallei cells as they transit through host cell infection at defined stages, yielding pathophysiological insights. We find that B. pseudomallei transits through host cells during infection in three observable stages: vacuole entry; cytoplasmic escape and replication; and membrane protrusion, promoting cell-to-cell spread. The B. pseudomallei 'TRANSITome' reveals dynamic gene-expression flux during transit in host cells and identifies genes that are required for pathogenesis. We find several hypothetical proteins and assign them to virulence mechanisms, including attachment, cytoskeletal modulation, and autophagy evasion. The B. pseudomallei 'TRANSITome' provides prokaryotic single-cell transcriptomics information enabling high-resolution understanding of host-pathogen interactions.
The epidemiology of melioidosis in Townsville, Australia Gassiep1, Ian; Ganeshalingam, Vibooshini; Chatfield, Mark D ...
Transactions of the Royal Society of Tropical Medicine and Hygiene,
04/2022, Letnik:
116, Številka:
4
Journal Article
Recenzirano
Abstract
Background
Melioidosis in an infection caused by Burkholderia pseudomallei, an organism endemic to tropical and subtropical regions.
Methods
This study describes the epidemiology of ...melioidosis in Townsville, QLD, Australia, as well as clinical features, risk factors associated with the disease, the burden of infection on the Aboriginal and Torres Strait Islander (ATSI) community and patient outcomes over time.
Results
From 1997 to 2020, 128 patients were admitted to Townsville University Hospital. The total annual incidence of infection was 3.2 cases per 100 000 compared with 15.3 per 100 000 in the ATSI population. The majority of cases (n=82 64%) were male. Alcohol excess (55%) and diabetes mellitus (48%) were the most common risk factors. Bacteraemia occurred in 87 (70%) patients and pneumonia was the most common focus of infection in 84 (69%). The case fatality rate was 23%, with no difference for the ATSI population (6/32 19%). The presence of malignancy was the risk factor most associated with mortality (relative risk 2.7 95% confidence interval 1.4–5.1, p=0.005).
Conclusions
The ATSI community was overrepresented in this study, however, there was no significant difference in adverse outcomes. The case fatality rate was higher than in other regions in Australia. This discrepancy may relate in part to the different risk groups seen in these settings coupled with potential organism variability.
Burkholderia pseudomallei is an environmental gram-negative bacterium that causes the disease melioidosis and is endemic in many countries of the Asia-Pacific region. In Australia, the mortality rate ...remains high at approximately 10%, despite curative antibiotic treatment being available. The bacterium is almost exclusively found in the endemic region, which spans the tropical Northern Territory and North Queensland, with clusters occasionally present in more temperate climates. Despite being endemic to North Queensland, these infections remain understudied compared to those of the Northern Territory.
This study aimed to assess the prevalence of central nervous system (CNS) disease associated variant bimABm, identify circulating antimicrobial resistance mutations and genetically distinct strains from Queensland, via comparative genomics. From 76 clinical isolates, we identified the bimABm variant in 20 (26.3%) isolates and in 9 (45%) of the isolates with documented CNS infection (n = 18). Explorative analysis suggests a significant association between isolates carrying the bimABm variant and CNS disease (OR 2.8, 95% CI 1.3-6.0, P = 0.009) compared with isolates carrying the wildtype bimABp. Furthermore, 50% of isolates were identified as novel multi-locus sequence types, while the bimABm variant was more commonly identified in isolates with novel sequence types, compared to those with previously described. Additionally, mutations associated with acquired antimicrobial resistance were only identified in 14.5% of all genomes.
The findings of this research have provided clinically relevant genomic data of B. pseudomallei in Queensland and suggest that the bimABm variant may enable risk stratification for the development CNS complications and be a potential therapeutic target.
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are autoimmune sequelae of group A streptococcal infections. Here we provide experimental evidence that group G Streptococcus may also ...induce and/or exacerbate ARF/RHD.
Abstract
Acute rheumatic fever and rheumatic heart disease (ARF/RHD) have long been described as autoimmune sequelae of Streptococcus pyogenes or group A streptococcal (GAS) infection. Both antibody and T-cell responses against immunodominant GAS virulence factors, including M protein, cross-react with host tissue proteins, triggering an inflammatory response leading to permanent heart damage. However, in some ARF/RHD-endemic regions, throat carriage of GAS is low. Because Streptococcus dysgalactiae subspecies equisimilis organisms, also known as β-hemolytic group C streptococci and group G streptococci (GGS), also express M protein, we postulated that streptococci other than GAS may have the potential to initiate or exacerbate ARF/RHD. Using a model initially developed to investigate the uniquely human disease of ARF/RHD, we have discovered that GGS causes interleukin 17A/interferon γ–induced myocarditis and valvulitis, hallmarks of ARF/RHD. Remarkably the histological, immunological, and functional changes in the hearts of rats exposed to GGS are identical to those exposed to GAS. Furthermore, antibody cross-reactivity to cardiac myosin was comparable in both GGS- and GAS-exposed animals, providing additional evidence that GGS can induce and/or exacerbate ARF/RHD.
Melioidosis is a neglected tropical disease that causes high morbidity and mortality. Public health awareness is essential for both prevention and early detection of the infection. This project aimed ...to develop an internationally applicable educational tool to increase community awareness in regions with high prevalence of diabetes and melioidosis. The animation was created with international collaboration. Sixty-four delegates from different cultural backgrounds participated in the survey to evaluate the animation. Feedback was positive, with 85% agreeing that they would use this video for public education and 82% agreeing that the video was culturally appropriate to them in the context of their region. The animation was refined after feedback. To supplement the 3-minute animation, a 13-minute film footage of interviews with clinicians, researchers and patients was also created. These materials have been made available online through the International Melioidosis Network and can be readily downloaded or subtitled in any language using publicly available software, demonstrating the utility of developing low-cost adaptable health education material targeted for widespread use internationally.
Melioidosis is an emerging infectious disease with an estimated global burden of 4.64 million disability-adjusted life years per year. A major determinant related to poor disease outcomes is delay to ...diagnosis due to the fact that identification of the causative agent
may be challenging. Over the last 25 years, advances in molecular diagnostic techniques have resulted in the potential for rapid and accurate organism detection and identification direct from clinical samples. While these methods are not yet routine in clinical practice, laboratory diagnosis of infectious diseases is transitioning to culture-independent techniques. This review article aims to evaluate molecular methods for melioidosis diagnosis direct from clinical samples and discuss current and future utility and limitations.
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