Infectious Disease Compendium

Burkholderia

Microbiology

Gram negative rod. Burkholderia cepacia, Burkholderia mallei, Burkholderia pseudomallei (NEJM Review). Can actually be misidentified and really be an Herbaspirillum.

Epidemiologic Risks

Ubiquitous in water, soil, plants, and decaying organic material. Burkholderia pseudomallei is endemic in the rice fields of SE Asia (esp N. Thailand) and Northern Australia. Diabetes is a risk for disease.

Under the right conditions it can be spread by aerosols (PubMed).

It is also endemic in Puerto Rico (PubMed).

There was a case of melioidosis in Arizona another in Ohio (PubMed) and a smattering of others and they don't know were it came from.

It has been found in unchlorinated domestic bore water in tropical Northern Australia (the source of the taste of Fosters?) and in imported birds from endemic areas.

Be the way, the word is from the Greek for an abnormal distemper of asses. Sounds like Fox news commentary.

Syndromes

Burkholderia cepacia: nosocomial infections and pneumonia in patients with cystic fibrosis and chronic granulomatous disease.

Burkholderia mallei: glanders in horses.

Burkholderia pseudomallei (review): melioidosis; bacteremia and sepsis, soft tissue infections (children), occasionally traumatic osteomyelitis, in people who have been in the rice fields of SE Asia. Pneumonia, and it may be inhalational during the wet season. Risk factors for melioidosis included diabetes (39%) (although curiously, Glyburide has a protective effect, perhaps due to immunomodulation (PubMed), hazardous alcohol use (39%), chronic lung disease (26%) and chronic renal disease (12%).

Also found in tomatoes.

Treatment

Burkholderia cepacia: trimethoprim-sulfamethoxazole, piperacillin, third-generation cephalosporins, quinolones or carbapenem.

Burkholderia mallei: doxycycline OR ciprofloxacin, streptomycin, novobiocin, gentamicin OR imipenem OR ceftazidime, and the sulfonamides.

Burkholderia pseudomallei: imipenem OR penicillin OR doxycycline OR amoxicillin./clavulanate acid OR ceftazidime OR ticarcillin/clavulanate OR ceftriaxone OR aztreonam.

"The current recommended management for all forms of melioidosis in Australia, including skin melioidosis, is generally a minimum of 10–14 days of intravenously administered antibiotics (ceftazidime or a carbapenem) and a prolonged eradication course of oral antibiotics (e.g. 3 months of high-dose trimethoprim/sulfamethoxazole)(PubMed)."

From NEJM Review.

Initial intensive therapy (2 weeks)

ceftazidime 50 mg/kg of body weight (up to 2 g), every 6–8 hr

meropenem 25mg/kg(upto1g),every8hr

imipenem 25 mg/kg (up to 1 g), every 6 hr

THEN

Oral eradication therapy (3-6 months)

trimethoprim/sulfamethoxazole

Body weight

>60kg 2×160 mg of TMP–800 mg of SMX (960 mg), every 12 hr

40–60 kg 3 × 80 mg of TMP–400 mg of SMX (480 mg), every 12 hr

<40 kg, adult 1 × 160 mg of TMP–800 mg of SMX (960 mg) or 2×80mg of TMP–400mg of SMX(480mg), every 12 hr.

In another trial (PubMed) trimethoprim/sulfamethoxazole is not inferior to trimethoprim/sulfamethoxazole plus doxycycline for the oral phase of treatment.

Relapse is common in diabetics, and with shorter courses of antibiotics.