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Pitfalls and optimal approaches to diagnose melioidosis

Asian Pacific Journal of Tropical Medicine 2016年第6期9卷 501-510页

作者： Paul Vijay Kingsley Govindakarnavar Arunkumar meghan tipre Mark Leader Nalini Sathiakumar Sultan Ismail Hospital Manipal Center for Virus Research Manipal University School of Public Health University of Alabama at Birmingham

Melioidosis is a severe and fatal infectious disease in the tropics and subtropics. It presents as a febrile illness with protean manifestation ranging from chronic localized infection to acute fulminant septicemia with dissemination of infection to multiple organs characterized by abscesses. Pneumonia is the most common clinical presentation. Because of the wide range of clinical presentations, physicians may often misdiagnose and mistreat the disease for tuberculosis, pneumonia or other pyogenic infections. The purpose of this paper is to present common pitfalls in diagnosis and provide optimal approaches to enable early diagnosis and prompt treatment of melidoidosis. Melioidosis may occur beyond the boundaries of endemic areas. There is no pathognomonic feature specific to a diagnosis of melioidosis. In endemic areas, physicians need to expand the diagnostic work-up to include melioidosis when confronted with clinical scenarios of pyrexia of unknown origin, progressive pneumonia or sepsis. Radiological imaging is an integral part of the diagnostic workup. Knowledge of the modes of transmission and risk factors will add support in clinically suspected cases to initiate therapy. In situations of clinically highly probable or possible cases where laboratory bacteriological confirmation is not possible, applying evidence-based criteria and empirical treatment with antimicrobials is recommended. It is of prime importance that patients undergo the full course of antimicrobial therapy to avoid relapse and recurrence. Early diagnosis and appropriate management is crucial in reducing serious complications leading to high mortality, and in preventing recurrences of the disease. Thus, there is a crucial need for promoting awareness among physicians at all levels and for improved diagnostic microbiology services. Further, the need for making the disease notifiable and/or initiating melioidosis registries in endemic countries appears to be compelling.

关键词： Melioidosis pseudomallei Review Diagnosis Treatment Pitfalls Approaches route of infection

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Melioidosis in India and Bangladesh: A review of case reports

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Asian Pacific Journal of Tropical Medicine 2018年第5期11卷 320-329页

作者： meghan tipre Paul Vijay Kingsley Tamika Smith Mark Leader Nalini Sathiakumar Department of Epidemiology School of Public HealthUniversity of Alabama Pantai Hospital Ipoh

Objective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further compared the clinical epidemiology of the melioidosis cases in India with case series from highly endemic areas in Northern Australia and Southeast Asia to elucidate any differences in presentations and risk factors between the regions.Results: We identified a total of 99 cases published between 1953 and June 2016, originating from India(n=85) or Bangladesh(n=14). Cases were predominantly male and ranged in age from 1 month to 90 years. Diabetes mellitus was the most common risk factor reported(58%). About 28% of the cases had history of exposure via high-risk occupations or exposure to contaminated water. The overall case fatality rate(CFR) was 26%. Factors influencing mortality included the occurrence of septic shock(CFR, 80%), environmental exposure(CFR,39%), primary presentation of pneumonia(CFR, 38%), misdiagnosed and/or mistreated cases(CFR, 33%) or the presence of a risk factor(CFR, 29%). Because of the small number of cases in Bangladesh, pattern of clinical epidemiology is limited to India. Soft tissue abscess(37%)was the most common clinical presentation reported from India followed by pneumonia(24%)and osteomyelitis/septic arthritis(18%). Neurological melioidosis(n=10, 12%) presented as pyemic lesions of the brain or meninges. A few cases of prostatic abscess(n=4) in men and parotid abscess(n=4) were also noted. The above patterns were consistent with case series from Southeast Asia and Northern Australia for the most part, in terms of risk factors associated with infection and factors influencing mortality. Differences included clinical presentation of pneumonia which was notably lower than that reported in Southeast Asia and Northern Australia; a higher proportion of neurological and parotid abscess presentation; and a lower CFR compared to that reported in case series in Southeast Asia. Ab

关键词： Melioidosis India Bangladesh Burkholderia pseudomallei Environmental

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Valorisation of fruit waste for enhanced exopolysaccharide production by Xanthomonas campestries using statistical optimisation of medium and process

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Food Bioscience 2022年第2期46卷 1014-1019页

作者： Avni Vaishnav Kinjal Upadhyay Manoj Koradiya Devayani tipre Shailesh Dave Department of Microbiology School of ScienceGujarat UniversityAhmedabad380009GujaratIndia Department of Biochemistry and Biotechnology St.Xavier’s CollegeAhmedabad380009GujaratIndia Department of Microbiology L.J.Institutes of Applied SciencesS.G.RoadAhmedabad382210GujaratIndia Xavier Research Foundation Loyola Centre for R&DSt.Xavier’s College CampusAhmedabad380009GujaratIndia

The aim of this research work was to enhance the fermentative production of exopolysaccharide(EPS)with mixed fruit waste as a key substrate.Xanothomonas campestries was isolated from spoiled orange and its EPS production efficiency was determined using EPS medium.Prior to optimisation,the production was 3.4 g/L,upon optimizing the medium the production improved to 9.2 g/L.The medium formulation was studied by sequential addition of medium components and replacement of sugar with mixed fruit waste.In formulated medium,the production enhanced to 11.1 g/L.For further optimisation,the response surface methodology was used,which resulted in the enhancement of production to 14.5 g/L.The scale-up study was undertaken in a 10 L shake flask and fermenter.In 10 L flask EPS,production was 14.45 g/L in 100 h,whereas in 10 L fermenter it was 21.10 g/L in 60h only.The optimisation studies gave nearly 500%(6.2fold)enhanced EPS production and dwindle in fermentation time.Replacement of sucrose with fruit waste extract made the process environment-friendly;omission of L-cystine and use of 50%reduced amount of sodium acetate in the medium lowered the production cost of EPS.The developed process resulted in the utilization of fruit waste and was also useful in solving the fruit waste disposal problem.

关键词： Exopolysaccharide Mixed fruits waste Formulated medium Scale up Response surface methodology

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