Currie Bart J
Global and Tropical Health Division, Menzies School of Health Research and Infectious Diseases Department, Royal Darwin Hospital, Darwin, Australia.
Semin Respir Crit Care Med. 2015 Feb;36(1):111-25. doi: 10.1055/s-0034-1398389. Epub 2015 Feb 2.
Infection with Burkholderia pseudomallei can result in asymptomatic seroconversion, a single skin lesion that may or may not heal spontaneously, a pneumonia which can be subacute or chronic and mimic tuberculosis or rapidly progressive resulting in fatal overwhelming sepsis. Latency with subsequent activation of disease is well recognized, but very uncommon. Melioidosis also has a myriad of other clinical presentations and diagnosis is often delayed because of this and because of difficulties with laboratory diagnosis and lack of recognition outside melioidosis-endemic regions. The perception of B. pseudomallei as a top tier biothreat agent has driven large funding for research, yet resources for diagnosis and therapy of melioidosis in many endemic locations remain extremely limited, with mortality as high as 50% in comparison to around 10% in regions where state-of-the-art intensive care therapy for sepsis is available. Fatal melioidosis is extremely unlikely from natural infection in a healthy person, provided the diagnosis is made early, ceftazidime or meropenem is commenced and intensive care therapy is available. While biothreat research is directed toward potential aerosol exposure to B. pseudomallei, the overall proportion of melioidosis cases resulting from inhalation rather than from percutaneous inoculation remains entirely uncertain, although the epidemiology supports a shift to inhalation during severe weather events such as cyclones and typhoons. What makes B. pseudomallei such a dangerous organism for patients with diabetes and other selective risk factors remains unclear, but microbial genome-wide association studies linking clinical aspects of melioidosis cases to nonubiquitous or polymorphic B. pseudomallei genes or genomic islands are beginning to uncover specific virulence signatures. Finally, what also remains uncertain is the global phylogeography of B. pseudomallei and whether melioidosis is spreading beyond historical locations or is just being unmasked in Africa and the Americas by better recognition and increased surveillance.
感染类鼻疽伯克霍尔德菌可导致无症状血清转化、单个皮肤损伤（可能自愈也可能不会）、亚急性或慢性肺炎（可类似肺结核或快速进展，导致致命性严重败血症）。疾病潜伏及随后激活已得到充分认识，但非常罕见。类鼻疽还有多种其他临床表现，由于这些以及实验室诊断困难和在类鼻疽流行地区以外缺乏认识，诊断往往延迟。将类鼻疽伯克霍尔德菌视为顶级生物威胁病原体促使大量资金投入研究，但许多流行地区用于类鼻疽诊断和治疗的资源仍然极其有限，死亡率高达50%，而在有败血症的最先进重症监护治疗的地区，死亡率约为10%。只要早期诊断、开始使用头孢他啶或美罗培南并提供重症监护治疗，健康人因自然感染而患致命类鼻疽的可能性极小。虽然生物威胁研究针对潜在的类鼻疽伯克霍尔德菌气溶胶暴露，但吸入而非经皮接种导致的类鼻疽病例的总体比例仍完全不确定，尽管流行病学支持在气旋和台风等恶劣天气事件期间向吸入途径转变。类鼻疽伯克霍尔德菌对糖尿病患者和其他选择性风险因素患者如此危险的原因尚不清楚，但将类鼻疽病例的临床方面与非普遍存在或多态性的类鼻疽伯克霍尔德菌基因或基因组岛联系起来的微生物全基因组关联研究开始揭示特定的毒力特征。最后，类鼻疽伯克霍尔德菌的全球系统地理学以及类鼻疽是否正在扩散到历史上的发病地点以外，或者只是由于更好的识别和加强监测而在非洲和美洲被发现，这些也仍然不确定。
