Center for Experimental and Molecular Medicine, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Center for Emerging and Tropical Diseases, Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Semin Respir Crit Care Med. 2020 Aug;41(4):496-508. doi: 10.1055/s-0040-1710570. Epub 2020 Jul 6.
Melioidosis, caused by the facultative intracellular gram-negative pathogen , is an emerging cause of community-acquired pneumonia across the tropics. The majority of patients present with pneumonia with or without sepsis, but localized and asymptomatic infection is also well recognized. Recent modeling and epidemiological studies have demonstrated the widespread presence of in otherwise unrecognized regions with a predicted mortality of 90,000 deaths worldwide. Innovative environmental studies are also uncovering how hydrodynamic, pedology, fauna, and weather events influence geographic distribution and incidence of melioidosis cases. Of concern is the changes associated with global warming, which will be conducive to in combination with the global diabetes pandemic. In fact, over 80% of patient developing melioidosis have underlying comorbidities. For this great mimicker, culture remains the mainstay of diagnosis and despite availability of other assays, challenges still remain in reducing time to diagnosis and avoiding misdiagnosis. With institution of timely antimicrobials such as ceftazidime and supportive intensive care, overall mortality can be reduced to 10%, although this can still be as high as 50% in poorly resourced areas. Promise is on the horizon with the first human vaccine trials being planned for 2021. Meanwhile new multiomics techniques are giving us a better understanding of the role of virulence and host-pathogen interactions on patient outcomes.
类鼻疽是一种由兼性细胞内革兰氏阴性病原体引起的疾病，是热带地区社区获得性肺炎的一个新兴病因。大多数患者表现为肺炎伴或不伴败血症，但也有局部和无症状感染。最近的建模和流行病学研究表明，在其他未被识别的地区也广泛存在 ，全球预计有 9 万人因此死亡。创新性的环境研究还揭示了水动力、土壤学、动物群和天气事件如何影响类鼻疽病例的地理分布和发病率。令人担忧的是与全球变暖相关的变化，这将有利于 与全球糖尿病大流行相结合。事实上，超过 80%的类鼻疽患者有潜在的合并症。对于这种高度模拟疾病，培养仍然是诊断的主要手段，尽管有其他检测方法，但在缩短诊断时间和避免误诊方面仍存在挑战。及时使用头孢他啶等抗生素和支持性强化护理，总死亡率可降低至 10%，但在资源匮乏地区，死亡率仍高达 50%。随着 2021 年首次人体疫苗试验的计划，前景一片光明。与此同时，新的多组学技术让我们更好地了解了毒力和宿主-病原体相互作用对患者预后的影响。
