Immune responses of selected phagotopes from monoclonal antibodies of Burkholderia pseudomallei.

Random peptide libraries displayed by bacteriophage T7 and M13 were employed to identify mimotopes from 4 monoclonal antibodies (MAbs) specific to Burkholderia pseudomallei. Insert DNA sequences of bound phages selected from four rounds of panning with each MAb revealed peptide sequences corresponding to B. pseudomallei K96243 hypothetical protein BPSL2046, hypothetical protein BpseP_02000035, B. pseudomallei K96243 hypothetical protein BPSS0784, B. pseudomallei 1710b hypothetical protein BURPS1710b_1104, and B. cenocepacia H12424 TonB-dependent siderophore receptor, all located at the outer membrane. The immune responses from all selected phagotopes were significantly higher than that of lipopolysaccharide. The study demonstrates the feasibility of identifying mimotopes through screening of phage-displayed random peptide libraries with B. pseudomallei MAbs.

Reduced interleukin-17 expression of Burkholderia pseudomallei-infected peripheral blood mononuclear cells of diabetic patients.

Burkholderia pseudomallei is the causative agent of melioidosis. One of the main risk factors for B. pseudomallei infection in endemic areas is diabetes mellitus. The present study investigated IL-17 mRNA and protein expression by peripheral blood mononuclear cells in response to B. pseudomallei infection in 10 diabetic patients in comparison to 10 healthy blood donors. The IL-17 expression in diabetic patients was significantly lower (p < 0.05) than in the controls. However, IL-23 mRNA expression of the 2 groups was comparable. The present findings suggest that melioidosis affects T cell IL-17 production and that patients with diabetes mellitus have a defective IL-17 production in response to this type of infection.

Serodiagnosis of melioidosis by a competitive enzyme-linked immunosorbent assay using a lipopolysaccharide-specific monoclonal antibody.

Burkholderia pseudomallei is the causative agent of melioidosis, a severe and potentially fatal infectious disease in humans known to be endemic in Southeast Asia and northern Australia. The infection is also increasingly recognized in various animal species with a potential to spread to humans. With the potential as a biological warfare agent, specific serodiagnosis of melioidosis for surveillance in large populations at risk, humans or animals, would be highly valuable. In this study, a competitive enzyme-linked immunosorbent assay (ELISA) using a lipopolysaccharide-specific monoclonal antibody was developed. The assay provides high specificity, based on a previously described monoclonal antibody to a specific epitope on the lipopolysaccharide (LPS) of B. pseudomallei. The assay sensitivity of 96.0% and specificity of 100% were achieved at a cutoff value of 50% inhibition in human culture-proven melioidosis cases. An optimal cutoff value of 65% inhibition for sera from a melioidosis endemic area was obtained by ROC analysis and resulted in an assay specificity of 86.2%, while maintaining assay sensitivity of 92.0%. A potential application of the assay in the serodiagnosis of melioidosis in animal species was also evaluated usina dolphin sera with satisfactory results.

Seroprevalence of Burkholderia pseudomallei in East Timorese refugees: implications for healthcare in East Timor.

Melioidosis is a disease with protean clinical manifestations caused by the bacterium Burkholderia pseudomallei. It is endemic in countries surrounding the newly independent East Timor, but has yet to be isolated or demonstrated serologically in that country. One illness that can be clinically indistinguishable from melioidosis is pulmonary tuberculosis, a condition with a very high prevalence in East Timor. We used an indirect hemagglutination test (IHA) to measure antibodies to B. pseudomallei in 407 East Timorese evacuated to Darwin, Australia, in September 1999. Assuming a positive IHA titer as > or = 1:40, the overall seroprevalence rate was 17.0%, in keeping with other seroprevalence studies from the region. The IHA titres ranged up to 1:320. After adjusting for age, females were 2.5 times more likely to be seropositive than males (p = 0.0001). There was an inverse relationship between seropositivity and age. This study shows that exposure to B. pseudomallei occurs in East Timor melioidosis is also likely to occur. Due to the lack of laboratory facilities at present, it may be some time before a laboratory-confirmed case proves that melioidosis occurs. In the meantime, clinicians in East Timor should include melioidosis in the differential diagnosis of the many conditions that it may mimic.

Etiologies and treatment outcomes in patients hospitalized with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand.

Local epidemiological data on the etiologies of in-patients who are hospitalized with CAP is needed to develop guidelines for clinical practice. This study was conducted to determine the pattern of microorganisms causing community-acquired pneumonia (CAP) in adult patients admitted to Srinagarind Hospital, Khon Kaen, Thailand, between January 2001 and December 2002. Altogether, 254 patients (124 males, 130 females) averaging 56.4 (SD 19.8) years were included. Eighty-six of them (33.8%) presented with severe CAP on initial clinical presentation. The etiologies for the CAP cases were discovered by isolating the organisms from the blood, sputum, pleural fluid, and other sterile sites. Serology for Chlamydia pneunmoniae and Mycoplasma pneumoniae were performed to diagnose current infection. The causative organisms were identified in 145 patients (57.1%). Streptococcus pneumoniae was the commonest pathogen, identified in 11.4% of the cases, followed by Burkholderia pseudomallei (11.0%) and Klebsiella pneumoniae (10.2%). The atypical pathogens, C. pneumoniae and M. pneumoniae, accounted for 8.7% and 3.9% of the isolates, respectively. Sixteen patients (6.3%) had dual infections; C. pneumoniae was the most frequent coinfecting pathogen. The average length of hospital stay was 12.9 (SD 14.0) days, with 27.9% staying more than 2 weeks. Overall, 83.9% of the patients improved with treatment, 10.2% did not improve and 5.9% died. The most common complications were acute respiratory failure (31.1%) and septic shock (20.9%). We conclude that initial antibiotic use should cover the atypical pathogens, C. pneumoniae and M. pneumoniae, in hospitalized CAP patients. B. pseudomallei is an endemic pathogen in Northeast Thailand, and should be considered in cases of severe CAP.

Indirect immunofluorescent antibody test for the rapid diagnosis of melioidosis.

Culture is the only reliable method available at present for the diagnosis of melioidosis. Though serological tests have been described, their value in routine diagnosis is controversial. All indirect immunofluorescent assay (IFA) was therefore evaluated to determine its use in the diagnosis of melioidosis. Whole cell antigen prepared from a laboratory isolate of Burkholderia pseudomallei was used to assay IgG and IgM antibodies. Fourteen of the 22 (63.6%) culture proven cases had IgM antibodies while only 10 (45.5%) had IgG antibodies. Negative predictive value of IgM assay was 92 per cent. Positive predictive value was 100 per cent if both IgM and IgG were considered together. The present study done on a limited number of samples suggests that IFA may be useful in routine diagnosis of melioidosis.

Seroprevalence of melioidosis in dairy cattle in Chiang Mai Province, northern Thailand.

The seroprevalence of melioidosis in dairy cattle in Chiang Mai Province was investigated using of the indirect hemagglutination antibody (IHA) method. Two hundred and fifty-three samples were tested for serum antibodies to Burkholderia pseudomallei. The samples were from a total population of 8,688 dairy cattle in the province; random sampling, stratified by the location of cattle, was used. The seroprevalence was determined as 2% at 1:40 cut-off value, which was estimated to equate to 0.3% to 3.7% (95% CI). This report of relatively low disease prevalence in the animal population corresponds to other prevalence studies of the agent in the environment and the human population in the region. The prevalence is markedly different to that reported from northeastern Thailand, where the disease is highly endemic.

An indirect ELISA for the diagnosis of melioidosis.

BACKGROUND & OBJECTIVES: Very little information is available on melioidosis in India. This disease caused by Burkholderia pseudomallei is not often considered as a differential diagnosis and patients are not usually investigated for it. Thus we are unaware of its prevalence in India. This study was undertaken to detect the presence of melioidosis in patients presenting with pyrexia of unknown origin (PUO) using an indirect ELISA. METHODS: The well established ELISA technique was adapted to detect melioidosis in patients attending the Christian Medical College and Hospital, Vellore and to provide a serological test using reagents with a reasonable shelf-life. The ELISA is designed to detect IgG antibodies to B. pseudomallei in serum samples. RESULTS: A cut-off optical density (OD) of 0.36 (mean +/- 2 SD of healthy controls) was chosen as diagnostic criterion for the diseased group. The mean OD values in the sera of patients with culture proven melioidosis was significantly (P < 0.001) higher than that of healthy controls. INTERPRETATION & CONCLUSION: The indirect ELISA was simple to perform and may be recommended as a diagnostic serological test when melioidosis is considered as a differential diagnosis.

Burkholderia pseudomallei-specific recombinant protein and its potential in the diagnosis of melioidosis.

Melioidosis is an important public health problem in Southeast Asia and Northern Australia. This disease is caused by the gram-negative bacilli, Burkholderia pseudomallei. Wide spectra of clinical manifestations are observed in melioidosis ranging from asymptomatic to septicemic infection. Although serodiagnostic methods of melioidosis have been improved significantly in recent years, a highly specific diagnostic test that can differentiate asymptomatic seropositive individuals and melioidosis patients remains to be the subject of current investigations. In this study, a B. pseudomallei-specific gene, pBps-1, expressing a novel 18.7 kDa recombinant protein was selected from genomic libraries of two B. pseudomallei virulent isolates by using pooled sera from septicemic melioidosis patients. Nucleotide sequence analysis demonstrated that this gene is unique and does not show substantial similarity with any known genes in the Genbank database. The Bps-1 recombinant protein was evaluated for its potential in serodiagnosis of melioidosis by Western blot analysis. A high degree of specificity was demonstrated using sera from healthy individuals in the endemic (98.5%) and non-endemic areas (100%), with moderate sensitivity (69.7%) in melioidosis patients. The study demonstrated that this approach can be used to obtain highly specific recombinant antigens such as that described in the present report. A combination of such antigens should provide materials for successful serodiagnosis of melioidosis in the endemic areas.

Production of specific monoclonal antibodies to Burkholderia pseudomallei and their diagnostic application.

Hybridomas secreting monoclonal antibodies (MAbs) specific to Burkholderia pseudomallei were produced by immunizing BALB/cJ mice with crude culture filtrate of B. pseudomallei. Two monoclonal antibodies were found to be highly specific to B.pseudomallei as tested by indirect enzyme-linked immunosorbent assay and immunoblotting against a panel of crude whole cell extracts from B. pseudomallei, B. cepacia, Pseudomonas aeruginosa, P.putida, and Escherichia coli. One of the specific MAbs, clone SP-M, IgM subclass, could directly agglutinate all 42 B. pseudomallei, isolates. The study has shown that the agglutinating MAb has potential for rapid identification of B. pseudomallei in primary bacterial culture from clinical specimens. The antibody can be used in bacteriology laboratories to reduce time of biochemical methods, which require a few days.

Indirect hemagglutination antibodies against Burkholderia pseudomallei in normal blood donors and suspected cases of melioidosis in Malaysia.

Interpretation of the indirect hemagglutination test (IHA) for melioidosis in endemic areas is difficult because of the presence of antibodies in apparently healthy individuals. Fifty-three out of 200 healthy blood donors in Malaysia showed positive antibody titers (> or = 1 : 40) against Burkholderia pseudomallei. Seven percent had an IHA titer of 1 : 40, 11% had an IHA titer of 1 : 80 while 8.5% had a titer > or = 1 : 160. Out of 258 sera sent for melioidosis serology, 7% of the patients had an IHA titer of 1 : 40, 9% had an IHA titer of 1 : 80 while 20% had an IHA titer of > or = 1 : 160. If a titer of > or = 1 : 80 is taken as cut off point for positivity, 29% of the patients had positive melioidosis serology. Increasing the positivity threshold may jeopardize the sensitivity of the test. A more specific and sensitive test is needed.

Application of indirect immunofluorescence microscopy to colony identification of Pseudomonas pseudomallei.

Indirect immunofluorescence microscopy was used as a colony identification method of Pseudomonas pseudomallei isolates. The antisera against lipopolysaccharide and protein fractions of P. pseudomallei were prepared in guinea pigs and rabbits. With these antisera and fluorescence-labelled anti-guinea pig IgG and anti-rabbit IgG prepared in sheep (goat), indirect immunofluorescence microscopy was conducted on the colonies of P. pseudomallei and other species of bacteria. The overall results indicated that this method is efficient, rapid and specific for identification of P. pseudomallei colonies from clinical specimens.

Characterization of Pseudomonas pseudomallei antigens by SDS-polyacrylamide gel electrophoresis and western blot.

Immunological characterization of various Pseudomonas pseudomallei preparations was carried out by SDS-PAGE and Western blot using sera from infected humans and from patients with other bacterial infections. Somatic (SOM) and partially purified cell extracts (PCE) gave more complex SDS-PAGE patterns: M(r) ranged from 86 to 12.7 and 48 to 10 kDa, respectively. The culture-filtrated antigens (CF) from 3 different kinds of synthetic media consisted of fairly simple profiles with common bands M(r) of 40, 26 and 16 kDa. PCE and CF reacted specifically with infected human sera; SOM did not. The components with M(r) of 40 kDa in CF reacted consistently with all infected sera but failed to react with sera infected with Escherichia coli, Enterobacter spp., Klebsiella pneumoniae, Proteus mirabilis, Salmonella spp., Staphylococcus aureus, Streptococcus spp., Pseudomonas aeruginosa and P. stutzeri. This peptide was demonstrated to be a major component in CF thus suggesting its potential for development of immunodiagnostic methods for melioidosis.

Use of endotoxin antigens in enzyme-linked immunosorbent assay for the diagnosis of P. pseudomallei infections (melioidosis).

An enzyme-linked immunosorbent assay (ELISA) with endotoxin preparations of P. pseudomallei as antigen was developed for detection of IgG antibodies specific to melioidosis. Forty-seven sera of bacteriologically confirmed melioidosis patients, 55 non-melioidosis sera and 50 sera of healthy blood donors from non-endemic areas were subjected to this assay in comparison with indirect hemagglutination assay (IHA). The data were treated by receiver operating characteristics analysis. The sensitivity, specificity and accuracy in this ELISA were 95.7%, 94.2%, and 94.7%, respectively, with cut-off value of OD = 0.312 at 490 nm. Meanwhile, those in IHA were 81.0%, 91.4%, and 88.1%, respectively, with a cut-off value of > or = 1:160. From these results, the ELISA was judged to be more reliable than IHA as the seroassay for diagnosis of melioidosis.

The prevalence of the indirect hemagglutination test for melioidosis in children in an endemic area.

The indirect hemaglutination test for melioidosis was studied in 295 children who live in the northeastern part of Thailand. Sixty-seven children (22.7%) were healthy children who came to the well baby clinic. Two hundred and twenty-eight children (77.3%) came to the hospital because of some illnesses other than melioidosis. Eighty-three percent of the children had an IHA titer of at least 1:10 or greater. Twenty-two percent had an IHA titer of 1:80 or greater. The prevalence of positive IHA titer and the mean titer were higher in the older age group. The age of children should be considered when interpreting IHA titer for milioidosis.

Immunoblot analysis to demonstrate antigenic variability of clinical isolated. Pseudomonas pseudomallei.

Pseudomonas pseudomallei (Ps.ps.) is the causative organism of melioidosis, and is widely distributed in Southeast Asia and Northern Australia. Clinical manifestations range from subclinical infection to fulminant septicemia. To demonstrate the antigenic variability of Ps.ps., 62 clinical isolates from 31 blood, 13 sputum, 9 pus, 3 urine and 6 body fluid culture specimens were studied by SDS-PAGE and immunoblotting. In SDS-PAGE, there were approximately 20 antigenic components with molecular weights ranging from 14 to 66 kilodaltons (KD) which suggested that there was antigenic variability among these 62 clinical isolates of Ps.ps. Attempts to correlate immunoblot profiles with clinical illness or sources of specimens were not successful but 6 common antigens were identified with molecular weight of 17.5, 21, 33, 34, 40 and 45 KD, respectively. Among these antigens, the 45 KD component was recognised by all patients' sera. Thus, the 45 KD protein antigen may be useful for the future approach in immunodiagnosis of melioidosis.