Melioidosis
Melioidosis
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DOI：
10.1038/nrdp.2017.107
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发表时间：
2018-02-01
影响因子：
81.5
通讯作者：
Limmathurotsakul, Direk
中科院分区：
文献类型：
--
作者：
Wiersinga, W. Joost;Virk, Harjeet S.;Limmathurotsakul, Direk
类鼻疽伯克霍尔德氏菌是一种革兰氏阴性环境细菌，是类鼻疽病的病原体，类鼻疽病是一种威胁生命的感染，估计每年全球约有89，000人死亡。糖尿病是类鼻疽病的主要危险因素，全球糖尿病大流行可能会增加类鼻疽病引起的死亡人数。类鼻疽是热带地区的地方病，特别是在东南亚和澳大利亚北方。疾病的表现可以从急性败血症到慢性感染，如B的兼性细胞内生活方式和毒力因子。假鼻疽促进病原体在广泛的细胞内的存活和持久性，并且细菌可以操纵宿主的免疫反应和信号通路以逃避监视。大多数患者存在脓毒症，但具体的临床表现及其严重程度取决于细菌进入途径（皮肤渗透、吸入或摄入）、宿主免疫功能以及细菌菌株和负荷。诊断基于临床和流行病学特征以及细菌培养。治疗需要长期静脉注射和口服抗生素疗程。由于临床识别和实验室诊断困难而导致的治疗延误往往导致不良结局，在某些地区死亡率可能超过40%。研究B。由于这种病原体的生物威胁潜力以及人们对这种疾病及其负担的认识不断提高，假鼻疽正在增加;然而，需要更好的诊断测试来改善诊断的早期确认，这将使治疗效果和生存率更好。
Burkholderia pseudomallei is a Gram-negative environmental bacterium and the aetiological agent of melioidosis, a life-threatening infection that is estimated to account for similar to 89,000 deaths per year worldwide. Diabetes mellitus is a major risk factor for melioidosis, and the global diabetes pandemic could increase the number of fatalities caused by melioidosis. Melioidosis is endemic across tropical areas, especially in southeast Asia and northern Australia. Disease manifestations can range from acute septicaemia to chronic infection, as the facultative intracellular lifestyle and virulence factors of B. pseudomallei promote survival and persistence of the pathogen within a broad range of cells, and the bacteria can manipulate the host's immune responses and signalling pathways to escape surveillance. The majority of patients present with sepsis, but specific clinical presentations and their severity vary depending on the route of bacterial entry (skin penetration, inhalation or ingestion), host immune function and bacterial strain and load. Diagnosis is based on clinical and epidemiological features as well as bacterial culture. Treatment requires long-term intravenous and oral antibiotic courses. Delays in treatment due to difficulties in clinical recognition and laboratory diagnosis often lead to poor outcomes and mortality can exceed 40% in some regions. Research into B. pseudomallei is increasing, owing to the biothreat potential of this pathogen and increasing awareness of the disease and its burden; however, better diagnostic tests are needed to improve early confirmation of diagnosis, which would enable better therapeutic efficacy and survival.