Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia
Introduction. Burkholderia pseudomallei (melioidosis) is an important cause of community-acquired pneumonia (CAP) in the tropics. Selective medium is recommended for laboratory diagnosis with non-sterile respiratory samples, while PCR is not routinely used due to variable reported performance. The e...
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Microbiology Society
2020
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| author | Subakir, Haida Chong, Yoong Min Chan, Yoke Fun Hasan, Mohd Shahnaz Jamaluddin, Mohamad Fadhil Hadi Pang, Yong Kek Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Sam, I-Ching |
| author_facet | Subakir, Haida Chong, Yoong Min Chan, Yoke Fun Hasan, Mohd Shahnaz Jamaluddin, Mohamad Fadhil Hadi Pang, Yong Kek Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Sam, I-Ching |
| author_sort | Subakir, Haida |
| collection | UM |
| description | Introduction. Burkholderia pseudomallei (melioidosis) is an important cause of community-acquired pneumonia (CAP) in the tropics. Selective medium is recommended for laboratory diagnosis with non-sterile respiratory samples, while PCR is not routinely used due to variable reported performance. The effectiveness of these diagnostic modalities varies by site. Aim. To compare selective media and real-time PCR (qPCR) with routine media in detecting B. pseudomallei in CAP respiratory samples in a low-incidence setting in Kuala Lumpur, Malaysia. Methodology. Respiratory samples were routinely cultured on blood, chocolate and MacConkey agar (RESP-ROUTINE), and compared to culture on selective Ashdown medium (RESP-SELECTIVE) and qPCR. The gold standard was routine culture of B. pseudomallei from any site (ALL-ROUTINE). Results. B. pseudomallei was detected in 8/204 (3.9%) samples. Overall sensitivity rates differed (P=0.03) for qPCR (100%), RESP-SELECTIVE (87.5%) and RESP-ROUTINE (50%). There was a trend towards lower median days to positive culture for RESP-SELECTIVE (1 day) compared to RESP-ROUTINE (2 days, P=0.08) and ALL-ROUTINE (2 days, P=0.06). Reagent costs for each additional detection were USD59 for RESP-SELECTIVE and USD354 for PCR. Conclusions. In a low-incidence setting, selective culture of respiratory samples on Ashdown was more sensitive and allowed quicker identification than routine media, at reasonable cost. Blood cultures are critical, confirming four cases missed by routine respiratory culture. Selective medium is useful in early pneumonia (pre-sepsis) and resource-limited settings where blood cultures are infrequently done. Real-time PCR is costly, but highly sensitive and useful for high-risk patients with diabetes, cancer or immunosuppressants, or requiring ventilation or intensive care. © 2020 The Authors |
| first_indexed | 2024-03-06T06:04:01Z |
| format | Article |
| id | um.eprints-24875 |
| institution | Universiti Malaya |
| last_indexed | 2024-03-06T06:04:01Z |
| publishDate | 2020 |
| publisher | Microbiology Society |
| record_format | dspace |
| spelling | um.eprints-248752020-06-17T02:11:20Z http://eprints.um.edu.my/24875/ Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia Subakir, Haida Chong, Yoong Min Chan, Yoke Fun Hasan, Mohd Shahnaz Jamaluddin, Mohamad Fadhil Hadi Pang, Yong Kek Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Sam, I-Ching R Medicine Introduction. Burkholderia pseudomallei (melioidosis) is an important cause of community-acquired pneumonia (CAP) in the tropics. Selective medium is recommended for laboratory diagnosis with non-sterile respiratory samples, while PCR is not routinely used due to variable reported performance. The effectiveness of these diagnostic modalities varies by site. Aim. To compare selective media and real-time PCR (qPCR) with routine media in detecting B. pseudomallei in CAP respiratory samples in a low-incidence setting in Kuala Lumpur, Malaysia. Methodology. Respiratory samples were routinely cultured on blood, chocolate and MacConkey agar (RESP-ROUTINE), and compared to culture on selective Ashdown medium (RESP-SELECTIVE) and qPCR. The gold standard was routine culture of B. pseudomallei from any site (ALL-ROUTINE). Results. B. pseudomallei was detected in 8/204 (3.9%) samples. Overall sensitivity rates differed (P=0.03) for qPCR (100%), RESP-SELECTIVE (87.5%) and RESP-ROUTINE (50%). There was a trend towards lower median days to positive culture for RESP-SELECTIVE (1 day) compared to RESP-ROUTINE (2 days, P=0.08) and ALL-ROUTINE (2 days, P=0.06). Reagent costs for each additional detection were USD59 for RESP-SELECTIVE and USD354 for PCR. Conclusions. In a low-incidence setting, selective culture of respiratory samples on Ashdown was more sensitive and allowed quicker identification than routine media, at reasonable cost. Blood cultures are critical, confirming four cases missed by routine respiratory culture. Selective medium is useful in early pneumonia (pre-sepsis) and resource-limited settings where blood cultures are infrequently done. Real-time PCR is costly, but highly sensitive and useful for high-risk patients with diabetes, cancer or immunosuppressants, or requiring ventilation or intensive care. © 2020 The Authors Microbiology Society 2020 Article PeerReviewed Subakir, Haida and Chong, Yoong Min and Chan, Yoke Fun and Hasan, Mohd Shahnaz and Jamaluddin, Mohamad Fadhil Hadi and Pang, Yong Kek and Ponnampalavanar, Sasheela and Syed Omar, Sharifah Faridah and Sam, I-Ching (2020) Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia. Journal of Medical Microbiology, 69 (1). pp. 49-51. ISSN 0022-2615, DOI https://doi.org/10.1099/jmm.0.001108 <https://doi.org/10.1099/jmm.0.001108>. https://doi.org/10.1099/jmm.0.001108 doi:10.1099/jmm.0.001108 |
| spellingShingle | R Medicine Subakir, Haida Chong, Yoong Min Chan, Yoke Fun Hasan, Mohd Shahnaz Jamaluddin, Mohamad Fadhil Hadi Pang, Yong Kek Ponnampalavanar, Sasheela Syed Omar, Sharifah Faridah Sam, I-Ching Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia |
| title | Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia |
| title_full | Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia |
| title_fullStr | Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia |
| title_full_unstemmed | Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia |
| title_short | Selective media and real-time PCR improves diagnosis of melioidosis in community-acquired pneumonia in a low-incidence setting in Kuala Lumpur, Malaysia |
| title_sort | selective media and real time pcr improves diagnosis of melioidosis in community acquired pneumonia in a low incidence setting in kuala lumpur malaysia |
| topic | R Medicine |
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