Burkholderia cepacia complex

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Burkholderia cepacia complex
Burkholderia cepacia.jpg
Scientific classification
Kingdom: Bacteria
Phylum: Proteobacteria
Class: Betaproteobacteria
Order: Burkholderiales
Family: Burkholderiaceae
Genus: Burkholderia
Species:B. cepacia complex
Binomial name
Burkholderia cepacia complex
(Palleroni and Holmes 1981)
Yabuuchi et al. 1993
Type species
ATCC 25416
CCUG 12691 and 13226
CFBP 2227
CIP 80.24
DSM 7288
HAMBI 1976
ICMP 5796
JCM 5964
LMG 1222
NBRC 14074
NCCB 76047
NCPPB 2993
NCTC 10743
NRRL B-14810
Synonyms
  • Pseudomonas cepaciaBurkholder 1950
  • Pseudomonas multivoransStanier et al. 1966
  • Pseudomonas cepacia(ex Burkholder 1950) Palleroni and Holmes 1981
  • Pseudomonas kingiiJonsson 1970

Burkholderia cepacia complex (BCC), or simply Burkholderia cepacia, is a group of catalase-producing, lactose-nonfermenting, Gram-negative bacteria composed of at least 20 different species, including B. cepacia, B. multivorans , B. cenocepacia , B. vietnamiensis , B. stabilis , B. ambifaria , B. dolosa , B. anthina , B. pyrrocinia and B. ubonensis. [1] B. cepacia is an opportunistic human pathogen that most often causes pneumonia in immunocompromised individuals with underlying lung disease (such as cystic fibrosis or chronic granulomatous disease). [2] Patients with sickle-cell haemoglobinopathies are also at risk. The species also attacks young onion and tobacco plants, as well as displaying a remarkable ability to digest oil.

Catalase protein-coding gene in the species Homo sapiens

Catalase is a common enzyme found in nearly all living organisms exposed to oxygen. It catalyzes the decomposition of hydrogen peroxide to water and oxygen. It is a very important enzyme in protecting the cell from oxidative damage by reactive oxygen species (ROS). Likewise, catalase has one of the highest turnover numbers of all enzymes; one catalase molecule can convert millions of hydrogen peroxide molecules to water and oxygen each second.

Lactose chemical compound

Lactose is a disaccharide. It is a sugar composed of galactose and glucose subunits and has the molecular formula C12H22O11. Lactose makes up around 2–8% of milk (by weight). The name comes from lac (gen. lactis), the Latin word for milk, plus the suffix -ose used to name sugars. The compound is a white, water-soluble, non-hygroscopic solid with a mildly sweet taste. It is used in the food industry.

Bacteria A domain of prokaryotes – single celled organisms without a nucleus

Bacteria are a type of biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a number of shapes, ranging from spheres to rods and spirals. Bacteria were among the first life forms to appear on Earth, and are present in most of its habitats. Bacteria inhabit soil, water, acidic hot springs, radioactive waste, and the deep portions of Earth's crust. Bacteria also live in symbiotic and parasitic relationships with plants and animals. Most bacteria have not been characterised, and only about half of the bacterial phyla have species that can be grown in the laboratory. The study of bacteria is known as bacteriology, a branch of microbiology.

Contents

Pathogenesis

BCC organisms are typically found in water and soil and can survive for prolonged periods in moist environments. They show a relatively poor virulence. Virulence factors include adherence to plastic surfaces (including those of medical devices) and production of several enzymes such as elastase and gelatinase. Also relevant might be the ability to survive attacks from neutrophils. [3]

Virulence is a pathogen's or microbe's ability to infect or damage a host.

Elastase

In molecular biology, elastase is an enzyme from the class of proteases (peptidases) that break down proteins. In particular, it is a serine protease.

In biology and chemistry, gelatinase is a proteolytic enzyme that allows a living organism to hydrolyse gelatin into its sub-compounds that can cross the cell membrane and be used by the organism. It is not a pepsin.

Person-to-person spread has been documented; as a result, many hospitals, clinics, and camps have enacted strict isolation precautions for those infected with BCC. Infected individuals are often treated in a separate area from uninfected patients to limit spread, since BCC infection can lead to a rapid decline in lung function and result in death.

Lung essential respiration organ in many air-breathing animals

The lungs are the primary organs of the respiratory system in humans and many other animals including a few fish and some snails. In mammals and most other vertebrates, two lungs are located near the backbone on either side of the heart. Their function in the respiratory system is to extract oxygen from the atmosphere and transfer it into the bloodstream, and to release carbon dioxide from the bloodstream into the atmosphere, in a process of gas exchange. Respiration is driven by different muscular systems in different species. Mammals, reptiles and birds use their different muscles to support and foster breathing. In early tetrapods, air was driven into the lungs by the pharyngeal muscles via buccal pumping, a mechanism still seen in amphibians. In humans, the main muscle of respiration that drives breathing is the diaphragm. The lungs also provide airflow that makes vocal sounds including human speech possible.

Diagnosis

Diagnosis of BCC involves culturing the bacteria from clinical specimens, such as sputum or blood. BCC organisms are naturally resistant to many common antibiotics, including aminoglycosides and polymyxin B. [4] and this fact is exploited in the identification of the organism. The organism is usually cultured in Burkholderia cepacia agar (BC agar) which contains crystal violet and bile salts to inhibit the growth of Gram-positive cocci and ticarcillin and polymyxin B to inhibit the growth of other Gram-negative bacilli. It also contains phenol red pH indicator which turns pink when it reacts with alkaline byproducts generated by the bacteria when it grows.

Microbiological culture multiplying microorganisms by letting them reproduce in culture media

A microbiological culture, or microbial culture, is a method of multiplying microbial organisms by letting them reproduce in predetermined culture medium under controlled laboratory conditions. Microbial cultures are foundational and basic diagnostic methods used extensively as a research tool in molecular biology.

Sputum mucus that is coughed up from the lower airways

Sputum is mucus and is the name used for the coughed-up material (phlegm) from the lower airways. In medicine, sputum samples are usually used for naked eye exam, microbiological investigations of respiratory infections, and cytological investigations of respiratory systems. It is critical that the patient not give a specimen that includes any mucoid material from the interior of the nose. Naked eye exam of sputum can be done at home by a patient in order to note the various colors. Any hint of yellow color suggests an airway infection. Such color hints are best detected when the sputum is viewed on a very white background such as white paper, a white pot, or a white sink surface. The more intense the yellow color, the more likely it is a bacterial infection.

Polymyxin B chemical compound

Polymyxin B is an antibiotic primarily used for resistant Gram-negative infections. It is derived from the bacterium Bacillus polymyxa. Polymyxin B is composed of a number of related compounds. It has a bactericidal action against almost all Gram-negative bacilli except the Proteus and Neisseria genera. Polymyxins bind to the cell membrane and alter its structure, making it more permeable. The resulting water uptake leads to cell death. Polymyxins are cationic, basic peptides that act like detergents (surfactants). Side effects include neurotoxicity and acute renal tubular necrosis. Polymyxins are used in the topical first-aid preparation Neosporin.

  1. Family of polypeptides with attached fatty acid; cationic detergent at physiological pH, both hydrophilic and hydrophobic properties
  2. Bactericidal for gram-negative; little to no effect on gram-positive, since cell wall is too thick to permit access to membrane

Alternatively, oxidation-fermentation polymyxin-bacitracin-lactose (OFPBL) agar can be used. OFPBL contains polymyxin (which kills most Gram-negative bacteria, including Pseudomonas aeruginosa ) and bacitracin (which kills most Gram-positive bacteria and Neisseria species). [5] [6] It also contains lactose, and organisms such as BCC that do not ferment lactose turn the pH indicator yellow, which helps to distinguish it from other organisms that may grow on OFPBL agar, such as Candida species, Pseudomonas fluorescens , and Stenotrophomonas species.

<i>Pseudomonas aeruginosa</i> common bacterium

Pseudomonas aeruginosa is a common encapsulated, Gram-negative, rod-shaped bacterium that can cause disease in plants and animals, including humans. A species of considerable medical importance, P. aeruginosa is a multidrug resistant pathogen recognized for its ubiquity, its intrinsically advanced antibiotic resistance mechanisms, and its association with serious illnesses – hospital-acquired infections such as ventilator-associated pneumonia and various sepsis syndromes.

Bacitracin mixture of related cyclic peptides

Bacitracin is a mixture of related cyclic peptides produced by organisms of the licheniformis group of Bacillus subtilisvar Tracy, first isolated in 1945. These peptides disrupt Gram-positive bacteria by interfering with cell wall and peptidoglycan synthesis.

<i>Neisseria</i> genus of bacteria

Neisseria is a large genus of bacteria that colonize the mucosal surfaces of many animals. Of the 11 species that colonize humans, only two are pathogens, N. meningitidis and N. gonorrhoeae. Most gonoccocal infections are asymptomatic and self-resolving, and epidemic strains of the meningococcus may be carried in >95% of a population where systemic disease occurs at <1% prevalence.

Treatment

Treatment typically includes multiple antibiotics and may include ceftazidime, doxycycline, piperacillin, meropenem, chloramphenicol, and trimethoprim/sulfamethoxazole(co-trimoxazole). [4] Although co-trimoxazole has been generally considered the drug of choice for B. cepacia infections, ceftazidime, doxycycline, piperacillin, and meropenem are considered to be viable alternative options in cases where co-trimoxazole cannot be administered because of hypersensitivity reactions, intolerance, or resistance. [7] In April 2007, researchers from the University of Western Ontario School of Medicine, working with a group from Edinburgh, announced that they had discovered a potential method to kill the organism, involving disruption in the biosynthesis of an essential cell membrane sugar. [8] [9]

Ceftazidime chemical compound

Ceftazidime, sold under the brand names Fortaz among others, is an antibiotic useful for the treatment of a number of bacterial infections. Specifically it is used for joint infections, meningitis, pneumonia, sepsis, urinary tract infections, malignant otitis externa, Pseudomonas aeruginosa infection, and vibrio infection. It is given by injection into a vein or muscle.

Doxycycline chemical compound

Doxycycline is an antibiotic that is used in the treatment of infections caused by bacteria and certain other parasites. It is useful for bacterial pneumonia, acne, chlamydia infections, early Lyme disease, cholera and syphilis. It is also useful for the treatment of malaria when used with quinine and for the prevention of malaria. Doxycycline can be used either by mouth or intravenously.

Piperacillin chemical compound

Piperacillin is a broad-spectrum β-lactam antibiotic of the ureidopenicillin class. The chemical structure of piperacillin and other ureidopenicillins incorporates a polar side chain that enhances penetration into gram-negative bacteria and reduces susceptibility to cleavage by gram-negative beta lactamase enzymes. These properties confer activity against the important hospital pathogen Pseudomonas aeruginosa. Thus piperacillin is sometimes referred to as an "anti-pseudomonal penicillin".

History

B. cepacia was discovered by Walter Burkholder in 1949 as the cause of onion skin rot, and first described as a human pathogen in the 1950s. [10] It was first isolated in patients with cystic fibrosis (CF) in 1977 when it was known as Pseudomonas cepacia. [11] In the 1980s, outbreaks of B. cepacia in individuals with CF were associated with a 35% death rate. B. cepacia has a large genome, containing twice the amount of genetic material as E. coli .

See also

Related Research Articles

Melioidosis Human disease

Melioidosis is an infectious disease caused by a Gram-negative bacterium, Burkholderia pseudomallei, found in soil and water. It is of public health importance in endemic areas, particularly in northeast Thailand, Vietnam, and northern Australia. It exists in acute and chronic forms. Signs and symptoms may include pain in chest, bones, or joints; cough; skin infections, lung nodules, and pneumonia.

<i>Burkholderia</i> genus of bacteria

Burkholderia is a genus of Proteobacteria whose pathogenic members include the Burkholderia cepacia complex which attacks humans and Burkholderia mallei, responsible for glanders, a disease that occurs mostly in horses and related animals; Burkholderia pseudomallei, causative agent of melioidosis; and Burkholderia cepacia, an important pathogen of pulmonary infections in people with cystic fibrosis (CF).

Neomycin/polymyxin B/bacitracin antibiotic composed of several compounds

Neomycin/polymyxin B/bacitracin, also known as triple antibiotic ointment and sold under the brand name Neosporin among others, is an antibiotic cream that contains neomycin, polymyxin B, and bacitracin. It is used to prevent infections. As recently as 2018, there have been calls to remove neomycin from the product, and other competing products containing only polymyxin B and Bacitracin A are available.

MacConkey agar culture medium used in microbiology

MacConkey agar is an indicator, a selective and differential culture medium for bacteria designed to selectively isolate Gram-negative and enteric bacilli and differentiate them based on lactose fermentation. The crystal violet and bile salts inhibit the growth of Gram-positive organisms which allows for the selection and isolation of gram-negative bacteria. Enteric bacteria that have the ability to ferment lactose can be detected using the carbohydrate lactose, and the pH indicator neutral red.

Carbapenem group of β-lactam antibiotics

Carbapenems are a class of highly effective antibiotic agents commonly used for the treatment of severe or high-risk bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections. Similar to penicillins and cephalosporins, carbapenems are members of the beta lactam class of antibiotics, which kill bacteria by binding to penicillin-binding proteins, thus inhibiting bacterial cell wall synthesis. However, these agents individually exhibit a broader spectrum of activity compared to most cephalosporins and penicillins. Furthermore, carbapenems are typically unaffected by emerging antibiotic resistance, even to other beta-lactams.

Stenotrophomonas maltophilia is an aerobic, nonfermentative, Gram-negative bacterium. It is an uncommon bacterium and human infection is difficult to treat. Initially classified as Bacterium bookeri, then renamed Pseudomonas maltophilia, S. maltophilia was also grouped in the genus Xanthomonas before eventually becoming the type species of the genus Stenotrophomonas in 1993.

<i>Burkholderia pseudomallei</i> species of bacterium

Burkholderia pseudomallei is a Gram-negative, bipolar, aerobic, motile rod-shaped bacterium. It is a soil-dwelling bacterium endemic in tropical and subtropical regions worldwide, particularly in Thailand and northern Australia. It infects humans and animals and causes the disease melioidosis. It is also capable of infecting plants.

<i>Burkholderia mallei</i> species of bacterium

Burkholderia mallei is a Gram-negative, bipolar, aerobic bacterium, a human and animal pathogen of genus Burkholderia causing glanders; the Latin name of this disease (malleus) gave its name to the species causing it. It is closely related to B. pseudomallei, and by multilocus sequence typing it is a subspecies of B. pseudomallei.B. mallei evolved from B. pseudomallei by selective reduction and deletions from the B. pseudomallei genome. Unlike B. pseudomallei and other genus members, B. mallei is nonmotile; its shape is coccobacillary measuring some 1.5–3.0 μm in length and 0.5–1.0 μm in diameter with rounded ends.

<i>Chromobacterium violaceum</i> species of bacterium

Chromobacterium violaceum is a Gram-negative, facultative anaerobic, non-sporing coccobacillus. It is motile with the help of a single flagellum which is located at the pole of the coccobacillus. Usually, there are one or two more lateral flagella as well. It is part of the normal flora of water and soil of tropical and sub-tropical regions of the world. It produces a natural antibiotic called violacein, which may be useful for the treatment of colon and other cancers. It grows readily on nutrient agar, producing distinctive smooth low convex colonies with a dark violet metallic sheen. Some strains of the bacteria which do not produce this pigment have also been reported. It has the ability to break down tarballs.

Burkholderia cenocepacia is a species of Gram-negative bacteria that is common in the environment, can form a biofilm with itself, is resistant to many antibiotics and may cause disease in plants.

Burkholderia gladioli is a species of aerobic gram-negative rod-shaped bacteria that causes disease in both humans and plants. It can also live in symbiosis with plants and fungi and is found in soil, water, the rhizosphere, and in many animals. It was formerly known as Pseudomonas marginata.

Burkholderia pyrrocinia is a Gram-negative bacterium which has been found in soil as well as in the sputum of patients with cystic fibrosis.

Ashdowns medium

Ashdown's medium is a selective culture medium for the isolation and characterisation of Burkholderia pseudomallei.

Pseudomonas infection refers to a disease caused by one of the species of the genus Pseudomonas.

Walter Hagemeyer Burkholder was an American plant pathologist who helped establish the role of bacteria as plant pathogens. He was awarded a Ph.D. by Cornell University in 1917 and subsequently appointed as professor of plant pathology.

Burkholderia contaminans is a gram-negative, bacterium from the genus of Burkholderia and the family of Burkholderiaceae and belongs to the Burkholderia cepacia complex, which was isolated from cystic fibrosis patients in Argentina. Burkholderia acidipaludis can cause biliary sepsis.

Ceftazidime/avibactam pharmaceutical drug

Ceftazidime/avibactam is a combination drug composed of ceftazidime, a cephalosporin antibiotic, and avibactam, a β-lactamase inhibitor. It is used for the treatment of serious bacterial infections.

Ornibactin chemical compound

Ornibactin is a siderophore, or small iron-binding compound secreted by bacteria to transport iron into the cell. Ornibactin is produced by Burkholderia cenocepacia under iron-deficient conditions. B. cenocepacia is known to opportunistically infect humans, specifically ones suffering from cystic fibrosis.

References

  1. Lipuma J (2005). "Update on the Burkholderia cepacia complex". Curr Opin Pulm Med. 11 (6): 528–33. doi:10.1097/01.mcp.0000181475.85187.ed. PMID   16217180.
  2. Mahenthiralingam E, Urban T, Goldberg J (2005). "The multifarious, multireplicon Burkholderia cepacia complex". Nat Rev Microbiol. 3 (2): 144–56. doi:10.1038/nrmicro1085. PMID   15643431.
  3. Torok, E.; Moran, E.; Cooke, F (2009). Oxford Handbook of Infectious Diseases and Microbiology. Oxford University Press. ISBN   978-0-19-856925-1.
  4. 1 2 McGowan J (2006). "Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum". Am J Infect Control. 34 (5 Suppl 1): S29–37, discussion S64–73. doi:10.1016/j.ajic.2006.05.226. PMID   16813979.
  5. Becton, Dickinson and Company (2003). BD Difco and BD BBL Manual: Manual of Microbiological Culture Media. Franklin Lakes, New Jersey: Becton Dickinson. pp. 422&ndash, 423.
  6. "OFPBL agar". Remel Technical Manual. Lenexa, Kan: Remel. 1997.
  7. Avgeri SG; Matthaiou DK; Dimopoulos G; Grammatikos AP; Falagas ME (May 2009). "Therapeutic options for Burkholderia cepacia infections beyond co-trimoxazole: a systematic review of the clinical evidence". Int. J. Antimicrob. Agents. 33 (5): 394–404. doi:10.1016/j.ijantimicag.2008.09.010. PMID   19097867.
  8. "Key Found to Kill Cystic Fibrosis Superbug". Innovations Report. April 25, 2007. Retrieved April 26, 2007.
  9. Ortega XP; Cardona ST; Brown AR; et al. (May 2007). "A Putative Gene Cluster for Aminoarabinose Biosynthesis Is Essential for Burkholderia cenocepacia Viability". J. Bacteriol. 189 (9): 3639–44. doi:10.1128/JB.00153-07. PMC   1855895 . PMID   17337576.
  10. Burkholder WH (1950). "Sour skin, a bacterial rot of onion bulbs". Phytopathology. 40 (1): 115–7.
  11. Lararya-Cuasay LR, Lipstein M, Huang NN (1977). "Pseudomonas cepacia in the respiratory flora of patients with cystic fibrosis". Pediatr Res. 11: 502. doi:10.1203/00006450-197704000-00792.

Further reading