Burkholderia cepacia complex

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Burkholderia cepacia complex
Burkholderia cepacia.jpg
Scientific classification
Domain:
Bacteria
Phylum:
Pseudomonadota
Class:
Betaproteobacteria
Order:
Burkholderiales
Family:
Burkholderiaceae
Genus:
Burkholderia
Species complex:
B. cepacia complex

Burkholderia cepacia complex (BCC) is a species complex consisting of Burkholderia cepacia and at least 20 different biochemically similar species of Gram-negative bacteria. They are catalase-producing and lactose-nonfermenting. [1] Members of BCC are opportunistic human pathogens that most often cause 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 complex also attacks young onion and tobacco plants, and displays a remarkable ability to digest oil.

Contents

Taxonomy

Burkholderia cepacia
Scientific classification OOjs UI icon edit-ltr.svg
Domain: Bacteria
Phylum: Pseudomonadota
Class: Betaproteobacteria
Order: Burkholderiales
Family: Burkholderiaceae
Genus: Burkholderia
Species:
B. cepacia
Binomial name
Burkholderia cepacia
(Palleroni and Holmes 1981)
Yabuuchi et al. 1993
Type strain
* ATCC 25416 [3] [a]
Synonyms
  • Pseudomonas cepaciaBurkholder 1950
  • Pseudomonas multivoransStanier et al. 1966
  • Pseudomonas cepacia(ex Burkholder 1950) Palleroni and Holmes 1981
  • Pseudomonas kingiiJonsson 1970

The group includes B. cepacia, B. multivorans , B. cenocepacia , B. vietnamiensis , B. stabilis , B. ambifaria , B. dolosa , B. anthina , B. pyrrocinia and B. ubonensis , among other species. [1]

Occurrence

BCC is resistant to a number of common disinfectants, specifically povidone-iodine, triclosan, chlorohexidine, cetylpyridinium chloride, and quaternary ammoniums such as benzalkonium chloride. Concentrations used as preservatives in water-based pharmaceutical products are often not enough to kill BCC or even stop it from proliferating. [5] Even higher-concentration versions of these biocides intended for disinfection, such as povidone-iodine solution for wound dressing and benzonium chloride wipes, may harbor live BCC if not sterilized using another method. [6] [7]

Burkholderia cepacia is also found in marine environments (marine sponges) and some strains of Burkholderia cepacia can tolerate high salinity. [8] S.I. Paul et al. (2021) [8] isolated and biochemically characterized salt tolerant strains of Burkholderia cepacia from marine sponges of Saint Martin's Island of the Bay of Bengal, Bangladesh. [8]

Human infection

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 their ability to survive attacks from neutrophils. [9]

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. [10]

BCC infection is a contraindication for lung transplantation and cystic fibrosis patients infected with BCC may be excluded from transplantation due to the increased mortality. [11] Additionally, lung transplant recipients infected with B. cenocepacia are six times more likely to die within a year of transplantation than those infected with other BCC organisms. [12]

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. [13] 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.[ citation needed ]

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). [14] [15] 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.[ citation needed ]

Treatment

Treatment typically includes multiple antibiotics and may include ceftazidime, minocycline, piperacillin, meropenem, chloramphenicol, and trimethoprim/sulfamethoxazole(co-trimoxazole). [13] [16] Although co-trimoxazole has been generally considered the drug of choice for B. cepacia infections, ceftazidime, minocycline, 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. [17] Newer beta-lactam / beta-lactamase combinations like ceftazidime-avibactam or ceftolozane-tazobactam can also be effective. [16] BCC intrinsically resistant to colistin and usually resistant to aminoglycosides. [18]

In people with cystic fibrosis, evidence is insufficient about the effectiveness of long-term antibiotic treatment with continuous inhaled aztreonam lysine (AZLI) in terms of lung function or chest infections. [19]

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. [20] It was first isolated in patients with cystic fibrosis (CF) in 1977, when it was known as Pseudomonas cepacia. [21] 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 .[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Cystic fibrosis</span> Genetic disorder affecting mostly the lungs

Cystic fibrosis (CF) is a genetic disorder inherited in an autosomal recessive manner that impairs the normal clearance of mucus from the lungs, which facilitates the colonization and infection of the lungs by bacteria, notably Staphylococcus aureus. CF is a rare genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. The hallmark feature of CF is the accumulation of thick mucus in different organs. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. Other signs and symptoms may include sinus infections, poor growth, fatty stool, clubbing of the fingers and toes, and infertility in most males. Different people may have different degrees of symptoms.

<span class="mw-page-title-main">Melioidosis</span> Human disease

Melioidosis is an infectious disease caused by a gram-negative bacterium called Burkholderia pseudomallei. Most people exposed to B. pseudomallei experience no symptoms; however, those who do experience symptoms have signs and symptoms that range from mild, such as fever and skin changes, to severe with pneumonia, abscesses, and septic shock that could cause death. Approximately 10% of people with melioidosis develop symptoms that last longer than two months, termed "chronic melioidosis".

<span class="mw-page-title-main">Colistin</span> Antibiotic

Colistin, also known as polymyxin E, is an antibiotic medication used as a last-resort treatment for multidrug-resistant Gram-negative infections including pneumonia. These may involve bacteria such as Pseudomonas aeruginosa, Klebsiella pneumoniae, or Acinetobacter. It comes in two forms: colistimethate sodium can be injected into a vein, injected into a muscle, or inhaled, and colistin sulfate is mainly applied to the skin or taken by mouth. Colistimethate sodium is a prodrug; it is produced by the reaction of colistin with formaldehyde and sodium bisulfite, which leads to the addition of a sulfomethyl group to the primary amines of colistin. Colistimethate sodium is less toxic than colistin when administered parenterally. In aqueous solutions, it undergoes hydrolysis to form a complex mixture of partially sulfomethylated derivatives, as well as colistin. Resistance to colistin began to appear as of 2015.

<i>Burkholderia</i> Genus of bacteria

Burkholderia is a genus of Pseudomonadota 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). Burkholderia species is also found in marine environments. S.I. Paul et al. (2021) isolated and characterized Burkholderia cepacia from marine sponges of the Saint Martin's Island of the Bay of Bengal, Bangladesh.

<span class="mw-page-title-main">Ceftazidime</span> Antibiotic medication

Ceftazidime, sold under the brand name Fortaz among others, is a third-generation cephalosporin 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, muscle, or eye.

<i>Pseudomonas aeruginosa</i> Species of bacterium

Pseudomonas aeruginosa is a common encapsulated, Gram-negative, aerobic–facultatively anaerobic, 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. P. aeruginosa is able to selectively inhibit various antibiotics from penetrating its outer membrane - and has high resistance to several antibiotics. According to the World Health Organization P. aeruginosa poses one of the greatest threats to humans in terms of antibiotic resistance.

<i>Stenotrophomonas maltophilia</i> Species of bacterium

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 was reported in 2008 that there had been an expansion of the affected regions due to significant natural disasters, and it could be found in Southern China, Hong Kong, and countries in the Americas. B. pseudomallei, amongst other pathogens, has been found in monkeys imported into the United States from Asia for laboratory use, posing a risk that the pathogen could be introduced into the country.

<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 characteristic striking 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.

<i>Burkholderia cenocepacia</i> Species of bacterium

Burkholderia cenocepacia is a Gram-negative, rod-shaped bacterium that is commonly found in soil and water environments and may also be associated with plants and animals, particularly as a human pathogen. It is one of over 20 species in the Burkholderia cepacia complex (Bcc) and is notable due to its virulence factors and inherent antibiotic resistance that render it a prominent opportunistic pathogen responsible for life-threatening, nosocomial infections in immunocompromised patients, such as those with cystic fibrosis or chronic granulomatous disease. The quorum sensing systems CepIR and CciIR regulate the formation of biofilms and the expression of virulence factors such as siderophores and proteases. Burkholderia cenocepacia may also cause disease in plants, such as in onions and bananas. Additionally, some strains serve as plant growth-promoting rhizobacteria.

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 the microbiome of 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.

<span class="mw-page-title-main">Polypeptide antibiotic</span> Class of antibiotics

Polypeptide antibiotics are a chemically diverse class of anti-infective and antitumor antibiotics containing non-protein polypeptide chains. Examples of this class include actinomycin, bacitracin, colistin, and polymyxin B. Actinomycin-D has found use in cancer chemotherapy. Most other polypeptide antibiotics are too toxic for systemic administration, but can safely be administered topically to the skin as an antiseptic for shallow cuts and abrasions.

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.

Hypothiocyanite is the anion [OSCN]− and the conjugate base of hypothiocyanous acid (HOSCN). It is an organic compound part of the thiocyanates as it contains the functional group SCN. It is formed when an oxygen is singly bonded to the thiocyanate group. Hypothiocyanous acid is a fairly weak acid; its acid dissociation constant (pKa) is 5.3.

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.

Pandoraea pulmonicola is a Gram-negative, non-spore-forming, motile bacterium with a single polar flagellum, of the genus Pandoraea. P. pulmonicola has been isolated from respiratory samples of patients with cystic fibrosis and other respiratory diseases. P. pulmonicola is a part of the Burkholderia cepacia complex, which is a group of bacteria commonly associated with infections in individuals with compromised immune systems.

Claire E. Wainwright is an Australian paediatric respiratory physician and professor of pediatrics, residing and working in Queensland. She commenced her medical training in London and completed her specialist training at the Royal Children's Hospital, Brisbane. She is now head of the Cystic Fibrosis Service at the Queensland Children's Hospital and a professor of pediatric medicine at the University of Queensland, Australia. Wainwright has published numerous academic papers focusing upon her main area of interest; the impacts of fungal infections upon children with cystic fibrosis. However, her interests also expand to include other airway complications within children.

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. ↑ Also: CCUG 12691 and 13226; CFBP 2227; CIP 80.24; DSM 7288; HAMBI 1976; ICMP 5796; [4] JCM 5964; LMG 1222; NBRC 14074; NCCB 76047; NCPPB 2993; NCTC 10743; NRRL B-14810
  1. 1 2 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. S2CID   19117513.
  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. S2CID   21736359.
  3. ↑ "ATCC 25416".
  4. ↑ "Specimen Details". scd.landcareresearch.co.nz.
  5. ↑ Tavares M, Kozak M, Balola A, Sá-Correia I (June 17, 2020). "Burkholderia cepacia Complex Bacteria: a Feared Contamination Risk in Water-Based Pharmaceutical Products". Clinical Microbiology Reviews. 33 (3). doi:10.1128/CMR.00139-19. PMC   7194853 . PMID   32295766.
  6. ↑ "OTC DRUG Recall of Benzalkonium Chloride Antiseptic Wipes". Missouri Health & Senior Services.
  7. ↑ Rose H, Baldwin A, Dowson CG, Mahenthiralingam E (March 2009). "Biocide susceptibility of the Burkholderia cepacia complex". The Journal of Antimicrobial Chemotherapy. 63 (3): 502–10. doi: 10.1093/jac/dkn540 . PMC   2640157 . PMID   19153076.
  8. 1 2 3 Paul SI, Rahman MM, Salam MA, Khan MA, Islam MT (December 2021). "Identification of marine sponge-associated bacteria of the Saint Martin's island of the Bay of Bengal emphasizing on the prevention of motile Aeromonas septicemia in Labeo rohita". Aquaculture. 545: 737156. Bibcode:2021Aquac.54537156P. doi:10.1016/j.aquaculture.2021.737156. ISSN   0044-8486.
  9. ↑ Torok E, Moran E, Cooke F (2009). Oxford Handbook of Infectious Diseases and Microbiology. Oxford University Press. ISBN   978-0-19-856925-1.
  10. ↑ "Cystic Fibrosis". Mandell, Douglas, and Bennett's principles and practice of infectious diseases. John E. Bennett, Raphael Dolin, Martin J. Blaser (9th ed.). Philadelphia, PA. 2020. p. 954. ISBN   978-0-323-55027-7. OCLC   1118693541.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  11. ↑ Aris RM, Routh JC, LiPUMA JJ, Heath DG, Gilligan PH (2001). "Lung Transplantation for Cystic Fibrosis Patients with Burkholderia cepacia Complex: Survival Linked to Genomovar Type". American Journal of Respiratory and Critical Care Medicine. 164 (11): 2102–2106. doi:10.1164/ajrccm.164.11.2107022. ISSN   1073-449X.
  12. ↑ Alexander B, Petzold E, Reller L, Palmer S, Davis R, Woods C, LiPuma J (2008). "Survival After Lung Transplantation of Cystic Fibrosis Patients Infected with Burkholderia cepacia Complex". American Journal of Transplantation. 8 (5): 1025–1030. doi:10.1111/j.1600-6143.2008.02186.x. hdl: 2027.42/71603 .
  13. 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.
  14. ↑ Becton, Dickinson and Company (2003). BD Difco and BD BBL Manual: Manual of Microbiological Culture Media. Franklin Lakes, New Jersey: Becton Dickinson. pp. 422–423.
  15. ↑ "OFPBL agar". Remel Technical Manual. Lenexa, Kan: Remel. 1997.
  16. 1 2 "Stenotrophomonas maltophilia and Burkholderia cepacia Complex". Mandell, Douglas, and Bennett's principles and practice of infectious diseases. John E. Bennett, Raphael Dolin, Martin J. Blaser (9th ed.). Philadelphia, PA. 2020. ISBN   978-0-323-55027-7. OCLC   1118693541.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  17. ↑ 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.
  18. ↑ The Sanford guide to antimicrobial therapy 2020. David N. Gilbert, Henry F. Chambers, Michael S. Saag, Andrew Pavia (50th ed.). Sperryville, VA, USA. 2020. ISBN   978-1-944272-13-5. OCLC   1151708870.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  19. ↑ Frost F, Shaw M, Nazareth D (December 10, 2021). "Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis". The Cochrane Database of Systematic Reviews. 2021 (12): CD013079. doi:10.1002/14651858.CD013079.pub3. ISSN   1469-493X. PMC   8662788 . PMID   34889457.
  20. ↑ Burkholder WH (1950). "Sour skin, a bacterial rot of onion bulbs". Phytopathology. 40 (1): 115–7.
  21. ↑ Lararya-Cuasay LR, Lipstein M, Huang NN (1977). "Pseudomonas cepacia in the respiratory flora of patients with cystic fibrosis". Pediatr Res. 11 (4): 502. doi: 10.1203/00006450-197704000-00792 .

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