Correspondence

Mother-to-Child Transmission of Burkholderia pseudomallei

N Engl J Med 2001; 344:1171-1172April 12, 2001

Article

To the Editor:

A 31-year-old woman (gravida 3, para 1) was hospitalized at 26 weeks of gestation with fever and vaginal bleeding from placenta previa. She was taking prednisone for an exacerbation of ulcerative colitis that had occurred on a recent vacation to Thailand. She did not recall other illnesses during her stay in Thailand. Blood, urine, and stool cultures were negative. She was treated with oral ofloxacin, recovered, and was discharged. At 32 weeks of gestation, an emergency cesarean section was performed because of severe vaginal bleeding. A girl (birth weight, 1850 g) was born with good Apgar scores. The child had sepsis and respiratory distress on the second day of life. Chest radiography showed consolidation in the right lung. She was placed on mechanical ventilation and treated with amoxicillin and gentamicin. On day 5 her condition deteriorated. Repeated chest radiography revealed abscess formation in the right lung. Blood cultures and a tracheal aspirate yielded a nonfermentative gram-negative rod, identified as Burkholderia pseudomallei (identification confirmed by T.L. Pitt, Central Public Health Laboratory, London), that was sensitive to ceftazidime, amoxicillin–clavulanate, and trimethoprim–sulfamethoxazole and resistant to amoxicillin and gentamicin. Neonatal melioidosis was diagnosed. The child received intravenous ceftazidime for eight weeks, followed by oral amoxicillin–clavulanate for six weeks. She recovered.

Melioidosis, a tropical disease caused by B. pseudomallei, occurs in Southeast Asia and northern Australia. It may affect all ages. The usual route of transmission is through the respiratory tract or the skin, through wounds.1 However, one review reported a high proportion of infections in the lower genitourinary system, including an infection in a woman in the 24th week of gestation who aborted a dead fetus several weeks later.2

Neonatal melioidosis often presents as sepsis, with a high mortality.3 Although small series have been described in areas of endemic disease, mother-to-child transmission was not confirmed.3 A Medline search revealed one possible case of mother-to-child transmission outside an area of endemic disease.4 In our case, postpartum cultures of the mother's cervix grew B. pseudomallei. Analysis of isolates from the mother and child by pulsed-field gel electrophoresis of XbaI chromosomal DNA digests indicated a single strain. Review of placental histologic specimens revealed microabscesses; no microorganisms were seen on Gram's staining. Serologic tests for anti–B. pseudomallei antibodies (IgG and IgM) were positive in the mother and negative in the father.

Mother-to-child transmission of B. pseudomallei probably occurred as a result of placental infection. The use of prednisone and the pregnancy may have increased the susceptibility to infection.

Floor C. Abbink, M.D.
Jurgen M. Orendi, M.D.
Leiden University Medical Center, 2300 RC Leiden, the Netherlands

Arnout J. de Beaufort, M.D.
Juliana Children's Hospital, 2506 LP The Hague, the Netherlands

4 References

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   Webling DD. Genito-urinary infections with Pseudomonas pseudomallei in Australian Aboriginals. Trans R Soc Trop Med Hyg 1980;74:138-139
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   Lumbiganon P, Pengsaa K, Puapermpoonsiri S, Puapairoj A. Neonatal melioidosis: a report of 5 cases. Pediatr Infect Dis J 1988;7:634-636
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   Osteraas GR, Hardman JM, Bass JW, Wilson C. Neonatal melioidosis. Am J Dis Child 1971;122:446-448
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Citing Articles (10)

Citing Articles

1. 1

   Eden V. Wells, Sandro K. Cinti, Thomas A. Clark, James T. Rudrik, Matthew L. Boulton. (2011) Melioidosis-Reactivation of Latent Disease. Infectious Diseases in Clinical Practice 19:3, 161-166
   CrossRef

2. 2

   Blandine Rammaert, Julien Beauté, Laurence Borand, Sopheak Hem, Philippe Buchy, Sophie Goyet, Rob Overtoom, Cécile Angebault, Vantha Te, Patrich Try, Charles Mayaud, Sirenda Vong, Bertrand Guillard. (2011) Pulmonary melioidosis in Cambodia: A prospective study. BMC Infectious Diseases 11:1, 126
   CrossRef

3. 3

   Victor Nizet, Jerome O. Klein. 2011. Bacterial Sepsis and Meningitis. , 222-275.
   CrossRef

4. 4

   Tyrone L. Pitt, David A. Dance. 2010. Burkholderia spp. and Related Genera. .
   CrossRef

5. 5

   Nuttaya Pattamapaspong, Wilfred C.G. Peh, Ban Hock Tan, Mearng Koon Tan, Ngai Nung Lo. (2007) Septic arthritis of the knee due to Burkhoderia pseudomallei. European Journal of Radiology Extra 61:3, 95-99
   CrossRef

6. 6

   Vanaporn Wuthiekanun, Sharon J Peacock. (2006) Management of melioidosis. Expert Review of Anti-infective Therapy 4:3, 445-455
   CrossRef

7. 7

   Sei Won Lee, Jongyoun Yi, Sae-Ik Joo, Young Ae Kang, Young Soon Yoon, Jae-Joon Yim, Chul-Gyu Yoo, Sung Koo Han, Young-Soo Shim, Eui-Chong Kim, Young Whan Kim. (2005) A Case of Melioidosis Presenting as Migrating Pulmonary Infiltration: The First Case in Korea. Journal of Korean Medical Science 20:1, 139
   CrossRef

8. 8

   NJ White. (2003) Melioidosis. The Lancet 361:9370, 1715-1722
   CrossRef

9. 9

   Jonathan Warawa, Donald E Woods. (2002) Melioidosis vaccines. Expert Review of Vaccines 1:4, 477-482
   CrossRef

10. 10

    David A.B. Dance. (2002) Melioidosis. Current Opinion in Infectious Diseases 15:2, 127-132
    CrossRef