Pan-drug-resistant and biofilm-producing strain of Burkholderia pseudomallei : first report of melioidosis from a diabetic patient in Yogyakarta, Indonesia [Response to Letter]

• Published in: International medical case reports journal 2019-06, Vol.12, p.171-172
• Main Authors: Nuryastuti, Titik, Umaroh, Nusaibah, Asdie, Rizka Humardewayanti, Sari, Ika Puspita, Musthafa, Ahmad
• Format: Article
• Language: English
• Subjects: Biochemistry; Dance; Drug resistance; Editors; Genes; Meropenem; Metronidazole; Oxidases; Polymerase chain reaction; Pseudomonas infections; Response to Letter; RNA
• ISSN: 1179-142X; 1179-142X
• DOI: 10.2147/IMCRJ.S213150

Titik Nuryastuti,1 Nusaibah Umaroh,2 Rizka Humardewayanti Asdie,3 Ika Puspita Sari,4 Ahmad Musthafa11Department of Microbiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 2Pharmacy Installation of Dr. Kariadi General Hospital, Semarang, Center of Java, Indonesia; 3Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta, Indonesia; 4Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada, Yogyakarta, Indonesia We thank Dr David Dance et al from the International Melioidosis Society Committeefor their interest in our case report. This is a response to their letter, which argued thatour paper1 does not support convincing identification of Burkholderia pseudomallei. Inour study, we performed culture on Ashdown agar and identification by Gram staining(Gram-negative bacilli), positive oxidase test, and biochemical testing by API 20NE.The identity of the bacterium was subsequently confirmed with nested PCR, using twosets of PCR amplification primers from the variable region of the 16S rRNA gene ofB. pseudomallei. As reported by Inglis et al, the API 20NE method identified only 37%of the B. pseudomallei isolates.2 B. pseudomallei has a high degree ofphenotypic plasticity and the colony morphology varies greatly within and betweensamples.3,4 Therefore, the identification was continued by nested PCR of 16S rRNA,which has been shown to be highly sensitive,5,6 being able to detect as few as twoorganisms present in the reaction.6 However, we fully welcome the suggestion ofDance et al that further additional testing, eg, multilocus sequence typing, nucleotidesequence analysis, or PCR for the TTS1 gene, is needed to verify the identification ofB. pseudomallei.We have previously asked a member of the International MelioidosisSociety Committee to review our identification method; however, that request wasdeclined at the time. View the original paper byTitik Nuryastuti and colleagues This is in response to the Letter to the Editor