View source for Burkholderia cepacia complex

{{Use mdy dates|date=May 2015}}
{{DISPLAYTITLE:''Burkholderia cepacia'' complex}}
{{Taxobox
| name = ''Burkholderia cepacia'' complex
| image = Burkholderia cepacia.jpg
| regnum = [[Bacteria]]
| phylum = [[Proteobacteria]]
| classis = [[Betaproteobacteria]]
| ordo = [[Burkholderiales]]
| familia = [[Burkholderiaceae]]
| genus = ''[[Burkholderia]]''
| species = '''''B. cepacia'' complex'''
| binomial = ''Burkholderia cepacia'' complex
| binomial_authority = (Palleroni and Holmes 1981) <br> Yabuuchi et al. 1993
| type_species =
[http://www.atcc.org/common/catalog/numSearch/numResults.cfm?atccNum=25416 ATCC 25416] <br>
CCUG 12691 and 13226 <br> CFBP 2227 <br> CIP 80.24 <br> DSM 7288 <br> HAMBI 1976 <br> [http://scd.landcareresearch.co.nz/Specimen/ICMP_5796 ICMP 5796] <br> JCM 5964 <br> LMG 1222 <br> NBRC 14074 <br> NCCB 76047 <br> NCPPB 2993 <br> NCTC 10743 <br> NRRL B-14810
| synonyms = *''Pseudomonas cepacia'' <small>Burkholder 1950</small>
*''Pseudomonas multivorans'' <small>Stanier et al. 1966</small>
*''Pseudomonas cepacia'' <small>(ex Burkholder 1950) Palleroni and Holmes 1981</small>
*''Pseudomonas kingii'' <small>Jonsson 1970</small>
}}

'''''Burkholderia cepacia'' complex''' ('''BCC'''), or simply '''''Burkholderia cepacia''''', is a group of [[catalase]]-producing, [[lactose]]-non[[fermentation (biochemistry)|fermenting]], [[Gram-negative]] [[bacteria]] composed of at least 20 different species, including ''B.&nbsp;cepacia'', ''[[Burkholderia multivorans|B.&nbsp;multivorans]]'', ''[[Burkholderia cenocepacia|B.&nbsp;cenocepacia]]'', ''[[Burkholderia vietnamiensis|B.&nbsp;vietnamiensis]]'', ''[[Burkholderia stabilis|B.&nbsp;stabilis]]'', ''[[Burkholderia ambifaria|B.&nbsp;ambifaria]]'', ''[[Burkholderia dolosa|B.&nbsp;dolosa]]'', ''[[Burkholderia anthina|B.&nbsp;anthina]]'',  ''[[Burkholderia pyrrocinia|B.&nbsp;pyrrocinia]]'' and '' B.&nbsp;ubonensis''.<ref name=Lipuma_2005>{{cite journal |author=Lipuma J |title=Update on the ''Burkholderia cepacia'' complex |journal=Curr Opin Pulm Med |volume=11 |issue=6 |pages=528–33 |year=2005 |pmid=16217180 |doi=10.1097/01.mcp.0000181475.85187.ed|s2cid=19117513 }}</ref> ''B.&nbsp;cepacia'' is an opportunistic human pathogen that most often causes [[pneumonia]] in [[immunocompromise]]d individuals with underlying lung disease (such as [[cystic fibrosis]] or [[chronic granulomatous disease]]).<ref name=Mahenthiralingam_2005>{{cite journal |vauthors=Mahenthiralingam E, Urban T, Goldberg J |title=The multifarious, multireplicon ''Burkholderia cepacia'' complex |journal=Nat Rev Microbiol |volume=3 |issue=2 |pages=144–56 |year=2005 |pmid=15643431 |doi=10.1038/nrmicro1085|s2cid=21736359 }}</ref> Patients with sickle-cell [[Hemoglobinopathy|haemoglobinopathies]] are also at risk.  The species complex also attacks young [[onion]] and [[tobacco]] plants, and displays a remarkable ability to digest [[oil]].

==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]].<ref>{{cite book |first1=E. |last1=Torok |first2=E. |last2=Moran |first3=F |last3=Cooke |title=Oxford Handbook of Infectious Diseases and Microbiology |date=2009 |publisher=Oxford University Press |isbn=978-0-19-856925-1}}</ref>

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.

== Diagnosis ==
Diagnosis of BCC involves [[microbiological culture|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]].<ref name=McGowan_2006>{{cite journal |author=McGowan J |title=Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum |journal=Am J Infect Control |volume=34 |issue=5 Suppl 1 |pages=S29–37; discussion S64–73 |year=2006 |pmid=16813979 |doi=10.1016/j.ajic.2006.05.226}}</ref> 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.

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).<ref>{{cite book|author=Becton, Dickinson and Company|title=BD Difco and BD BBL Manual: Manual of Microbiological Culture Media|location=Franklin Lakes, New Jersey|publisher=Becton Dickinson|year=2003|pages=422&ndash;423}}</ref><ref>{{cite book|title=Remel Technical Manual|chapter=OFPBL agar|location=Lenexa, Kan|publisher=Remel|year=1997}}</ref>  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 (genus)|Candida]]'' species, ''[[Pseudomonas fluorescens]]'', and ''[[Stenotrophomonas]]'' species.

== Treatment ==
Treatment typically includes multiple antibiotics and may include [[ceftazidime]], [[doxycycline]], [[piperacillin]], [[meropenem]], [[chloramphenicol]], and [[trimethoprim/sulfamethoxazole]](co-trimoxazole).<ref name=McGowan_2006 /> 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.<ref>{{cite journal |author1=Avgeri SG |author2=Matthaiou DK |author3=Dimopoulos G |author4=Grammatikos AP |author5=Falagas ME |title=Therapeutic options for ''Burkholderia cepacia'' infections beyond co-trimoxazole: a systematic review of the clinical evidence |journal=Int. J. Antimicrob. Agents |volume=33 |issue=5 |pages=394–404 |date=May 2009 |pmid=19097867 |doi=10.1016/j.ijantimicag.2008.09.010 }}</ref> 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.<ref>{{cite news | title=Key Found to Kill Cystic Fibrosis Superbug | date=April 25, 2007 | url =http://www.innovations-report.com/html/reports/life_sciences/report-83296.html | work =Innovations Report | access-date = April 26, 2007 }}</ref><ref>{{cite journal |author=Ortega XP |title=A Putative Gene Cluster for Aminoarabinose Biosynthesis Is Essential for ''Burkholderia cenocepacia'' Viability |journal=J. Bacteriol. |volume=189 |issue=9 |pages=3639–44 |date=May 2007 |pmid=17337576 |pmc=1855895 |doi=10.1128/JB.00153-07 |author2=Cardona ST |author3=Brown AR |display-authors=3 |last4=Loutet |first4=S. A. |last5=Flannagan |first5=R. S. |last6=Campopiano |first6=D. J. |last7=Govan |first7=J. R. W. |last8=Valvano |first8=M. A. }}</ref>

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.<ref>{{cite journal |last1=Frost |first1=F |last2=Shaw |first2=M |last3=Nazareth |first3=D |title=Antibiotic therapy for chronic infection with Burkholderia cepacia complex in people with cystic fibrosis. |journal=The Cochrane Database of Systematic Reviews |date=13 June 2019 |volume=6 |pages=CD013079 |doi=10.1002/14651858.CD013079.pub2 |pmid=31194880|pmc=6564086 }}</ref>

==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.<ref name=Burkholder_1950>{{cite journal | author = Burkholder WH | title = Sour skin, a bacterial rot of onion bulbs | journal = Phytopathology | year = 1950 | volume = 40| pages = 115–7 |url=https://www.cabdirect.org/cabdirect/abstract/19501101355 |issue=1}}</ref> It was first isolated in patients with cystic fibrosis (CF) in 1977, when it was known as ''Pseudomonas cepacia''.<ref>{{cite journal |vauthors=Lararya-Cuasay LR, Lipstein M, Huang NN |title=''Pseudomonas cepacia'' in the respiratory flora of patients with cystic fibrosis |journal=Pediatr Res |volume=11 |issue=4 |pages=502 |year=1977 |doi=10.1203/00006450-197704000-00792 |doi-access=free }}</ref> 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 ''[[Escherichia coli|E. coli]]''.

==See also==

*[[Contamination control]]  
*[[Povidone-iodine]] (contamination by BCC)

==References==
{{Reflist}}

== Further reading ==
* {{Cite journal|title = Recovery of Stressed (Acclimated) ''Burkholderia cepacia'' Complex Organisms|date = April 29, 2014|journal = American Pharmaceutical Review|access-date = January 29, 2016|vauthors = Barlasov J, Sutton S, Jakober R|url = http://www.americanpharmaceuticalreview.com/Featured-Articles/160451-Recovery-of-Stressed-Acclimated-Burkholderia-cepacia-Complex-Organisms/|volume = 17|issue = 3|pages = 16–24}}

==External links==
*{{cite journal |vauthors=Loutet SA, Valvano MA |title=A decade of ''Burkholderia cenocepacia'' virulence determinant research |journal=Infect. Immun. |volume=78 |issue=10 |pages=4088–100 |date=October 2010 |pmid=20643851 |pmc=2950345 |doi=10.1128/IAI.00212-10 }}
* [https://www.ncbi.nlm.nih.gov/Taxonomy/Browser/wwwtax.cgi?mode=Info&id=87882 ''Burkholderia cepacia complex''] in the NCBI Taxonomy Browser
*[http://bacdive.dsmz.de/index.php?search=1906&submit=Search Type strain of ''Burkholderia cepacia complex''] at BacDive, the Bacterial Diversity Metadatabase
*[https://bacdive.dsmz.de/strain/1906 Type strain of ''Burkholderia cepacia''] at BacDive, the Bacterial Diversity Metadatabase

{{Gram-negative bacterial diseases}}
{{Taxonbar|from1=Q21401468|from2=Q139227}}

{{DEFAULTSORT:Burkholderia Cepacia Complex}}
[[Category:Bacterial diseases]]
[[Category:Burkholderiaceae]]
[[Category:Healthcare-associated infections]]