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Misidentification of Burkholderia pseudomallei and Other Burkholderia Species From Pediatric Infections in Mexico

Misidentification of Burkholderia pseudomallei and Other Burkholderia Species From Pediatric... Downloaded from https://academic.oup.com/ofid/article-abstract/6/2/ofz008/5292470 by Ed 'DeepDyve' Gillespie user on 06 February 2019 applyparastyle “fig//caption/p[1]” parastyle “FigCapt” Open Forum Infectious Diseases BRIEF REPORT siblings (aged 12 and 16) [5]. These last 2 cases occurred in the Misidentification of Burkholderia northwest part of Mexico, in Sonora, a state where the climate is pseudomallei and Other Burkholderia not tropical or subtropical, but is dry to semidry, with tempera- tures averaging 22°C and ranging from 5°C to 38°C. This sug- Species From Pediatric Infections gests that Bps can adapt to a variety of climates [6]. In Mexico, in Mexico species from the Bcc have been found in human infections and 1,a 1,a 2 Georgina Meza-Radilla, Ausel Mendez-Canarios, Juan Xicohtencatl-Cortes, in the environment, such as in the rhizosphere of sugarcane 3 4 1 Marcos R. Escobedo-Guerra, Alfredo G. Torres, J. Antonio Ibarra, and 1, and maize [1]. This raises the possibility that one could acquire Paulina Estrada-de los Santos an infection from the environment. Currently, the occurrence Instituto Politecnico Nacional, Escuela Nacional de Ciencias Biológicas, Mexico City, Mexico; 2 3 Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico; Instituto Nacional de of Bps in the environment in several other states in Mexico is Perinatologia, Mexico City, Mexico; University of Texas Medical Branch, Galveston, Texas being investigated by our research group. Additionally, the Bcc encompasses an assembly of opportunistic pathogens that have Burkholderia pseudomallei and Burkholderia cepacia com- been associated with infections in cystic fibrosis patients [7 ]. Bcc plex are poorly studied in Mexico. The genotypic analysis of 38 strains isolated from children with pneumonia were iden- has several clinical manifestations that span from no symptoms tified and showed that both Burkholderia groups were present to respiratory infections and septicemia. Currently, this group in patients. From our results, it is plausible to suggest that new includes 24 species, many of which cause human infections. species are among the analyzed strains. Among them, B.  cenocepacia is considered the most frequent Keywords. Burkholderia cepacia complex; Burkholderia and problematic species, but B.  multivorans and B.  dolosa are pseudomallei; emergent bacterial infections. also becoming common causes of infections [8]. In the present study, a group of 38 strains previously identi- fied as B.  cepacia by the VITEK2 system were genotypically and Burkholderia is a genus comprising several species, including the phenotypically characterized. All strains were isolated from pedi- Burkholderia pseudomallei (Bps) group, the Burkholderia cepacia atric patients in the Hospital Infantil de Mexico Federico Gomez complex (Bcc), and a cluster of phytopathogen species [1]. The (Mexico Children’s Hospital) in Mexico City. The samples were Bps group contains the well-known human pathogen Bps and taken from pharyngeal exudates from children who arrived at the the animal pathogen B.  mallei, causative agents of melioidosis hospital with pneumonia in the period from 2012 to 2016. The 16S and glanders, respectively [2]. Melioidosis is an infectious dis- rRNA fragment and the atpD gene from each strain were amplified, ease acquired from water or soil that comes into contact with sequenced, and analyzed according to Estrada de los Santos et al. broken skin or is inhaled or ingested. The infection can be acute, [9]. The accession numbers of 16S rRNA and atpD are included latent, or chronic. Diabetes mellitus is a major risk factor, and in Supplementary Table 1. The 16S rRNA fragment was analyzed individuals suffering from this disease are at higher risk for using the EzBiocloud database (www.ezbiocloud.net), and the developing melioidosis than the rest of the population [3]. Bps is results showed that 10 strains belonged to the Bps group, 20 were primarily found in tropical areas, mainly in northern Australia identified as part of the Bcc, 1 was classified as Acinetobacter lwoffii, and the south of Asia, but it is being found more frequently in 3 were Pseudomonas songenensis, 2 were Enterococcus faecalis, and other tropical countries as well [4]. In Mexico, there have been 1 belonged to the genus Stenotrophomonas (Supplementary Table 15 documented cases of melioidosis, between 1958 and 2018 2). These results confirmed that in addition to the VITEK2 system, [4], with the most recent resulting in the fatality of 2 teenaged additional tests are needed to correctly identify Burkholderia species. Other studies have validated the finding that it is not Received 4 November 2018; editorial decision 18 December 2018; accepted 15 January 2019.; unusual to misidentify B.  pseudomallei, even in endemic coun- Published online January 18, 2019. tries [10]. Because it is well known that the identification at the Equal contribution Correspondence: P.  Estrada de los Santos, PhD, Instituto Politecnico Nacional, Escuela species level for the Bcc cannot be based only on the analysis of Nacional de Ciencias Biológicas, Prol. Carpio y Plan de Ayala s/n, Col. Santo Tomás, Del. Miguel 16S rRNA due to its poor resolution in taxonomical analysis, it Hidalgo. Mexico City, Mexico, C. P. 11340 (pestradadelossantos@gmail.com). is necessary to complement identification with a phylogenetic Open Forum Infectious Diseases © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases study of other housekeeping genes [9]. We therefore concatenated Society of America. This is an Open Access article distributed under the terms of the Creative the sequence of the atpD gene with the 16S rRNA gene using Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any the program Mesquite 3.51 (http://www.mesquiteproject.org) medium, provided the original work is not altered or transformed in any way, and that the and performed a phylogenetic analysis with the program work is properly cited. For commercial re-use, please contact journals.permissions@oup.com DOI: 10.1093/ofid/ofz008 PhyML, v.  3.0 [11], using the maximum likelihood method. BRIEF REPORT • ofid • 1 Downloaded from https://academic.oup.com/ofid/article-abstract/6/2/ofz008/5292470 by Ed 'DeepDyve' Gillespie user on 06 February 2019 es Th e analyses showed that the strains identified as part of the 4 strains that were phylogenetically related to B.  pseudomul- Bcc are now recognized as different species, which included 2 tivorans, and 1 strain related to B.  contaminans (Figure 1). The strains classified as B.  cenocepacia , 2 strains as B.  vietnamiensis, misidentification of species from the Bcc is known in other Burkholderia sp. 923U Burkholderia sp. 584U Burkholderia sp. 426D Burkholderia sp. BC1608 Burkholderia sp. 661U Burkholderia sp. 60H Burkholderia sp. 1H Burkholderia sp. 337D B. stabilis LMG 14294 Burkholderia sp. 40H B. contaminans I29B B. lata 383 B. pyrrocinia LMG 14191 B. cepacia ATCC 25416 B. ambifaria AMMD B. puraquae LMG 29660 B. metallica LMG 24069 B. seminalis LMG 24067 B. latens LMG 24064 Burkholderia sp. 184D Burkholderia sp. 662D B. vietnamiensis TVV75 B. di usa LMG 24065 B. territorii LMG 240 77 B. anthina LMG 20980 B. cenocepacia J2315 Burkholderia sp. 500H Burkholderia sp. 501H B. paludis MSh1 B. stagnalis LMG 28156 Burkholderia sp. 407H B. dolosa AU1058 B. multivorans LMG 13010 B. pseudomultivorans LMG 26883 Burkholderia sp. 235H Burkholderia sp. 236H Burkholderia sp. 785H Burkholderia sp. 467H B. ubonensis Bu B. singularis LMG 28154 B. oklahomensis EO147 B. thailandensis E264 B. humptyodonensis MSMB122 B. malleiATCC 23344 B. pseudomallei ATCC 23343 Burkholderia sp. 294H Burkholderia sp. 205H Burkholderia sp. 45H Burkholderia sp. 339H Burkholderia sp. 215H Burkholderia sp. 339H Burkholderia sp. 306H Burkholderia sp. 305H Burkholderia sp. 337H Burkholderia sp. 297H Paraburkholderia unamae MTI-641 0.005 Figure 1. Maximum likelihood tree inferred from the concatenated alignment of atpD-16S rRNA genes of Burkholderia species. The bar represents the number of expected substitutions per site under the general time reversible + gamma distributed rate variation among sites. 2 • ofid • BRIEF REPORT Downloaded from https://academic.oup.com/ofid/article-abstract/6/2/ofz008/5292470 by Ed 'DeepDyve' Gillespie user on 06 February 2019 the authors, so questions or comments should be addressed to the corre- countries; however, in Mexico, this cluster of species is poorly sponding author. recognized and rarely studied. Moreover, several strains were not included in any of the Bcc species described so far (Figure 1). Acknowledgments es Th e strains may represent members of novel species, and We thank Dr. Sherry Haller for editorial assistance.  polyphasic taxonomy analyses are being performed to confirm Financial support. This work was partially supported by Instituto this observation. Politecnico Nacional projects SIP 2017-0492, SIP 2018-0647, and SIP 2018-0117. P.E.S. and J.A.I. are grateful for fellowships from Comisión de The analysis also showed that 10 strains were closely related Operación y Fomento de Actividades Académicas (COFAA), Estímulo to Bps and B. mallei (Figure 1). To corroborate our findings, al Desempeño de los Investigadores (EDI), and Sistema Nacional de suspected strains were streaked in Ashdown medium. This has Investigadores (SNI). been proven to be a gold standard method for the identification Potential conifl cts of interest. All authors: no reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of of Bps isolates [12]. We obser ved typical Bps growth as wrinkled Potential Conflicts of Interest. Conflicts that the editors consider relevant to colonies in the Ashdown medium (Supplementary Table 3). the content of the manuscript have been disclosed. In contrast, B.  mallei is unable to grow in this medium [13]. What is noteworthy is that this finding confirms the presence References of Bps, a causative agent of melioidosis, in Mexican patients. 1. Rojas-Rojas FU, Lopez-Sanchez D, Meza-Radilla G, et al. El controvertido com- plejo Burkholderia cepacia, un grupo de especies promotoras del crecimiento Although the clinical implications have not been established, vegetal y patógenas de plantas, animales y humanos. Rev Argent Microbiol. nor is there a protocol to identify the disease in the clinical doi:10.1016/j.ram.2018.01.002. setting, further studies will have significant implications for 2. Wiersinga WJ, Virk HS, Torres AG, et al. Melioidosis. Nat Rev Dis Primers 2018; 4:17107. public health. Therefore, we are currently analyzing more 3. Currie  BJ. Melioidosis: evolving concepts in epidemiology, pathogenesis, and strains from other hospitals in Mexico and evaluating soil treatment. Semin Respir Crit Care Med 2015; 36:111–25. 4. Sanchez-Villamil JI, Torres AG. Melioidosis in Mexico, Central America, and the and water from tropical and subtropical regions. Our pre- Caribbean. Trop Med Infect Dis 2018; 3:24. liminary results indicate that Bps has been misidentified in 5. Paredes O. El Imparcial.com. 2018. https://elimparcial.com/EdicionEnLinea/ Notas/Sonora/09092018/1371570-Detectan-bacteria-rara-en-2-hermanos- other hospitals, and it has been isolated from soil samples fallecidos.html. Accessed 9 September 2018. from the Sonora, Chiapas, and Tabasco states in Mexico 6. Yip TW, Hewagama S, Mayo M, et al. Endemic melioidosis in residents of desert region after atypically intense rainfall in central Australia, 2011. Emerg Infect Dis (unpublished data). 2011; 21:1038–40. In summary, here we confirm the presence of Bps in clin- 7. Lipuma JJ. The changing microbial epidemiology in cystic fibrosis. Clin Microbiol ical isolates, which were not previously identified adequately Rev 2010; 23:299–323. 8. Sfeir MM. Burkholderia cepacia complex infections: more complex than the bac- and were classified as B. cepacia . These findings corroborate the terium name suggest. J Infect 2018; 77:166–70. presence of this and other species of the Bps and Bcc groups 9. Estrada-de  los  Santos  P, Vinuesa  P, Martinez-Aguilar  L, Hirsch  AM, Caballero- Mellado J. Phylogenetic analysis of Burkholderia species by multilocus sequence as potential causative agents for disease in Mexico. We also analysis. Curr Microbiol 2013; 67:51–60. demonstrate that careful and more extensive microbiological 10. Greer  RC, Wangrangsimakul  T, Amornchai  P, et  al. Misidentification of Burkholderia pseudomallei as Acinetobacter species in northern Thailand. Trans analysis should be done in the clinical laboratory with more R Soc Trop Med Hyg 2019; 113:48–51. effective tools to accurately identify these species. 11. Guindon  S, Delsuc  F, Dufayard  JF, Gascuel  O. Estimating maximum likelihood phylogenies with PhyML. Methods Mol Biol 2009; 537:113–37. 12. Ashdown  LR. An improved screening technique for isolation of Pseudomonas Supplementary Data pseudomallei from clinical specimens. Pathology 1979; 11:293–7. Supplementary materials are available at Open Forum Infectious Diseases 13. Glass MB, Beesley CA, Wilkins PP, Hoffmaster AR. Comparison of four selective online. Consisting of data provided by the authors to benefit the reader, media for the isolation of Burkholderia mallei and Burkholderia pseudomallei. Am the posted materials are not copyedited and are the sole responsibility of J Trop Med Hyg 2009; 80:1023–8. BRIEF REPORT • ofid • 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Open Forum Infectious Diseases Oxford University Press

Misidentification of Burkholderia pseudomallei and Other Burkholderia Species From Pediatric Infections in Mexico

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Abstract

Downloaded from https://academic.oup.com/ofid/article-abstract/6/2/ofz008/5292470 by Ed 'DeepDyve' Gillespie user on 06 February 2019 applyparastyle “fig//caption/p[1]” parastyle “FigCapt” Open Forum Infectious Diseases BRIEF REPORT siblings (aged 12 and 16) [5]. These last 2 cases occurred in the Misidentification of Burkholderia northwest part of Mexico, in Sonora, a state where the climate is pseudomallei and Other Burkholderia not tropical or subtropical, but is dry to semidry, with tempera- tures averaging 22°C and ranging from 5°C to 38°C. This sug- Species From Pediatric Infections gests that Bps can adapt to a variety of climates [6]. In Mexico, in Mexico species from the Bcc have been found in human infections and 1,a 1,a 2 Georgina Meza-Radilla, Ausel Mendez-Canarios, Juan Xicohtencatl-Cortes, in the environment, such as in the rhizosphere of sugarcane 3 4 1 Marcos R. Escobedo-Guerra, Alfredo G. Torres, J. Antonio Ibarra, and 1, and maize [1]. This raises the possibility that one could acquire Paulina Estrada-de los Santos an infection from the environment. Currently, the occurrence Instituto Politecnico Nacional, Escuela Nacional de Ciencias Biológicas, Mexico City, Mexico; 2 3 Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico; Instituto Nacional de of Bps in the environment in several other states in Mexico is Perinatologia, Mexico City, Mexico; University of Texas Medical Branch, Galveston, Texas being investigated by our research group. Additionally, the Bcc encompasses an assembly of opportunistic pathogens that have Burkholderia pseudomallei and Burkholderia cepacia com- been associated with infections in cystic fibrosis patients [7 ]. Bcc plex are poorly studied in Mexico. The genotypic analysis of 38 strains isolated from children with pneumonia were iden- has several clinical manifestations that span from no symptoms tified and showed that both Burkholderia groups were present to respiratory infections and septicemia. Currently, this group in patients. From our results, it is plausible to suggest that new includes 24 species, many of which cause human infections. species are among the analyzed strains. Among them, B.  cenocepacia is considered the most frequent Keywords. Burkholderia cepacia complex; Burkholderia and problematic species, but B.  multivorans and B.  dolosa are pseudomallei; emergent bacterial infections. also becoming common causes of infections [8]. In the present study, a group of 38 strains previously identi- fied as B.  cepacia by the VITEK2 system were genotypically and Burkholderia is a genus comprising several species, including the phenotypically characterized. All strains were isolated from pedi- Burkholderia pseudomallei (Bps) group, the Burkholderia cepacia atric patients in the Hospital Infantil de Mexico Federico Gomez complex (Bcc), and a cluster of phytopathogen species [1]. The (Mexico Children’s Hospital) in Mexico City. The samples were Bps group contains the well-known human pathogen Bps and taken from pharyngeal exudates from children who arrived at the the animal pathogen B.  mallei, causative agents of melioidosis hospital with pneumonia in the period from 2012 to 2016. The 16S and glanders, respectively [2]. Melioidosis is an infectious dis- rRNA fragment and the atpD gene from each strain were amplified, ease acquired from water or soil that comes into contact with sequenced, and analyzed according to Estrada de los Santos et al. broken skin or is inhaled or ingested. The infection can be acute, [9]. The accession numbers of 16S rRNA and atpD are included latent, or chronic. Diabetes mellitus is a major risk factor, and in Supplementary Table 1. The 16S rRNA fragment was analyzed individuals suffering from this disease are at higher risk for using the EzBiocloud database (www.ezbiocloud.net), and the developing melioidosis than the rest of the population [3]. Bps is results showed that 10 strains belonged to the Bps group, 20 were primarily found in tropical areas, mainly in northern Australia identified as part of the Bcc, 1 was classified as Acinetobacter lwoffii, and the south of Asia, but it is being found more frequently in 3 were Pseudomonas songenensis, 2 were Enterococcus faecalis, and other tropical countries as well [4]. In Mexico, there have been 1 belonged to the genus Stenotrophomonas (Supplementary Table 15 documented cases of melioidosis, between 1958 and 2018 2). These results confirmed that in addition to the VITEK2 system, [4], with the most recent resulting in the fatality of 2 teenaged additional tests are needed to correctly identify Burkholderia species. Other studies have validated the finding that it is not Received 4 November 2018; editorial decision 18 December 2018; accepted 15 January 2019.; unusual to misidentify B.  pseudomallei, even in endemic coun- Published online January 18, 2019. tries [10]. Because it is well known that the identification at the Equal contribution Correspondence: P.  Estrada de los Santos, PhD, Instituto Politecnico Nacional, Escuela species level for the Bcc cannot be based only on the analysis of Nacional de Ciencias Biológicas, Prol. Carpio y Plan de Ayala s/n, Col. Santo Tomás, Del. Miguel 16S rRNA due to its poor resolution in taxonomical analysis, it Hidalgo. Mexico City, Mexico, C. P. 11340 (pestradadelossantos@gmail.com). is necessary to complement identification with a phylogenetic Open Forum Infectious Diseases © The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases study of other housekeeping genes [9]. We therefore concatenated Society of America. This is an Open Access article distributed under the terms of the Creative the sequence of the atpD gene with the 16S rRNA gene using Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/ by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any the program Mesquite 3.51 (http://www.mesquiteproject.org) medium, provided the original work is not altered or transformed in any way, and that the and performed a phylogenetic analysis with the program work is properly cited. For commercial re-use, please contact journals.permissions@oup.com DOI: 10.1093/ofid/ofz008 PhyML, v.  3.0 [11], using the maximum likelihood method. BRIEF REPORT • ofid • 1 Downloaded from https://academic.oup.com/ofid/article-abstract/6/2/ofz008/5292470 by Ed 'DeepDyve' Gillespie user on 06 February 2019 es Th e analyses showed that the strains identified as part of the 4 strains that were phylogenetically related to B.  pseudomul- Bcc are now recognized as different species, which included 2 tivorans, and 1 strain related to B.  contaminans (Figure 1). The strains classified as B.  cenocepacia , 2 strains as B.  vietnamiensis, misidentification of species from the Bcc is known in other Burkholderia sp. 923U Burkholderia sp. 584U Burkholderia sp. 426D Burkholderia sp. BC1608 Burkholderia sp. 661U Burkholderia sp. 60H Burkholderia sp. 1H Burkholderia sp. 337D B. stabilis LMG 14294 Burkholderia sp. 40H B. contaminans I29B B. lata 383 B. pyrrocinia LMG 14191 B. cepacia ATCC 25416 B. ambifaria AMMD B. puraquae LMG 29660 B. metallica LMG 24069 B. seminalis LMG 24067 B. latens LMG 24064 Burkholderia sp. 184D Burkholderia sp. 662D B. vietnamiensis TVV75 B. di usa LMG 24065 B. territorii LMG 240 77 B. anthina LMG 20980 B. cenocepacia J2315 Burkholderia sp. 500H Burkholderia sp. 501H B. paludis MSh1 B. stagnalis LMG 28156 Burkholderia sp. 407H B. dolosa AU1058 B. multivorans LMG 13010 B. pseudomultivorans LMG 26883 Burkholderia sp. 235H Burkholderia sp. 236H Burkholderia sp. 785H Burkholderia sp. 467H B. ubonensis Bu B. singularis LMG 28154 B. oklahomensis EO147 B. thailandensis E264 B. humptyodonensis MSMB122 B. malleiATCC 23344 B. pseudomallei ATCC 23343 Burkholderia sp. 294H Burkholderia sp. 205H Burkholderia sp. 45H Burkholderia sp. 339H Burkholderia sp. 215H Burkholderia sp. 339H Burkholderia sp. 306H Burkholderia sp. 305H Burkholderia sp. 337H Burkholderia sp. 297H Paraburkholderia unamae MTI-641 0.005 Figure 1. Maximum likelihood tree inferred from the concatenated alignment of atpD-16S rRNA genes of Burkholderia species. The bar represents the number of expected substitutions per site under the general time reversible + gamma distributed rate variation among sites. 2 • ofid • BRIEF REPORT Downloaded from https://academic.oup.com/ofid/article-abstract/6/2/ofz008/5292470 by Ed 'DeepDyve' Gillespie user on 06 February 2019 the authors, so questions or comments should be addressed to the corre- countries; however, in Mexico, this cluster of species is poorly sponding author. recognized and rarely studied. Moreover, several strains were not included in any of the Bcc species described so far (Figure 1). Acknowledgments es Th e strains may represent members of novel species, and We thank Dr. Sherry Haller for editorial assistance.  polyphasic taxonomy analyses are being performed to confirm Financial support. This work was partially supported by Instituto this observation. Politecnico Nacional projects SIP 2017-0492, SIP 2018-0647, and SIP 2018-0117. P.E.S. and J.A.I. are grateful for fellowships from Comisión de The analysis also showed that 10 strains were closely related Operación y Fomento de Actividades Académicas (COFAA), Estímulo to Bps and B. mallei (Figure 1). To corroborate our findings, al Desempeño de los Investigadores (EDI), and Sistema Nacional de suspected strains were streaked in Ashdown medium. This has Investigadores (SNI). been proven to be a gold standard method for the identification Potential conifl cts of interest. All authors: no reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of of Bps isolates [12]. We obser ved typical Bps growth as wrinkled Potential Conflicts of Interest. Conflicts that the editors consider relevant to colonies in the Ashdown medium (Supplementary Table 3). the content of the manuscript have been disclosed. In contrast, B.  mallei is unable to grow in this medium [13]. What is noteworthy is that this finding confirms the presence References of Bps, a causative agent of melioidosis, in Mexican patients. 1. Rojas-Rojas FU, Lopez-Sanchez D, Meza-Radilla G, et al. El controvertido com- plejo Burkholderia cepacia, un grupo de especies promotoras del crecimiento Although the clinical implications have not been established, vegetal y patógenas de plantas, animales y humanos. Rev Argent Microbiol. nor is there a protocol to identify the disease in the clinical doi:10.1016/j.ram.2018.01.002. setting, further studies will have significant implications for 2. Wiersinga WJ, Virk HS, Torres AG, et al. Melioidosis. Nat Rev Dis Primers 2018; 4:17107. public health. Therefore, we are currently analyzing more 3. Currie  BJ. Melioidosis: evolving concepts in epidemiology, pathogenesis, and strains from other hospitals in Mexico and evaluating soil treatment. Semin Respir Crit Care Med 2015; 36:111–25. 4. Sanchez-Villamil JI, Torres AG. Melioidosis in Mexico, Central America, and the and water from tropical and subtropical regions. Our pre- Caribbean. Trop Med Infect Dis 2018; 3:24. liminary results indicate that Bps has been misidentified in 5. Paredes O. El Imparcial.com. 2018. https://elimparcial.com/EdicionEnLinea/ Notas/Sonora/09092018/1371570-Detectan-bacteria-rara-en-2-hermanos- other hospitals, and it has been isolated from soil samples fallecidos.html. Accessed 9 September 2018. from the Sonora, Chiapas, and Tabasco states in Mexico 6. Yip TW, Hewagama S, Mayo M, et al. Endemic melioidosis in residents of desert region after atypically intense rainfall in central Australia, 2011. Emerg Infect Dis (unpublished data). 2011; 21:1038–40. In summary, here we confirm the presence of Bps in clin- 7. Lipuma JJ. The changing microbial epidemiology in cystic fibrosis. Clin Microbiol ical isolates, which were not previously identified adequately Rev 2010; 23:299–323. 8. Sfeir MM. Burkholderia cepacia complex infections: more complex than the bac- and were classified as B. cepacia . These findings corroborate the terium name suggest. J Infect 2018; 77:166–70. presence of this and other species of the Bps and Bcc groups 9. Estrada-de  los  Santos  P, Vinuesa  P, Martinez-Aguilar  L, Hirsch  AM, Caballero- Mellado J. Phylogenetic analysis of Burkholderia species by multilocus sequence as potential causative agents for disease in Mexico. We also analysis. Curr Microbiol 2013; 67:51–60. demonstrate that careful and more extensive microbiological 10. Greer  RC, Wangrangsimakul  T, Amornchai  P, et  al. Misidentification of Burkholderia pseudomallei as Acinetobacter species in northern Thailand. Trans analysis should be done in the clinical laboratory with more R Soc Trop Med Hyg 2019; 113:48–51. effective tools to accurately identify these species. 11. Guindon  S, Delsuc  F, Dufayard  JF, Gascuel  O. Estimating maximum likelihood phylogenies with PhyML. Methods Mol Biol 2009; 537:113–37. 12. Ashdown  LR. An improved screening technique for isolation of Pseudomonas Supplementary Data pseudomallei from clinical specimens. Pathology 1979; 11:293–7. Supplementary materials are available at Open Forum Infectious Diseases 13. Glass MB, Beesley CA, Wilkins PP, Hoffmaster AR. Comparison of four selective online. Consisting of data provided by the authors to benefit the reader, media for the isolation of Burkholderia mallei and Burkholderia pseudomallei. Am the posted materials are not copyedited and are the sole responsibility of J Trop Med Hyg 2009; 80:1023–8. BRIEF REPORT • ofid • 3

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Published: Feb 1, 2019

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