Pan-drug-resistant and biofilm-producing strain of Burkholderia pseudomallei: first report of melioidosis from a diabetic patient in Yogyakarta, Indonesia [Response to Letter]
Titik Nuryastuti,1 Nusaibah Umaroh,2 Rizka Humardewayanti Asdie,3 Ika Puspita Sari,4 Ahmad Musthafa1
1Department 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 Committee for their interest in our case report. This is a response to their letter, which argued that our paper1 does not support convincing identification of Burkholderia pseudomallei. In our 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 two sets of PCR amplification primers from the variable region of the 16S rRNA gene of B. 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 of phenotypic plasticity and the colony morphology varies greatly within and between samples.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 two organisms present in the reaction.6 However, we fully welcome the suggestion of Dance et al that further additional testing, eg, multilocus sequence typing, nucleotide sequence analysis, or PCR for the TTS1 gene, is needed to verify the identification of B. pseudomallei.We have previously asked a member of the International Melioidosis Society Committee to review our identification method; however, that request was declined at the time.
View the original paper by Titik Nuryastuti and colleagues
This is in response to the Letter to the Editor
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