Abstract
1 Division of Medical Microbiology and Genitourinary Medicine, University of Liverpool, Daulby Street, Liverpool L69 3GA, United Kingdom
2 Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
3 Laboratory of Microbial Interactions, Department of Molecular and Cellular Interactions, Flanders Interuniversity Institute of Biotechnology, Vrije Universiteit Brussel, Brussels, Belgium
Correspondence
Craig Winstanley
(C.Winstanley{at}liv.ac.uk )
The Burkholderia cepacia complex (BCC) is a group of bacteria comprising at least nine recognized species (or genomovars) (Mahenthiralingam et al., 2005) and associated with various opportunistic human infections. BCC bacteria have been identified in infections of cystic fibrosis (CF) patients and assorted nosocomial infections. Epidemic spread of BCC strains amongst CF patients has been widely documented (Mahenthiralingam et al., 2005). In addition, there have been several reports of outbreaks amongst non-CF patients (Agodi et al., 2002; Souza et al., 2004; Woods et al., 2004; Magalhães et al., 2003; Shehabi et al., 2004). Relatively few studies have identified the BCC species types implicated in an outbreak, and these have generally used PCR-based diagnostic tests targeting the recA gene (Mahenthiralingam et al., 2000). Agodi et al. (2002) identified episodes of cross-transmission involving Burkholderia cenocepacia and Burkholderia stabilis in non-CF patients. B. cenocepacia has also been implicated in interpatient spread in studies of patients with bacteraemia (Woods et al., 2004), or bacteraemia and respiratory tract colonization (Shehabi et al., 2004). In a previous study of bacteraemia in haemodialysis patients in Recife, Brazil, B. cenocepacia and Burkholderia vietnamiensis were identified in a polyclonal outbreak (Magalhães et al., 2003). A further study characterized strains as B. cepacia complex or unclassifiable using recA PCR-RFLP analysis (Souza et al., 2004), and water was defined as the source of the outbreak.
Previously, we reported B. cenocepacia as the most prevalent species amongst a collection of non-CF BCC isolates from Brazil, and identified nine B. cenocepacia isolates, from different clinical sources and patients, but sharing a common genotype (Detsika et al., 2003). We also identified isolates from six CF patients that shared the same atypical genotype not corresponding to recognized genomovars (Detsika et al., 2003). Further isolates obtained from in- and outpatients attending the Hospital Portugues in Recife, Brazil, recovered on sheep blood agar or EMB plates, have been identified as belonging to the BCC by using a series of phenotypic tests (Henry et al., 2001). Amongst these isolates are a collection of seven that share phenotypic characteristics (Table 1), with the exception of isolate BC203, which was positive for ornithine decarboxylase. The one CF isolate from this group, BC111 (Table 1), was isolated from one of the six patients in our previous study from whom related isolates of unknown genomovar status were isolated (Detsika et al., 2003). However, isolate BC111 is different from the previous isolate, which is exemplified by isolate BC14 (Detsika et al., 2003).