LETTERS

5. Mätz-Rensing K, Jentsch KD, Rensing S, Melioidosis in Birds However, these are mostly birds Langenhuynsen S, Verschoor E, Niphuis in captivity and often exotic to the H, et al. Fatal herpes simplex infection in and Burkholderia a group of common marmosets (Callithrix location, suggesting potential reduced jacchus). Vet Pathol. 2003;40:405–11. pseudomallei immunity. Little is known about doi:10.1354/vp.40-4-405 Dispersal, Australia melioidosis in wild birds. In Sabah, 6. Bruno SF, Liebhold M, Mätz-Rensing K, Malaysia, only 1 of 440 wild birds Romão MA, Didier A, Brandes A, et al. Herpesvirus infection in free-living black- To the Editor: Melioidosis is an admitted to a research center over 9 tufted-ear marmoset (Callithrix penicil- emerging infectious disease of humans years was found to have melioidosis lata E. Geoffroyi 1812) at the state park of and animals caused by the gram- (6). Serra da Tiririca, Niterói, Rio de Janeiro, negative bacterium Burkholderia Although birds are endotherms, Brazil. Berl Munch Tierarztl Wochenschr. 1997;110:427–30. pseudomallei, which inhabits soil and with high metabolic rates and body 7. Kalter SS, Heberling RL. Comparative surface water in the disease-endemic temperature (40°C–43°C) protecting virology of primates. Bacteriol Rev. regions of Southeast Asia and northern them from many diseases, some birds 1971;35:310–64. Australia (1). The aim of this study appear more susceptible to melioidosis. 8. Mansfi eld K. Emerging and re-emerging infectious diseases of nonhuman primates. was to assess the potential for birds Indeed, high body temperature would Proceedings of the American College to spread B. pseudomallei. Birds are not deter B. pseudomallei, which of Veterinary Pathologists/American known carriers of various human is routinely cultured at 42°C and at Society for Veterinary Clinical Pathology pathogens, including infl uenza viruses, this temperature shows increased Concurrent Annual Meeting, San Antonio, Texas, USA. November 15–19, 2008. West Nile virus, Campylobacter expression of a signal transduction 9. Bruno SF, Hilsberg S, Guimarães LF, jejuni, and antimicrobial drug– system, which is involved in de Barreto Netto MR, de Mello Affonso resistant Escherichia coli (2). pathogenesis (7). PRA, et al. Observations of two species of During February–August 2007, Examples of birds with fatal Callithrix in the State of Serra da Tiririca, Niterói, Rio de Janeiro, Brazil. Proceed- we conducted a survey to determine melioidosis in our studies in the ings of American Association of Zoo Vet- B. pseudomallei carriage in 110 wild Darwin region include a domesticated erinarians, Houston, USA. 1997. native fi nches and doves from the emu in 2009 with B. pseudomallei 10. Coimbra-Filho AF. Situacao atual dos melioidosis-endemic Darwin region, cultured from brain tissue and a calitriquideos que ocorrem no Brasil. Anais do 1° Congresso Sociedade Northern Territory, Australia. Swab chicken in 2007 with B. pseudomallei Brasileira de Primatologia, Belo specimens from the beaks, feet, cultured from facial abscesses. In Horizonte, Brazil, 1983. cloacae, and feces were cultured for 2007, an outbreak of melioidosis B. pseudomallei as described (3). One occurred in an aviary; 4 imported Address for correspondence: Camila S. Longa, healthy (normal physical appearance, exotic yellow-bibbed lorikeets (Lorius Empresa de Pesquisa Agropecuária, Alameda weight, and hematocrit) native chlorocercus) died within months São Boaventura, 770, Niterói, Rio de Janeiro peaceful dove (Geopelia placida) at of arriving from a breeder in South CEP 24.120-191, Brazil; email: mila.longa@ a coastal nature reserve was found Australia. On necropsy, the birds gmail.com to carry B. pseudomallei in its beak. showed nodules throughout the liver The peaceful dove is a common, and spleen (Figure). B. pseudomallei sedentary, ground-foraging species in was cultured from the liver, spleen, the Darwin region. B. pseudomallei crop, beak, and rectum. At the aviary, was not detected in environmental B. pseudomallei was also found in samples from the capture site, but B. water from sprinklers, the water bore pseudomallei is known to occur within head, soil next to the bore, and the 3 km of the capture site (4), the typical drain of the aviary. The unchlorinated movement range for this bird species. sprinkler system used to cool the On multilocus sequence typing aviary was identifi ed as the likely (MLST) (5), the B. pseudomallei source of infection. MLST and 4-locus isolate was identifi ed as sequence type multilocus variable-number tandem (ST) 144, which we have previously repeat analysis (8) suggested a point- found in humans and soil within 30 source outbreak with an identical km of the site. 4-locus multilocus variable-number Numerous cases of melioidosis in tandem repeat analysis pattern and ST birds have been documented (online for all B. pseudomallei isolated from Technical Appendix, www.cdc.gov/ the diseased birds and the sprinkler EID/content/17/7/1310-Techapp.pdf). system. The ST was novel (ST673),

1310 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 7, July 2011 LETTERS

Author affi liations: Menzies School of Health Research–Charles Darwin University, Darwin, Northern Territory, Australia (V. Hampton, M. Kaestli, M. Mayo, J. Low Choy, G. Harrington, L. Richardson, B.J. Currie); School for Environmental Research–Charles Darwin University, Darwin (R. Noske, S.T. Garnett); Berrimah Veterinary Laboratories, Darwin (S. Benedict); and Imperial College, London, UK (D. Godoy, B.G. Spratt)

Figure. Images from necropsy of yellow-bibbed lorikeet that died of melioidosis, DOI: 10.3201/eid1707.100707 showing multiple diffuse nodular lesions in the liver (A) and spleen (B). Photographs by Jodie Low Choy. A color version of this fi gure is available online (www.cdc.gov/EID/ References content/17/7/1310-F.htm). 1. Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and with no single-locus variants in the In summary, melioidosis is management. Clin Microbiol Rev. global MLST dataset. uncommon in wild birds but occurs 2005;18:383–416 [erratum in Clin Although an infected exotic or in captive or exotic birds brought Microbiol Rev. 2007;20:533]. 2. Reed KD, Meece JK, Henkel JS, Shukla captive bird is likely to quickly die from to melioidosis-endemic locations. SK. Birds, migration and emerging melioidosis, our survey suggests that Asymptomatic carriage of B. zoonoses: West Nile virus, Lyme disease, native birds are not very susceptible pseudomallei can occur in wild birds infl uenza A and enteropathogens. Clin to infection with B. pseudomallei and but appears to be unusual. We believe Med Res. 2003;1:5–12. 3. Mayo M, Kaestli M, Harrington G, Cheng resulting disease. Further studies are the risk for spread of B. pseudomallei A, Ward L, Karp D, et al. Burkholderia required to quantify the carriage of by birds is low, but such occurrence pseudomallei in unchlorinated domestic B. pseudomallei in wild native birds does provide a possible explanation bore water, tropical northern Australia. in melioidosis-endemic locations. for the spread of melioidosis from Emerg Infect Dis. 2011;17:1283–5. 4. Kaestli M, Mayo M, Harrington G, Nevertheless, although no direct proof Australia to offshore islands. Ward L, Watt F, Hill JV, et al. Landscape exists for spread of B. pseudomallei by changes infl uence the occurrence of the birds, our fi nding of an asymptomatic Acknowledgments melioidosis bacterium Burkholderia pseudomallei in soil in northern Australia. native bird with B. pseudomallei in We are grateful to Cathy Shilton for PLoS Negl Trop Dis. 2009;3:e364. its beak supports the hypothesis of advice and to the owners of the lorikeet 5. Godoy D, Randle G, Simpson A, Aanensen potential dispersal of these bacteria aviary for their enthusiastic cooperation D, Pitt T, Kinoshita R, et al. Multilocus by birds from melioidosis-endemic and help. We also thank the Charles Darwin sequence typing and evolutionary relationships among the causative agents regions to previously uncontaminated University Animal Ethics Committee and of melioidosis and glanders, Burkholderia areas. For instance, carriage by birds Northern Territory Parks and Wildlife pseudomallei and Burkholderia mallei. J could explain the introduction of Commission for permission to trap wild Clin Microbiol. 2003;41:2068–79. B. pseudomallei to New Caledonia birds, collect swab specimens, and release 6. Ouadah A, Zahedi M, Perumal R. Animal melioidosis surveillance in Sabah. The in the Pacifi c, 2,000 km east of the wild birds. Internet Journal of Veterinary Medicine. Australia. B. pseudomallei strains 2007;2 [cited 2011 May 16]. http://www. from New Caledonia are related Vanya Hampton,1 ispub.com/journal/the_internet_journal_ by MLST to Australian strains; 1 of_veterinary_medicine/volume_2_ Mirjam Kaestli,1 Mark Mayo, strain is a single-locus variant of a number_2_2/article/animal_melioidosis_ Jodie Low Choy, surveillance_in_sabah.html strain from Australia’s east coast Glenda Harrington, 7. Mahfouz ME, Grayson TH, Dance DA, (9). Vagrant water birds are known Leisha Richardson, Gilpin ML. Characterization of the mrgRS to irregularly disperse from eastern locus of the opportunistic pathogen Suresh Benedict, tropical Australia to the southwestern Burkholderia pseudomallei: temperature Richard Noske, regulates the expression of a two- Pacifi c, presumably driven by drought Stephen T. Garnett, component signal transduction system. and offshore winds (G. Dutson, Daniel Godoy, Brian G. Spratt, BMC Microbiol. 2006;6:70. pers. comm.). Thus, B. pseudomallei 8. Currie BJ, Haslem A, Pearson T, Hornstra and Bart J. Currie could have been introduced to New H, Leadem B, Mayo M, et al. Identifi cation 1These authors contributed equally to this of melioidosis outbreak by multilocus Caledonia by an infected bird that fl ew variable number tandem repeat analysis. there from northeastern Australia. article. Emerg Infect Dis. 2009;15:169–74.

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 7, July 2011 1311 LETTERS

9. Le Hello S, Currie BJ, Godoy D, Spratt he was admitted with peritonitis to a fl uid by using the QIAamp DNA mini- BG, Mikulski M, Lacassin F, et al. community hospital in Pennsylvania, kit (QIAGEN, Valencia, CA, USA). Melioidosis in New Caledonia. Emerg Infect Dis. 2005;11:1607–9. United States. He lived on a farm that PCR testing for T. vaginalis was had swine, horses, and cats. Exposure performed (2). PCR for T. foetus was Address for correspondence: Bart J. Currie, to cattle was unknown. He denied performed by using primers TFR3 and Menzies School of Health Research, PO Box having a history of sexually transmitted TFR4 with thermocycling conditions 41096, Casuarina, NT 0811, Australia; email: infections or high-risk sexual behavior. outlined previously (3). PCR was [email protected] Initial examination showed para- performed in a 50-μL reaction centesis fl uid with numerous motile, volume with 1 μL of deoxynucleoside fl agellated organisms consistent with triphosphate mix (12.5 mmol/L each trichomonads. Bacterial fl uid cultures of dATP, dCTP, dGTP, and 5 mmol/L had no growth. Despite receiving of dUTP; Applied Biosystems, Foster

antimicrobial drugs (including City, CA, USA), 5 μL of MgCl2 metronidazole 500 mg intravenously (25 mmol/L; Applied Biosystems), every 6 hours), he became increasingly 0.2 μM each primer, 2.5U of Rare Case of ill over the following 72 hours with AmpliTaq Gold polymerase (Applied Trichomonal hypotension, acute renal failure, and Biosystems), 5 μL of 10× PCR buffer Peritonitis metabolic acidosis, which required (Applied Biosystems), and 5 μL of transfer to Penn State Milton S. DNA. PCR products were analyzed To the Editor: Trichomonads Hershey Medical Center (Hershey, on an Agilent 2100 Bioanalyzer are fl agellated protozoa with PA, USA) for further care. (Agilent Technologies, Palo Alto, CA, several species capable of infecting Upon arrival, the man was afebrile USA). Amplicons were purifi ed with or colonizing humans. The most but hypotensive and tachycardic. the QIAquick PCR purifi cation kit common, Trichomonas vaginalis, Abdominal examination showed (QIAGEN) and directly sequenced causes genitourinary infection ascites, decreased bowel sounds, and with PCR primers on an ABI 3130- in adults and, rarely, respiratory diffuse tenderness. Genitourinary XL Genetic Analyzer (Applied infections in premature neonates of examination results were normal. Biosystems). Sequences were infected mothers. Pentatrichomonas Repeat paracentesis demonstrated assembled and aligned with Lasergene hominis has been isolated from numerous motile trichomonads. software (DNASTAR, Inc., Madison, the human gastrointestinal tract, Urinalysis and routine cultures of perito- WI, USA) and deposited in GenBank and Trichomonas tenax, a human neal fl uid and blood were negative. (accession no. HQ849063). oropharynx commensal, has caused Computed tomography of the abdomen Metronidazole sensitivity was empyema in immunocompomised and pelvis showed edematous bowel, tested with methods previously persons. Rare cases of human ascites, and peritonitis. His condition described (4). The patient’s peritonitis caused by trichomonads deteriorated during the following 48 trichomonads had minimal lethal have been reported. hours. Despite ongoing treatment with concentration (MLC) of 3.1 μg/mL Some trichomonads, including broad-spectrum antimicrobial drugs for metronidazole, similar to MLCs Tritrichomonas foetus and (including metronidazole 500 mg of the known metronidazole–sensitive Tritrichomonas suis, primarily infect intravenously every 6 hours), he died T. vaginalis isolate. T. vaginalis and colonize animals. Although of multiorgan failure. metronidazole MLCs >50 μg are they were previously thought to be Autopsy showed peritonitis associated with resistance (5). different species, current molecular with copious intraabdominal exudate PCR performed by using primers and biologic evidence suggests they and peripancreatic and perigastric TFR3/4 produced a 348-bp amplicon are indistinguishable (1). T. foetus abscesses. No intestinal perforation with DNA extracted from peritoneal (synonym T. suis) causes genitourinary or genitourinary abnormalities were fl uid and culture (Figure). Comparison infection in cattle and diarrhea in cats noted. No portal of entry for peritoneal of DNA sequence from the parasite to and colonizes the gastrointestinal tract infection was identifi ed. Premortem GenBank sequences showed 100% of swine. abdominal fl uid samples were sent to identity with cattle isolates of T. foetus. We report T. foetus peritonitis the Centers for Disease Control and Two human cases of T. foetus in a 52-year-old man with common Prevention (Atlanta, GA, USA) for infection have been reported. T. variable immunodefi ciency, rheuma- analysis. foetus was identifi ed by PCR in toid arthritis, splenectomy, and DNA was extracted from the the respiratory tract of a patient cryptogenic cirrhosis. In June 2007, trichomonad culture and peritoneal with AIDS and pneumonia (6) and

1312 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 7, July 2011