One of my favourite microorganisms, viz., Burkholderia pseudomallei (the cause of Melioidosis)

As a young pathology trainee I remember reading about this mysterious bacterium and the disease it caused. I wasn’t far into my training when one morning I found a rapidly motile bacillus in a wet preparation from the blood culture bottle from a young man in our spinal unit with bacteræmia. The patient was from Cairns. He’d ridden his motorcycle off a cliff and landed in some mud. He had a fractured spine and a bad burn on his leg from the motorcycle’s exhaust pipe. The Gram’s stain from the blood culture bottle revealed a thin Gram-negative bacillus with a bipolar staining pattern. At the time I assumed it would be a Pseudomonas aeruginosa, a common enough finding in spinal patients with indwelling (urinary) catheters. The following morning the colonial morphology on horse blood agar and MacConkey were not typical for Ps. aeruginosa. The bacterium was oxidase positive but there was no green pigmentation. I set up an API 20E and API 20NE. The following day the colonial morphology was very odd, the colonies had become wrinkled and dry. It hit me then that this was likely to be either Burkholderia pseudomalleiBurkholderia cepacia or Pseudomonas stutzeri. The patient’s history suggested he was bacteræmic and had Melioidosis with the portal of entry being the leg burn that was exposed to mud in which B. pseudomallei could be found. B. pseudomallei is commonly found in Northern Australia including far north Queensland.

As my training in Brisbane was coming to an end at the Princess Alexandra Hospital, we experienced a summer of really heavy rainfall. I remember two patients with Melioidosis who had never travelled further north than Brisbane. I was told by a very senior microbiologist that when the Brisbane was first settled an awful lot of horses where buried. Whenever there was really heavy rain, for example, associated with a tropical low or tropical cyclone occasional cases of Melioidosis would emerge. I really have no way of verifying that story, but I know that in subequatorial and tropical climes monsoonal rains which raise the water table brought cases of Melioidosis usually within 10 to 14 days. This was a constant event at the beginning of the ‘wet’ when I was living and working in Darwin.

When I moved to Darwin in February 1996 I grew to love this bacterium and the disease it caused.

For some very basic facts about the bacterium, the disease, how we diagnose it and treat it I’ve created a little presentation. You can view it as a PDF.

During my time in Darwin I learnt so much from the preeminent clinician and scientist in Melioidosis, viz., Prof. Bart Currie. If you enter “Currie and Melioidosis” into a search engine you’ll see he’s authored hundreds of articles in high impact peer reviewed medical and scientific journals. I managed to get involved a couple of times in contributing to the American Society for Microbiology’s Manual of Clinical Microbiology’s Burkholderia chapters.

  1. Gilligan, P. H., G. Lum, P. Vandamme, and S. Whittier.  Burkholderia, Stenotrophomonas, Ralstonia, Brevundimonas, Comamonas, Pandoraea and Acidovorax.  Manual of Clinical Microbiology.  Eighth edition.  ASM Press, Washington D.C.  2003.
  2. LiPuma J., P. Vandamme, and G. Lum. Burkholderia, Stenotrophomonas, Ralstonia, Cupriavidus, Brevundimonas, Comamonas, Delftia, Pandoraea, and Acidovorax Manual of Clinical Microbiology.  Ninth edition.  ASM Press, Washington D.C.  2007.

When I changed jobs and moved to Canberra and the Australian Government’s Department of Health and Ageing my engagement with the B. pseudomallei community was confined to some specialist groups. My biggest thrill though was to be able to talk about B. pseudomallei before senators at Senate Estimates in 2011.

Senate Estimates Hansard Community Affairs 31 May 2011 Check out from page 152 of the document for my responses to the Senators’ questions.

One day I’ll write about my favourite bacterium, viz., Chromobacterium violaceum.

Today I’m thinking obstetrics

On this day my youngest brother was born. On this day my Mum could no longer have any more children. Mum had three sons. I’m the eldest. We were all troublesome. I was a transverse lie and the obstetrician couldn’t turn me. I had the umbilical cord wrapped around my neck. Mum needed a Caesarean section and I was 2 weeks premature. The middle brother was a grade four placenta prævia. Mum was instructed to rest for three months. She had a Caesarian section and the middle brother was a month premature. My youngest brother whose birth we celebrate today was born in an emergency Caesarian section after Mum’s uterus ruptured. Mum recalls the blood and the pain. He was ten weeks premature. Forty something years ago, that was fairly premature. Mum objects when others say she didn’t have a proper pregnancy because she didn’t experience a normal vaginal delivery. People who suggest that to Mum should watch out. Mum suffered a lot to have three healthy sons.

When I was in high school Dad often assisted obstetricians who delivered babies to Dad’s patients when things got complicated. I remember Dad taking me to a delivery. I’d made it clear I was intending to read medicine at university. Dad checked with his patients and the obstetrician and everyone was sweet. I really enjoyed being in an operating theatre as a high school student watching the miracle of birth. I recall the obstetrician spraying me with amniotic fluid.

As a medical student I recall the confinement of a Spanish lady who didn’t speak English. The midwife made panting noises and gestures and the lady pushed rather than pant. Disasters occur in slow motion. I watched her perineum tear and I remember seeing the end of her rectum. It appeared to happen so slowly yet I know it happened in a second or two. The baby was fine. The Mum needed some repair work. I hope she ended up okay as she grew older.

The last deliveries I was involved with professionally were when I was a junior house officer doing my country relieving stint in Wondai. The head midwife was the Mum of a famous Australian cricket player. She told great stories of her son and amazing stories of the local politicians. “Old Rack” was fun catching babies with. That was her term for delivering babies, “Catching baby time”.

Obstetrics is really important as a clinical microbiologist. So many serious infections can occur. Some can lead to ongoing congenital problems. Others are deadly at the time of confinement. Understanding obstetric microbiology is really important and so many lives have been saved and so many humans owe a normal human existence to the pioneers of obstetric clinical microbiology.

Happy birthday Grasshopper, I hope you have a great day.

The National Critical Care and Trauma Response Centre

NCCTRC

One of the things I’m proudest of is my association with the National Critical Care and Trauma Response Centre in Darwin.

I was there last week for meetings.

Check out their website http://www.nationaltraumacentre.nt.gov.au/

Check out my initiation and involvement with the NCCTRC http://yummylummy.com/2012/10/12/the-2002-bali-bombings-my-experience-and-my-memories/

Gram’s stain joy

One of the most useful ‘tests’ in clinical microbiology is the Gram’s stain named after Hans Christian Gram from Copenhagen, Denmark.

This differential staining technique is one of the most important things we do in the clinical microbiology laboratory.

Unfortunately because of newer technology, e.g., fancy chromogenic media, latex agglutination, MALDI-TOF and nucleic acid amplification assays simple things like a wet preparation and a Gram’s stain are being done less often. A “wet prep” and a “Gram” are quick and easy and tell you so much about what is growing on a plate. That said, the newer technologies are ‘must haves’ in any modern clinical microbiology laboratory. I am so impressed with the value of the MALDI-TOF.

Last week I started with seeing a Gram’s stain consistent with Vincent’s angina and finished the day seeing gonococci in a female genital specimen from a patient with an interesting clinical history. I smiled all night thinking about how cool my day was.

Escherichia coli on MacConkey agar

Mmm… I love the smell of Escherichia coli on MacConkey agar

A photo posted by Gary Lum (@garydlum) on

I love the smell that a pure growth of Escherichia coli has on MacConkey agar. Its sweet and smells like expensive perfume. If it was made into a perfume I’d hope it was popular. It really is such a lovely smell.

A medical family

This is the first post to this blog. It’ll be short and sweet. Regular readers of Yummy Lummy know I’m usually light on words and let images tell the story.

I grew up in a medical family. My father trained in Otago and wanted to be an orthopædic surgeon. In the end Dad spent more than 30 years as a general practitioner in suburban Brisbane. Mum was a domestic science school teacher. In her teaching days the curriculum included zoölogy and physiology. This meant Mum taught how to dissect animals. As a kid I had access to Dad’s books and Mum’s instruments and while I’m not proud of it many animals in our backyard were captured and dissected.

One of my brothers is a medical practitioner and my maternal uncle is a specialist urologist (retired). My uncle’s eldest son and my cousin is a specialist otorhinolaryngologist (ear, nose and throat specialist).

Our dinner table conversation often revolved around medical discussion. It was second nature to us and I assumed as a boy, teenager and young man that talking about surgical procedures, infections and pus were perfectly acceptable topics for dinner conversation.

I’m happy I studied medicine. I’m happy I put myself through medical school working in a medical testing laboratory. I’m happy I specialised in clinical microbiology. I’m happy I learnt management. I’m happy I learnt how to work in a public service policy agency. I’m happy I can think medically and be surrounded by really interesting people every day.