Adapting microarray gene expression signatures for early melioidosis diagnosis.

2020 
Melioidosis is caused by Burkholderia pseudomallei and is predominantly seen in tropical regions. The clinical signs and symptoms of the disease are non-specific often resulting in misdiagnosis, failure of treatment, and poor clinical outcome. Septicemia with septic shock is the most common cause of death with mortality rates above 40%. Bacterial culture is the gold standard for diagnosis but it has low sensitivity and takes days to produce definitive results. Early laboratory diagnosis can help guide physicians to provide treatment specific to B. pseudomallei. In our study, we adapted host gene expression signatures obtained from microarray data of B. pseudomallei infected cases to develop a real-time PCR diagnostic test using two differentially expressed genes, AIM2 (Absent in Melanoma 2) and FAM26F (Family with sequence similarity 26, member F). We tested blood from 33 patients with B. pseudomallei and 29 patients with other bacterial infections to validate the test and determine cutoff values for use in a cascading diagnostic algorithm. Differentiation of septicemic melioidosis from other sepsis cases had a sensitivity of 82%, specificity of 93%, and negative and positive predictive values (NPV and PPV) of 82% and 93% respectively. Separation of cases likely to be melioidosis from unlikely cases in non-bacteremic situations showed a sensitivity of 40%, specificity of 54%, and NPV and PPV of 44% and 50% respectively. We suggest that our AIM2 and FAM26F expression combination algorithm could be beneficial for early melioidosis diagnosis offering a result within 24 hours of admission.
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