{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:31:48Z","timestamp":1759336308905,"version":"3.41.2"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2023,7,26]],"date-time":"2023-07-26T00:00:00Z","timestamp":1690329600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Burkholderia pseudomallei, the causative agent of melioidosis, has not yet been reported in Timor-Leste, a sovereign state northwest of Australia. In the context of improved access to diagnostic resources and expanding clinical networks in the Australasian region, we report the first 3 cases of culture-confirmed melioidosis in Timor-Leste. These cases describe a broad range of typical presentations, including sepsis, pneumonia, multifocal abscesses, and cutaneous infection. Phylogenetic analysis revealed that the Timor-Leste isolates belong to the Australasian clade of B. pseudomallei, rather than the Asian clade, consistent with the phylogeographic separation across the Wallace Line. This study underscores an urgent need to increase awareness of this pathogen in Timor-Leste and establish diagnostic laboratories with improved culture capacity in regional hospitals. Clinical suspicion should prompt appropriate sampling and communication with laboratory staff to target diagnostic testing. Local antimicrobial guidelines have recently been revised to include recommendations for empiric treatment of severe sepsis.<\/jats:p>","DOI":"10.1093\/ofid\/ofad405","type":"journal-article","created":{"date-parts":[[2023,7,25]],"date-time":"2023-07-25T12:53:42Z","timestamp":1690289622000},"source":"Crossref","is-referenced-by-count":1,"title":["Melioidosis in Timor-Leste: First Case Description and Phylogenetic Analysis"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3917-1187","authenticated-orcid":false,"given":"Helio","family":"Guterres","sequence":"first","affiliation":[{"name":"National Hospital Guido Valadares , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celia","family":"Gusmao","sequence":"additional","affiliation":[{"name":"National Hospital Guido Valadares , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mateus","family":"Pinheiro","sequence":"additional","affiliation":[{"name":"National Hospital Guido Valadares , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joana","family":"Martins","sequence":"additional","affiliation":[{"name":"National Hospital Guido Valadares , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Odio","sequence":"additional","affiliation":[{"name":"National Hospital Guido Valadares , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Maia","sequence":"additional","affiliation":[{"name":"National Health Laboratory , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginia","family":"da Conceicao","sequence":"additional","affiliation":[{"name":"National Health Laboratory , Dili , Timor-Leste"},{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Messias","family":"Soares","sequence":"additional","affiliation":[{"name":"National Health Laboratory , Dili , Timor-Leste"},{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Celita","family":"Osorio","sequence":"additional","affiliation":[{"name":"National Health Laboratory , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Endang Soares","family":"da Silva","sequence":"additional","affiliation":[{"name":"National Health Laboratory , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arijayanti","family":"Tilman","sequence":"additional","affiliation":[{"name":"National Health Laboratory , Dili , Timor-Leste"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney","family":"Givney","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tessa","family":"Oakley","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Yan","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Toto","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elfiana","family":"Amaral","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodney","family":"James","sequence":"additional","affiliation":[{"name":"Peter Doherty Institute for Infection and Immunity , Melbourne, Victoria , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kirsty","family":"Buising","sequence":"additional","affiliation":[{"name":"Peter Doherty Institute for Infection and Immunity , Melbourne, Victoria , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Mayo","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam","family":"Kaestli","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica R","family":"Webb","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"},{"name":"Peter Doherty Institute for Infection and Immunity , Melbourne, Victoria , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert W","family":"Baird","sequence":"additional","affiliation":[{"name":"Territory Pathology, Royal Darwin Hospital , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart J","family":"Currie","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua R","family":"Francis","sequence":"additional","affiliation":[{"name":"Menzies School of Research, Charles Darwin University , Darwin, Northern Territory , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3161-8199","authenticated-orcid":false,"given":"Stephen","family":"Muhi","sequence":"additional","affiliation":[{"name":"Peter Doherty Institute for Infection and Immunity , Melbourne, Victoria , Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,26]]},"reference":[{"key":"2023081019260750700_ofad405-B1","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1016\/S1473-3099(21)00022-0","article-title":"The Darwin Prospective Melioidosis Study: a 30-year prospective, observational investigation","volume":"21","author":"Currie","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"2023081019260750700_ofad405-B2","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.3201\/eid1812.120638","article-title":"Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. mallei infection, 2010","volume":"18","author":"Lipsitz","year":"2012","journal-title":"Emerg Infect Dis"},{"key":"2023081019260750700_ofad405-B3","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3390\/tropicalmed3020038","article-title":"Melioidosis in Thailand: present and future","volume":"3","author":"Hinjoy","year":"2018","journal-title":"Trop Med Infect Dis"},{"key":"2023081019260750700_ofad405-B4","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1056\/NEJMra1204699","article-title":"Melioidosis","volume":"367","author":"Wiersinga","year":"2012","journal-title":"N Engl J Med"},{"key":"2023081019260750700_ofad405-B5","first-page":"e141045","article-title":"Melioidosis diagnostic workshop, 2013","volume":"21","author":"Hoffmaster","year":"2015","journal-title":"Emerg Infect Dis"},{"key":"2023081019260750700_ofad405-B6","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1128\/CMR.4.1.52","article-title":"Dance DA. Melioidosis: the tip of the iceberg?","volume":"4","year":"1991","journal-title":"Clin Microbiol Rev"},{"key":"2023081019260750700_ofad405-B7","first-page":"1496","article-title":"Seroprevalence of Burkholderia pseudomallei in East Timorese refugees: implications for healthcare in East Timor","volume":"36","author":"Armstrong","year":"2005","journal-title":"Southeast Asian J Trop Med Public Health"},{"year":"2016","key":"2023081019260750700_ofad405-B8"},{"key":"2023081019260750700_ofad405-B9","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.4269\/ajtmh.15-0292","article-title":"Emergence of melioidosis in Indonesia","volume":"93","author":"Tauran","year":"2015","journal-title":"Am J Trop Med Hygiene"},{"key":"2023081019260750700_ofad405-B10","doi-asserted-by":"crossref","first-page":"4","DOI":"10.33321\/cdi.2020.44.1","article-title":"Antimicrobial resistance and antibiotic use in Timor-Leste: building surveillance capacity with a one health approach","volume":"44","author":"Francis","year":"2020","journal-title":"Commun Dis Intell (2018)"},{"key":"2023081019260750700_ofad405-B11","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1071\/MA22039","article-title":"Strong relationships between the Northern Territory of Australia and Timor-Leste","volume":"43","author":"Sarmento","year":"2022","journal-title":"Microbiol Aust"},{"key":"2023081019260750700_ofad405-B12","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1128\/JCM.44.1.85-90.2006","article-title":"Development and evaluation of a real-time PCR assay targeting the type III secretion system of Burkholderia pseudomallei","volume":"44","author":"Novak","year":"2006","journal-title":"J Clin Microbiol"},{"key":"2023081019260750700_ofad405-B13","doi-asserted-by":"crossref","first-page":"e0008659","DOI":"10.1371\/journal.pntd.0008659","article-title":"2020 review and revision of the 2015 Darwin Melioidosis Treatment Guideline; paradigm drift not shift. Dunachie SJ, editor","volume":"14","author":"Sullivan","year":"2020","journal-title":"PLoS Negl Trop Dis"},{"key":"2023081019260750700_ofad405-B14","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/1471-2334-7-68","article-title":"Using BOX-PCR to exclude a clonal outbreak of melioidosis","volume":"7","author":"Currie","year":"2007","journal-title":"BMC Infect Dis"},{"author":"Seemann","key":"2023081019260750700_ofad405-B15"},{"key":"2023081019260750700_ofad405-B16","doi-asserted-by":"crossref","first-page":"14240","DOI":"10.1073\/pnas.0403302101","article-title":"Genomic plasticity of the causative agent of melioidosis, Burkholderia pseudomallei","volume":"101","author":"Holden","year":"2004","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2023081019260750700_ofad405-B17","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1093\/molbev\/msu300","article-title":"IQ-TREE: a fast and effective stochastic algorithm for estimating maximum-likelihood phylogenies","volume":"32","author":"Nguyen","year":"2015","journal-title":"Mol Biol Evol"},{"key":"2023081019260750700_ofad405-B18","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1038\/nmeth.4285","article-title":"Modelfinder: fast model selection for accurate phylogenetic estimates","volume":"14","author":"Kalyaanamoorthy","year":"2017","journal-title":"Nat Methods"},{"key":"2023081019260750700_ofad405-B19","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s40475-017-0111-9","article-title":"Genomic insights into the melioidosis pathogen, Burkholderia pseudomallei","volume":"4","author":"Price","year":"2017","journal-title":"Curr Trop Med Rep"},{"first-page":"e96","year":"2020","author":"Yu","key":"2023081019260750700_ofad405-B20"},{"key":"2023081019260750700_ofad405-B21","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1186\/1471-2105-11-595","article-title":"Bigsdb: scalable analysis of bacterial genome variation at the population level","volume":"11","author":"Jolley","year":"2010","journal-title":"BMC Bioinformatics"},{"key":"2023081019260750700_ofad405-B22","doi-asserted-by":"crossref","first-page":"e0005182","DOI":"10.1371\/journal.pntd.0005182","article-title":"Melioidosis in Malaysia: a review of case reports. Nascimento AL, editor","volume":"10","author":"Kingsley","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"2023081019260750700_ofad405-B23","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1186\/s12879-019-3793-x","article-title":"Melioidosis: misdiagnosed in Nepal","volume":"19","author":"Shrestha","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2023081019260750700_ofad405-B24","first-page":"1531","article-title":"Case series study of melioidosis","volume":"25","author":"Rodr\u00edguez","year":"2019","journal-title":"Colombia. Emerg Infect Dis"},{"key":"2023081019260750700_ofad405-B25","doi-asserted-by":"crossref","first-page":"32","DOI":"10.3390\/tropicalmed3010032","article-title":"Emergence of melioidosis in Indonesia and today's challenges","volume":"3","author":"Tauran","year":"2018","journal-title":"TropicalMed"},{"key":"2023081019260750700_ofad405-B26","first-page":"1209","article-title":"Tuberculosis mimicked by melioidosis","volume":"12","author":"Vidyalakshmi","year":"2008","journal-title":"Int J Tuberc Lung Dis"},{"key":"2023081019260750700_ofad405-B27","doi-asserted-by":"crossref","first-page":"302","DOI":"10.12688\/f1000research.5935.1","article-title":"Detection of Burkholderia pseudomallei in sputum using selective enrichment broth and Ashdown's medium at Kampong Cham Provincial Hospital, Cambodia","volume":"3","author":"Nhem","year":"2014","journal-title":"F1000Research"},{"key":"2023081019260750700_ofad405-B28","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1186\/1741-7007-7-78","article-title":"Phylogeographic reconstruction of a bacterial species with high levels of lateral gene transfer","volume":"7","author":"Pearson","year":"2009","journal-title":"BMC Biol"},{"key":"2023081019260750700_ofad405-B29","first-page":"5","article-title":"The arachnogeography and the \u2018lines\u2019 (of Wallace, Lydekker, Weber)","volume":"22","author":"Beron","year":"2015","journal-title":"Hist Nat Bulg"},{"key":"2023081019260750700_ofad405-B30","doi-asserted-by":"crossref","first-page":"16263","DOI":"10.1038\/nmicrobiol.2016.263","article-title":"Global and regional dissemination and evolution of Burkholderia pseudomallei","volume":"2","author":"Chewapreecha","year":"2017","journal-title":"Nat Microbiol"},{"key":"2023081019260750700_ofad405-B31","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1056\/NEJMoa2116130","article-title":"Multistate outbreak of melioidosis associated with imported aromatherapy spray","volume":"386","author":"Gee","year":"2022","journal-title":"N Engl J Med"},{"key":"2023081019260750700_ofad405-B32","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/QCO.0000000000000869","article-title":"Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination","volume":"35","author":"Currie","year":"2022","journal-title":"Curr Opin Infect Dis"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofad405\/50969739\/ofad405.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/10\/8\/ofad405\/51089552\/ofad405.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/10\/8\/ofad405\/51089552\/ofad405.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,10]],"date-time":"2023-08-10T19:26:33Z","timestamp":1691695593000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofad405\/7231704"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,26]]},"references-count":32,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofad405","relation":{},"ISSN":["2328-8957"],"issn-type":[{"type":"electronic","value":"2328-8957"}],"subject":[],"published-other":{"date-parts":[[2023,8]]},"published":{"date-parts":[[2023,7,26]]},"article-number":"ofad405"}}