Given the postulated association of impaired neutrophil function as Epigenetics Compound Library a risk factor for melioidosis, G-CSF would be attractive as an adjunctive treatment

to improve outcomes of severe melioidosis with septicaemia. Studies have shown varying results regarding its use in the setting of severe sepsis. In a retrospective study from Australia comprising of 42 patients with septic shock and culture-confirmed melioidosis, mortality rates were significantly lower with G-CSF (10% vs 95% in historical controls without G-CSF therapy).[52] However, in a different setting with limited resources of intensive care from Thailand, in a randomized controlled trial comprising of 60 patients with severe sepsis suspected to be related to melioidosis, G-CSF was associated with a longer duration of survival (34 vs

15 h) but without any mortality benefit.[53] It is considered that the benefits of state-of-the-art intensive care facilities are far more important than a potential benefit of therapy with G-CSF.[12] Nevertheless, G-CSF is still used in the intensive care unit at Royal Darwin Hospital in patients with life-threatening melioidosis septic shock. Patients living in, or visiting from melioidosis endemic regions, Autophagy Compound Library clinical trial or those with evidence of past exposure to B. pseudomallei (an indirect haemagglutination titre of >1:40), that are anticipated to commence immunosuppressive therapy, such as those enlisted for an organ transplant, should be screened for melioidosis. This entails a chest X-ray and microbial cultures of rectal and throat swabs placed into selective Ashdown’s broth, urine microscopy and culture, sputum culture if respiratory symptoms are present and culture on Ashdown’s agar of swabs from any skin lesions. Patients confirmed as culture positive should be treated for melioidosis as in Table 1. Patients who have no evidence of melioidosis can commence immunosuppression

and be active on transplant lists, but ongoing vigilance is essential for either activation of B. pseudomallei from a latent focus in those seropositive, or for new infection with B. pseudomallei in those continuing to live in an endemic Cobimetinib location. In a recent systematic review by Peacock et al. it was concluded that from the studies to date in animal models, it should be theoretically possible to develop a vaccine for public-health purposes that would be cost-effective for the prevention of naturally acquired melioidosis in high-risk populations in hyper-endemic regions such as Thailand and tropical northern Australia.[54] However, at present there is no vaccine available for effective prevention of melioidosis, making general preventive measures and possibly anti-microbial prophylaxis the only available options for prevention currently.