[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-437609-105":59,"doc-detail-437609-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","methodological-issue-in-a-dental-neuromelioidosis-outbreak-investigation-correspondence","Methodological issue in a dental neuromelioidosis outbreak investigation - correspondence","","The correspondence analyzes methodological limitations in a dental neuromelioidosis outbreak investigation, despite pivotal genomic evidence linking a Tamil Nadu cluster to iatrogenic transmission via contaminated saline. Key concerns include low CSF culture confirmation, incomplete whole-genome sequencing for available isolates, limited environmental sampling, and uncertainty in virulence interpretation. Additional confounding may stem from reduced meropenem use in dental-acquired cases. The authors conclude that stringent IPC measures are needed while interpreting lineage and transmission mechanistically with caution.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/methodological-issue-in-a-dental-neuromelioidosis-outbreak-investigation-correspondence/437609/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/methodological-issue-in-a-dental-neuromelioidosis-outbreak-investigation-correspondence/437609.png","ImageObject",300,407,{"name":92,"@type":93},"Franzy","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-01","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What key methodological gaps are highlighted in confirming neuromelioidosis?","Question",{"text":112,"@type":113},"The correspondence notes a low microbiological confirmation rate, with CSF culture positivity reported as inherently difficult and often below 30%.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does incomplete whole-genome sequencing affect the outbreak conclusions?",{"text":117,"@type":113},"Whole-genome sequencing covered only a subset of available isolates, which limits the robustness of phylogenetic inferences and interpretation of the outbreak lineage.",{"name":119,"@type":110,"acceptedAnswer":120},"What additional uncertainties could influence mortality and transmission interpretation?",{"text":121,"@type":113},"The correspondence identifies potential confounding from lower meropenem use in dental-acquired cases and discusses that hematogenous spread remains a plausible alternative pathway.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},437609,1790767925,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":8,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":81},2336478945519,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Correspondence   \nMethodological issue in a dental neuromelioidosis outbreak investigation  \nBijayini Beheraa,∗ and Prasanta Raghab Mohapatrab  \naDepartment of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India  \nbDepartment of Pulmonary Medicine & Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India  \nThirugnanakumar and colleagues1 provided critical genomic evidence linking a neuromelioidosis cluster in Tamil Nadu to iatrogenic transmission via contaminated saline at a dental clinic.1 The identification of B. pseudomallei ST1553 with the bimABmBm allele in both clinical (brain tissue) and environmental (saline bottle) isolates unravelled a novel transmission route. The high fatality (80%) underscores severe neurovirulence concerns. While pivotal in revealing a novel transmission route, several aspects warrant further scientific discussion:  \n1. Diagnostic gaps: The low microbiological confirmation rate, 24% (5 of 21 samples), though consistent with global literature of low CSF culture positivity (\u003C30%) in neuromelioidosis cases, is consistent with known challenges in culturing  \nB. pseudomallei from CSF (\u003C30%), highlighting inherent diagnostic difficulties.2  \n2. Incomplete genomic data: WGS of only two clinical and one environmental isolate from 5 available isolates (missing 3 clinical isolates) limits the robustness of the phylogenetic conclusion.  \n3. Environmental sampling: Positivity in only 1 of 28 samples (open saline bottle), combined with the inability to test dental water systems/instruments due to clinic closure, leaves potential contamination sources incompletely defined.  \n4. Virulence interpretation: Detection of BimABm allele in both neurological as well as nonneurological isolates suggests its role in neurotropism may be more complex than suggested and requires further validation.  \n5. Outcome confounding: Significantly lower meropenem use in the dental-acquired cases (30% vs.  \n91%, p = 0.004) represents a plausible confounding factor contributing to the observed higher mortality, independent of transmission route  \n6. Transmission mechanism: While direct neural invasion remains hypothetical, hematogenous spread remains a viable alternative pathway that can’t be ruled out.  \n7. Phylogenetic context: Exclusion of 93% of global genomes (>2900 isolates) due to metadata gaps limits interpretation and constrains the broader interpretability of the outbreak strain’s lineage.  \nWhile pivotal in exposing dental transmission risks, methodological constraints in confirmation, genomics, and environmental analysis necessitate cautious interpretation. Finally, this report calls for stringent IPC measures to prevent atypical and iatrogenic transmission routes of the deadly B. pseudomallei.  \nContributors  \nDr Bijayini Behera- Conceptualization, writing (Original draft), writing (Review and Editing) .  \nDr Prasanta Raghab Mohapatra- writing (Original draft), writing (Review and Editing) .  \nDeclaration of interests  \nNone.  \nReferences  \n1 Miraclin Thirugnanakumar A, Rajkumar P, Gunasekaran K, et al. Neuromelioidosis outbreak in Tamil Nadu, India: an investigation of transmission with genomic insights. Lancet Reg Health Southeast Asia. 2025;37:100602. [https://doi.org/10.1016/j.lansea](https://doi.org/10.1016/j.lansea). 2025.100602.  \n2 Currie BJ, Fisher DA, Howard DM, Burrow JN. Neurological melioidosis. Acta Trop. 2000;74(2–3):145–151. [https://doi.org/10](https://doi.org/10) . 1016/s0001-706x(99)00064-9 .  \nThe Lancet Regional Health -Southeast Asia 2025;43: 100658  \nPublished Online 20 August 2025 [https://doi.org/10](https://doi.org/10) .  \n1016/j.lansea.2025 . 100658  \nDOIs of original articles: [https://doi.org/10.1016/j.lansea.2025.100602](https://doi.org/10.1016/j.lansea.2025.100602), [https://doi.org/10.1016/j.lansea.2025.100659](https://doi.org/10.1016/j.lansea.2025.100659)  \n*Corresponding author. Department of Microbiology, All India Institute of Med","cbCaipl0VGsQfWle","https://ap.wps.com/l/cbCaipl0VGsQfWle","pdf",105688,"English","# Correspondence\n## Diagnostic gaps\n## Incomplete genomic data\n## Environmental sampling\n## Virulence and outcome interpretation\n## Transmission mechanism and phylogenetic context\n## Contributors and declarations","[{\"question\":\"What key methodological gaps are highlighted in confirming neuromelioidosis?\",\"answer\":\"The correspondence notes a low microbiological confirmation rate, with CSF culture positivity reported as inherently difficult and often below 30%.\"},{\"question\":\"How does incomplete whole-genome sequencing affect the outbreak conclusions?\",\"answer\":\"Whole-genome sequencing covered only a subset of available isolates, which limits the robustness of phylogenetic inferences and interpretation of the outbreak lineage.\"},{\"question\":\"What additional uncertainties could influence mortality and transmission interpretation?\",\"answer\":\"The correspondence identifies potential confounding from lower meropenem use in dental-acquired cases and discusses that hematogenous spread remains a plausible alternative pathway.\"}]","Methodological issue in a dental neuromelioidosis outbreak investigation - correspondence | PDF",1790682518]