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Increased Von Willebrand factor, decreased ADAMTS13 and thrombocytopenia in melioidosis

Emma Birnie1, Gavin C K W Koh1,2,3,4, Ester C Löwenberg5

  • 1Center for Experimental and Molecular Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.

Plos Neglected Tropical Diseases
|March 16, 2017
PubMed
Abstract

Insights

Melioidosis causes low platelet counts linked to mortality. While excess Von Willebrand factor (VWF) and ADAMTS13 deficiency occur, they don't drive this thrombocytopenia, requiring further research into Burkholderia pseudomallei infection.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Pathogenesis of bacterial infections

Background:

  • Melioidosis, a severe Gram-negative sepsis caused by Burkholderia pseudomallei, is prevalent in Southeast Asia and Northern Australia.
  • Understanding melioidosis pathogenesis is crucial for improving treatment and reducing mortality.
  • The study investigated potential changes in Von Willebrand factor (VWF) function due to endothelial stimulation and thrombin presence in melioidosis.

Purpose of the Study:

  • To investigate the role of Von Willebrand factor (VWF) and ADAMTS13 in melioidosis.
  • To determine the relationship between VWF, platelet counts, and mortality in melioidosis patients.
  • To explore the underlying causes of thrombocytopenia in acute melioidosis.

Main Methods:

  • Recruited 34 culture-confirmed melioidosis patients and 52 diabetic controls in Thailand.
  • Measured platelet counts, VWF antigen, VWF propeptide, and ADAMTS13 levels.
  • Analyzed correlations between these parameters and patient mortality.

Main Results:

  • Melioidosis patients exhibited significantly lower platelet counts compared to controls, correlating with mortality.
  • Elevated VWF antigen levels were observed in patients, attributed to increased endothelial stimulation and reduced VWF clearance (ADAMTS13 deficiency).
  • VWF levels did not correlate with platelet counts, suggesting alternative causes for thrombocytopenia.

Conclusions:

  • Thrombocytopenia is a significant feature of melioidosis, associated with increased mortality.
  • Excess VWF and ADAMTS13 deficiency are present in acute melioidosis but do not primarily cause thrombocytopenia.
  • Further research is needed to elucidate the mechanisms of thrombocytopenia in Burkholderia pseudomallei infections.

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