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Clinical

A Blood Transcriptional Diagnostic Assay for Septicemic Melioidosis - GSE69528

Purpose

Melioidosis, caused by Gram negative bacteria Burkholderia pseudomallei, is a major type of community-acquired septicemia in Southeast Asia and Northern Australia with high mortality and morbidity rate. More accurate and rapid diagnosis is needed for improving the management of septicemic melioidosis. We previously identified 37-gene candidate signature to distinguish septicemic melioidosis from sepsis due to other pathogens. The aims of this current study were to independently validate our previous biomarker and consolidate gene selection from each of our microarray data set for establishing a targeted assay for the differential diagnosis of melioidosis. Blood samples were collected from patients who presented with severe inflammatory response syndromes from 3 provincial hospitals in Northeast of Thailand during September 2009 and November 2011. Only culture-confirmed sepsis were included in the study (n=166). We generated a new microarray dataset comprising of 29 patients with septicemic melioidosis and 54 patients with sepsis due to other pathogens. Validation of the 37-gene signature using this new dataset demonstrated the prediction accuracy of approximately 80% for detecting type of sepsis. In order to develop a nanoliter-scale high throughput PCR technology, we further identified additional gene signature from this new microarray dataset and by revisiting our published data. Altogether 85 genes including 6 housekeeping genes were selected. Using multi-steps iteration approach we could reduce the number of biomarkers to 12 genes while the performance is comparable to that of the full panel. The high performance (accuracy >70%) of this 12-gene signature could be validated in a second independent set of samples. The 12-gene panel identified by our study provides high performance for the differential diagnosis of septicemic melioidosis. This finding will be useful for improving the management of septicemic melioidosis in term of diagnosis, treatment and follow up.

Hypothesis

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Experimental Design

Total RNA from whole blood obtained from patients with sepsis caused by B.pseudomallei (n=29) or other pathogens (n=54) and uninfected controls (28 healthy and 27 subjects with type 2 diabetes mellitus) were collected. In order to validate the published signature, microarray data were generated from these samples. This dataset was also used for an independent selection of signature for septicemic melioidosis. The same RNA samples were used for validation by a high throughput real-time PCR technique, Fluidigm.Please note that the non_normalized.txt contains background-subtracted raw data.

Experimental Variables

Septicemic Melioidosis (2021 ICD-10-CM code* = A24.1)

Controls

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Methods

The data were preprocessed using R, which included the following steps: quantile normalization, flooring all intensities <10 to 10, and log2 transformation. PALO (Presence in At least One), which selects only transcripts with detection p-values < 0.01 in at least one sample, was performed to reduce background noise.

Additional Information

https://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=GSE69528

Microarray
Illumina HumanHT-12 v4
138 Samples Loaded: 138
Human (Homo sapiens)
Whole Blood
Septicemic Melioidosis
Total RNA was isolated from whole blood lysate using the MagMAX™ for Stabilized Blood Tubes RNA Isolation Kit (Life Technologies, CA) according to the manufacturer’s instructions. Quality control was performed with the Agilent Bioanalyser.
Sample Set Spreadsheet
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Samples Preview
Sample ID !Sample Title !Sample_title tissue Grouping study group
GSM1702888 CIU11-318 CIU11-318 Whole blood Control Uninfected healthy
GSM1702889 CIU11-322 CIU11-322 Whole blood Control Uninfected type 2 diabetes mellitus
GSM1702890 CIU11-323 CIU11-323 Whole blood Control Uninfected type 2 diabetes mellitus
GSM1702891 CIU11-326 CIU11-326 Whole blood Control Uninfected type 2 diabetes mellitus
GSM1702892 CIU11-335 CIU11-335 Whole blood Control Uninfected type 2 diabetes mellitus
Please log in in order to upload files.
File
sampleset4000169_sampleannotations_mod.csv
Sample Set Spreadsheet
Log2 Transformed
Raw Signal
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Samples Viewer / Editor

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Sample ID !Sample Title !Sample Title Tissue Grouping Study group Pathogens Study group
GSM1702888
CIU11-318
CIU11-318
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702889
CIU11-322
CIU11-322
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702890
CIU11-323
CIU11-323
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702891
CIU11-326
CIU11-326
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702892
CIU11-335
CIU11-335
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702893
CIU11-336
CIU11-336
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702894
CIU11-338
CIU11-338
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702895
CIU11-339
CIU11-339
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702896
CIU11-346
CIU11-346
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702897
CIU11-347
CIU11-347
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702898
CIU11-351
CIU11-351
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702899
CIU11-352
CIU11-352
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702900
CIU11-353
CIU11-353
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702901
CIU11-354
CIU11-354
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702902
CIU11-359
CIU11-359
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702903
CIU11-360
CIU11-360
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702904
CIU11-363
CIU11-363
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702905
CIU11-364
CIU11-364
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702906
CIU11-365
CIU11-365
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702907
CIU11-367
CIU11-367
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702908
CIU11-368
CIU11-368
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702909
CIU11-369
CIU11-369
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702910
CIU12-0486
CIU12-0486
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702911
CIU12-0489
CIU12-0489
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702912
CIU12-0490
CIU12-0490
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702913
CIU12-0492
CIU12-0492
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702914
CIU12-0494
CIU12-0494
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702915
CIU12-0496
CIU12-0496
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702916
CIU12-0497
CIU12-0497
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702917
CIU12-0498
CIU12-0498
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702918
CIU12-0499
CIU12-0499
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702919
CIU12-0501
CIU12-0501
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702920
CIU12-0503
CIU12-0503
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702921
CIU12-0504
CIU12-0504
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702922
CIU12-0505
CIU12-0505
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702923
CIU12-0506
CIU12-0506
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702924
CIU12-0507
CIU12-0507
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702925
CIU12-0508
CIU12-0508
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702926
CIU12-0510
CIU12-0510
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702927
CIU12-0511
CIU12-0511
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702928
CIU12-0512
CIU12-0512
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702929
CIU12-0515
CIU12-0515
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702930
CIU12-0517
CIU12-0517
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702931
CIU12-0518
CIU12-0518
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702932
CIU12-0519
CIU12-0519
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702933
CIU12-0520
CIU12-0520
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702934
CIU12-0521
CIU12-0521
Whole blood
Control
Uninfected healthy
Control
Uninfected healthy
GSM1702935
CIU12-0522
CIU12-0522
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702936
CIU12-0523
CIU12-0523
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702937
CIU12-0524
CIU12-0524
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702938
CIU12-0525
CIU12-0525
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702939
CIU12-0526
CIU12-0526
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702940
CIU12-0528
CIU12-0528
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702941
CIU12-0530
CIU12-0530
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702942
CIU12-0531
CIU12-0531
Whole blood
Control
Uninfected type 2 diabetes mellitus
Control
Uninfected type 2 diabetes mellitus
GSM1702943
MK09-652
MK09-652
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702944
MK09-653
MK09-653
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702945
MK09-663
MK09-663
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702946
MK09-664
MK09-664
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702947
MK09-672
MK09-672
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702948
MK09-683
MK09-683
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702949
MK09-686
MK09-686
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702950
MK09-687
MK09-687
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702951
MK09-712
MK09-712
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702952
MK09-714
MK09-714
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702953
MK09-732
MK09-732
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702954
MK10-1220
MK10-1220
Whole blood
Other sepsis
Other sepsis
Salmonella gr.C
Other sepsis
GSM1702955
MK10-793
MK10-793
Whole blood
Other sepsis
Other sepsis
Klebseilla pneumoniae, Viridans Streptococci
Other sepsis
GSM1702956
MK10-799
MK10-799
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702957
MK10-811
MK10-811
Whole blood
Other sepsis
Other sepsis
Sphingomanas spp.
Other sepsis
GSM1702958
MK10-812
MK10-812
Whole blood
Other sepsis
Other sepsis
Klebsiella pneumoniae
Other sepsis
GSM1702959
MK10-854
MK10-854
Whole blood
Other sepsis
Other sepsis
Enterococcus spp.
Other sepsis
GSM1702960
MK10-897
MK10-897
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702961
MK10-904
MK10-904
Whole blood
Other sepsis
Other sepsis
Salmonella
Other sepsis
GSM1702962
MK11-1267
MK11-1267
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702963
MK11-1272
MK11-1272
Whole blood
Other sepsis
Other sepsis
Micrococcus spp.
Other sepsis
GSM1702964
MK11-1289
MK11-1289
Whole blood
Other sepsis
Other sepsis
Streptococcus pyogenes
Other sepsis
GSM1702965
MK11-1294.1
MK11-1294.1
Whole blood
Other sepsis
Other sepsis
Viridans Streptococci
Other sepsis
GSM1702966
MK11-1299
MK11-1299
Whole blood
Other sepsis
Other sepsis
Corynebacterium spp.
Other sepsis
GSM1702967
MK11-1303
MK11-1303
Whole blood
Other sepsis
Other sepsis
Streptococcus pyogenes
Other sepsis
GSM1702968
MK11-1310
MK11-1310
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1702969
MK11-1342
MK11-1342
Whole blood
Other sepsis
Other sepsis
Klebsiella pneumoniae
Other sepsis
GSM1702970
MK11-1346
MK11-1346
Whole blood
Other sepsis
Other sepsis
Citrobacter freundii
Other sepsis
GSM1702971
MK11-1348
MK11-1348
Whole blood
Other sepsis
Other sepsis
Micrococcus spp.
Other sepsis
GSM1702972
MK11-1370
MK11-1370
Whole blood
Other sepsis
Other sepsis
Aeromonas spp.
Other sepsis
GSM1702973
MK11-1373
MK11-1373
Whole blood
Other sepsis
Other sepsis
Aeromonas spp.
Other sepsis
GSM1702974
MK11-1392
MK11-1392
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1702975
MK11-1398
MK11-1398
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702976
MK11-1400
MK11-1400
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1702977
MK11-1411
MK11-1411
Whole blood
Other sepsis
Other sepsis
Klebsiella pneumoniae
Other sepsis
GSM1702978
MK11-1412
MK11-1412
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702979
MK11-1427
MK11-1427
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702980
MK11-1436
MK11-1436
Whole blood
Other sepsis
Other sepsis
Eschericia coli, Viridans Streptococcus
Other sepsis
GSM1702981
MK11-1455
MK11-1455
Whole blood
Other sepsis
Other sepsis
Acinetobacter Iwoffii
Other sepsis
GSM1702982
MK11-1463
MK11-1463
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1702983
MK11-1467
MK11-1467
Whole blood
Other sepsis
Other sepsis
Corynebacterium spp.
Other sepsis
GSM1702984
MK11-1476
MK11-1476
Whole blood
Other sepsis
Other sepsis
Corynebacterium spp.
Other sepsis
GSM1702985
MK11-1480
MK11-1480
Whole blood
Other sepsis
Other sepsis
Sphingobacterium spp.
Other sepsis
GSM1702986
MK11-1482
MK11-1482
Whole blood
Other sepsis
Other sepsis
Corynebacterium spp.
Other sepsis
GSM1702987
MK11-1484
MK11-1484
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1702988
MK11-1496
MK11-1496
Whole blood
Other sepsis
Other sepsis
Staphylococcus aureus
Other sepsis
GSM1702989
MK11-1502
MK11-1502
Whole blood
Other sepsis
Other sepsis
Cryptococcus neoformans
Other sepsis
GSM1702990
MK11-1514
MK11-1514
Whole blood
Other sepsis
Other sepsis
Klebslella pneumoniae
Other sepsis
GSM1702991
MK11-1524
MK11-1524
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702992
MK11-1530
MK11-1530
Whole blood
Other sepsis
Other sepsis
Klebseilla spp., Pseudomonas aeruginosa
Other sepsis
GSM1702993
MK11-1533
MK11-1533
Whole blood
Other sepsis
Other sepsis
Viridans Streptococci
Other sepsis
GSM1702994
MK11-1540
MK11-1540
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702995
MK11-1543
MK11-1543
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1702996
MK11-1545
MK11-1545
Whole blood
Other sepsis
Other sepsis
Bacillus spp., Micrococcus spp.
Other sepsis
GSM1702997
MK11-1553
MK11-1553
Whole blood
Other sepsis
Other sepsis
Klebslella pneumoniae
Other sepsis
GSM1702998
MK11-1573
MK11-1573
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1702999
MK11-1574
MK11-1574
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1703000
MK11-1577
MK11-1577
Whole blood
Other sepsis
Other sepsis
Viridans Streptococci
Other sepsis
GSM1703001
MK11-1603
MK11-1603
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703002
MK11-1604
MK11-1604
Whole blood
Other sepsis
Other sepsis
Staphylococcus aureus
Other sepsis
GSM1703003
MK11-1610
MK11-1610
Whole blood
Other sepsis
Other sepsis
Enterococcus spp.
Other sepsis
GSM1703004
MK11-1626
MK11-1626
Whole blood
Other sepsis
Other sepsis
Acinetobacter lwoffii
Other sepsis
GSM1703005
MK11-1628
MK11-1628
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703006
MK11-1639
MK11-1639
Whole blood
Other sepsis
Other sepsis
Acinetobacter baumannii
Other sepsis
GSM1703007
MK11-1642
MK11-1642
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703008
MK11-1649
MK11-1649
Whole blood
Other sepsis
Other sepsis
Staphylococcus aureus
Other sepsis
GSM1703009
MK11-1656
MK11-1656
Whole blood
Other sepsis
Other sepsis
Eschericia coli
Other sepsis
GSM1703010
MK11-1657
MK11-1657
Whole blood
Other sepsis
Other sepsis
Staphylococcus aureus
Other sepsis
GSM1703011
MK11-1659
MK11-1659
Whole blood
Other sepsis
Other sepsis
Streptococcus pyogenes
Other sepsis
GSM1703012
MK11-1661
MK11-1661
Whole blood
Other sepsis
Other sepsis
Streptoccus suis
Other sepsis
GSM1703013
MK11-1662
MK11-1662
Whole blood
Other sepsis
Other sepsis
Acinetobacter baumannii
Other sepsis
GSM1703014
SN10-0675
SN10-0675
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703015
SN10-0686
SN10-0686
Whole blood
Other sepsis
Other sepsis
Acinetobacter baumannii
Other sepsis
GSM1703016
SN10-0747
SN10-0747
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703017
SN10-0756
SN10-0756
Whole blood
Other sepsis
Other sepsis
Micrococcus spp.
Other sepsis
GSM1703018
SN10-0761
SN10-0761
Whole blood
Other sepsis
Other sepsis
Salmonella
Other sepsis
GSM1703019
SN10-0772
SN10-0772
Whole blood
Other sepsis
Other sepsis
Micrococcus spp.
Other sepsis
GSM1703020
SN10-0782
SN10-0782
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703021
SN10-0790
SN10-0790
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703022
SN10-0821
SN10-0821
Whole blood
Other sepsis
Other sepsis
Staphylococcus aureus
Other sepsis
GSM1703023
SN10-0868
SN10-0868
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703024
SN10-0917
SN10-0917
Whole blood
Septicemic melioidosis
Septicemic melioidosis
Burkholderia pseudomallei
Septicemic melioidosis
GSM1703025
SN10-0920
SN10-0920
Whole blood
Other sepsis
Other sepsis
Viridans Streptococci
Other sepsis

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