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Global Burden and Challenges of Melioidosis
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Global Burden and Challenges of Melioidosis

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366). This special issue belongs to the section "One Health".

Deadline for manuscript submissions: closed (31 January 2018) | Viewed by 153356

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Direk Limmathurotsakul

E-Mail Website
Guest Editor
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
Interests: infection; microbiology; epidemiology; statistics; tropical infectious diseases; melioidosis and antimicrobial resistance
Prof. Dr. David AB Dance

E-Mail Website
Guest Editor
Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Vientiane, Laos
Interests: clinical and public health microbiology; tropical bacterial infections; melioidosis; Burkholderia pseudomallei; antimicrobial resistance

Special Issue Information

Dear Colleagues,

A recent spatial modelling study estimated that there are about 165,000 human melioidosis cases per year worldwide, of which 89,000 (54%) end in death. Globally, mortality due to melioidosis (89,000 per year) is comparable to measles, and higher than that for leptospirosis and dengue infections.

 

Nonetheless, melioidosis is so neglected that it is missing from all the lists of neglected tropical diseases. The spatial modelling study suggested that melioidosis is severely under-reported in the 45 countries in which it is known to be endemic, and likely to be present in a further 34 countries, which have never reported the disease. It is crucial, now, to carefully compare the numbers predicted by the model and the numbers confirmed by researchers, clinicians and diagnostic laboratories, and to identify gaps in the current surveillance of melioidosis in each country. This will be essential for both national and international policy makers to help determine the allocation of the limited resources available for public health to save lives from melioidosis.

 

National surveillance data for melioidosis are non-existent in most countries. It is likely that there are many different gaps in surveillance systems in different melioidosis-endemic tropical countries. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations, the limited availability of microbiological laboratories serving the rural poor who are most likely to contract the disease, a lack of familiarity of doctors and laboratory staff with the clinical and bacteriological features, and the inadequacy of conventional bacterial identification methods. Furthermore, Burkholderia pseudomallei is intrinsically resistant to a wide range of commonly used antimicrobials, and treatment with ineffective antimicrobials results in high mortality. Access, availability and rational usage of effective antimicrobials for melioidosis in resource-limited countries are rarely discussed. Awareness and commitment from policy makers and all stakeholders for melioidosis are crucial, and availability of relevant information is limited.

 

This Special Issue is dedicated to exploring and discussing the burden and challenges of melioidosis in each country, region or continent. We encourage the submission of contributions, specific to a country, region or continent, in the following areas: (1) observed evidence of melioidosis, (2) current standards and availability of measures to diagnose, report, treat and prevent melioidosis, (3) current public awareness, awareness among healthcare providers, and actions in relation to melioidosis from Ministries of Health, (4) major findings, changes or achievements against melioidosis during the last five years (2012–2016/7), and (5) future challenges relating to melioidosis. Observed evidence should include a review of the evidence of infections in humans, animals and the presence of the organism in the environment, including both indigenous and exported cases. Measures to diagnose, report, treat and prevent melioidosis should discuss recommended measures, and the availability and diversity of those measures across the whole country, region or continent. Actions in relation to melioidosis from Ministries of Health should discuss the existence (or non-existence) and quality of notifiable disease systems, laboratory-based surveillance systems, formal announcements, support, and any campaigns against melioidosis in the country, region or continent.

 

We look forward to your useful contributions on this interesting and important topic.

 

Prof. Dr. David AB  Dance
Dr. Direk  Limmathurotsakul
Guest Editors

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Keywords

  • Melioidosis

  • Burkholderia pseudomallei

  • Epidemiology

  • Human cases

  • Animal cases

  • Environment

  • Diagnosis

  • Microbiological laboratory

  • Reporting system

  • Notifiable disease

  • National surveillance report

  • Treatment

  • Prevention

  • Public awareness

  • Healthcare workers’ awareness

  • Policy makers’ awareness

  • Policy

  • Resources

Published Papers (23 papers)

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Editorial

Jump to: Research, Review, Other

3 pages, 173 KiB  
Editorial
Global Burden and Challenges of Melioidosis
by David AB Dance and Direk Limmathurotsakul
Trop. Med. Infect. Dis. 2018, 3(1), 13; https://doi.org/10.3390/tropicalmed3010013 - 29 Jan 2018
Cited by 21 | Viewed by 4265
Abstract
Melioidosis, an infectious disease caused by the environmental bacterium Burkholderia pseudomallei, has remained in the shadows for far too long[...] Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)

Research

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12 pages, 919 KiB  
Article
Melioidosis in the Philippines
by Peter Franz M. San Martin, Joseph C. Chua, Ralph Louie P. Bautista, Jennifer M. Nailes, Mario M. Panaligan and David A. B. Dance
Trop. Med. Infect. Dis. 2018, 3(3), 99; https://doi.org/10.3390/tropicalmed3030099 - 05 Sep 2018
Cited by 7 | Viewed by 7078
Abstract
The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly [...] Read more.
The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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5 pages, 525 KiB  
Article
Melioidosis in Papua New Guinea and Oceania
by Jeffrey M. Warner and Bart J. Currie
Trop. Med. Infect. Dis. 2018, 3(1), 34; https://doi.org/10.3390/tropicalmed3010034 - 15 Mar 2018
Cited by 2 | Viewed by 9278
Abstract
Melioidosis has only been sporadically reported throughout Melanesia and the Pacific region since the first report from Guam in 1946; therefore, its contribution to the disease burden in this region is largely unknown. However, the outcome of a small number of active surveillance [...] Read more.
Melioidosis has only been sporadically reported throughout Melanesia and the Pacific region since the first report from Guam in 1946; therefore, its contribution to the disease burden in this region is largely unknown. However, the outcome of a small number of active surveillance programs, serological surveys, and presumptive imported cases identified elsewhere provide an insight into its epidemiology and potential significance throughout the region. Both clinical cases and environmental reservoirs have been described from the rural district of Balimo in the Western Province of Papua New Guinea and from the Northern Province of New Caledonia. In both these locations the incidence of disease is similar to that described in tropical Australia and Burkholderia pseudomallei isolates are also phylogenetically linked to Australian isolates. Serological evidence and presumptive imported cases identified elsewhere suggest that melioidosis exists in other countries throughout the Pacific. However, the lack of laboratory facilities and clinical awareness, and the burden of other infections of public health importance such as tuberculosis, contribute to the under-recognition of melioidosis in this region. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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14 pages, 1346 KiB  
Article
Emergence of Melioidosis in Indonesia and Today’s Challenges
by Patricia M. Tauran, Sri Wahyunie, Farahanna Saad, Andaru Dahesihdewi, Mahrany Graciella, Munawir Muhammad, Delly Chipta Lestari, Aryati Aryati, Ida Parwati, Tonny Loho, Dewi Indah Noviana Pratiwi, Vivi Keumala Mutiawati, Ricke Loesnihari, Dewi Anggraini, Siwipeni Irmawanti Rahayu, Wahyu Nawang Wulan, Ungke Antonjaya, David A. B. Dance, Bart J. Currie, Direk Limmathuthurotsakul, Mansyur Arif, Abu Tholib Aman, Ni Nyoman Sri Budayanti and Diah Iskandriatiadd Show full author list remove Hide full author list
Trop. Med. Infect. Dis. 2018, 3(1), 32; https://doi.org/10.3390/tropicalmed3010032 - 13 Mar 2018
Cited by 9 | Viewed by 6647
Abstract
A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed [...] Read more.
A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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11 pages, 1579 KiB  
Article
Melioidosis in Sri Lanka
by Enoka M. Corea, Aruna Dharshan De Silva and Vasanthi Thevanesam
Trop. Med. Infect. Dis. 2018, 3(1), 22; https://doi.org/10.3390/tropicalmed3010022 - 21 Feb 2018
Cited by 19 | Viewed by 6939
Abstract
Until recently, Sri Lanka was not considered a country with endemic melioidosis. However, an increasing number of cases is being reported. National surveillance for melioidosis was instituted after 2008. A total of 250 culture-positive cases was recorded between 2006 and May 2017. Males [...] Read more.
Until recently, Sri Lanka was not considered a country with endemic melioidosis. However, an increasing number of cases is being reported. National surveillance for melioidosis was instituted after 2008. A total of 250 culture-positive cases was recorded between 2006 and May 2017. Males predominated (71.6%). The age range was wide (2–92 years) reflecting a ubiquity of exposure. The majority (201/250, 80%) lived in rural areas. All provinces were affected. Case load increased during the two monsoonal periods (67%). There was representation of every population group including farmers (n = 44), housewives (n = 24), school children (n = 10), professionals (n = 5), businesspersons (n = 6), white-collar workers (n = 10) and blue-collar workers (n = 8). Diabetes was the predominant risk factor (n = 163, 65.2%). Clinical presentations included community-acquired sepsis and pneumonia, superficial and deep abscesses, and septic arthritis. Mortality was 20.4% (51/250). A majority (n = 212) of isolates belonged to the YLF (Yersinia-like fimbrial) clade but 38 were BTFC (B. thailandensis-like flagellum and chemotaxis). A total of 108 isolates was genotyped and 46 sequence types (STs) were identified, 40 being novel. It is clear that melioidosis is endemic in Sri Lanka with a wide geographic and demographic distribution. There is an urgent need to extend surveillance of melioidosis to under-resourced parts of the country and to populations at high risk. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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Review

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15 pages, 2079 KiB  
Review
Endemic Melioidosis in Southern China: Past and Present
by Xiao Zheng, Qianfeng Xia, Lianxu Xia and Wei Li
Trop. Med. Infect. Dis. 2019, 4(1), 39; https://doi.org/10.3390/tropicalmed4010039 - 25 Feb 2019
Cited by 22 | Viewed by 6996
Abstract
Melioidosis is a severe tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei, predominantly endemic to Southeast Asia and northern Australia. Between the 1970s and the 1990s, the presence of B. pseudomallei causing melioidosis in humans and other animals was demonstrated [...] Read more.
Melioidosis is a severe tropical infectious disease caused by the soil-dwelling bacterium Burkholderia pseudomallei, predominantly endemic to Southeast Asia and northern Australia. Between the 1970s and the 1990s, the presence of B. pseudomallei causing melioidosis in humans and other animals was demonstrated in four coastal provinces in southern China: Hainan, Guangdong, Guangxi, and Fujian, although indigenous cases were rare and the disease failed to raise concern amongst local and national health authorities. In recent years, there has been a rise in the number of melioidosis cases witnessed in the region, particularly in Hainan. Meanwhile, although China has established and maintained an effective communicable disease surveillance system, it has not yet been utilized for melioidosis. Thus, the overall incidence, social burden and epidemiological features of the disease in China remain unclear. In this context, we present a comprehensive overview of both historical and current information on melioidosis in Southern China, highlighting the re-emergence of the disease in Hainan. Surveillance and management strategies for melioidosis should be promoted in mainland China, and more research should be conducted to provide further insights into the present situation. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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9 pages, 581 KiB  
Review
Melioidosis in Hong Kong
by Grace Lui, Anthony Tam, Eugene Y. K. Tso, Alan K. L. Wu, Jonpaul Zee, Kin Wing Choi, Wilson Lam, Man Chun Chan, Wan Man Ting and Ivan F. N. Hung
Trop. Med. Infect. Dis. 2018, 3(3), 91; https://doi.org/10.3390/tropicalmed3030091 - 25 Aug 2018
Cited by 6 | Viewed by 4239
Abstract
Melioidosis, although endemic in many parts of Southeast Asia, has not been systematically studied in Hong Kong, which is a predominantly urban area located in the subtropics. This review describes the early outbreaks of melioidosis in captive animals in Hong Kong in the [...] Read more.
Melioidosis, although endemic in many parts of Southeast Asia, has not been systematically studied in Hong Kong, which is a predominantly urban area located in the subtropics. This review describes the early outbreaks of melioidosis in captive animals in Hong Kong in the 1970s, as well as the early reports of human clinical cases in the 1980s. A review of all hospitalized human cases of culture-confirmed melioidosis in the last twenty years showed an increasing trend in the incidence of the disease, with significant mortality observed. The lack of awareness of this disease among local physicians, the delay in laboratory diagnosis and the lack of epidemiological surveillance are among the greatest challenges of managing melioidosis in the territory. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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9 pages, 283 KiB  
Review
Melioidosis in Africa: Time to Uncover the True Disease Load
by Ivo Steinmetz, Gabriel E. Wagner, Estelle Kanyala, Mamadou Sawadogo, Hema Soumeya, Mekonnen Teferi, Emawayish Andargie, Biruk Yeshitela, Louise Yaba Atsé-Achi, Moussa Sanogo, Bassirou Bonfoh, Raphael Rakotozandrindrainy, Célestin Pongombo Shongo, Mick Shongoya Pongombo, Eric Kasamba Ilunga, Sabine Lichtenegger, Karoline Assig, Jürgen May, Eric Bertherat, Michael Owusu, Ellis Owusu-Dabo and Yaw Adu-Sarkodieadd Show full author list remove Hide full author list
Trop. Med. Infect. Dis. 2018, 3(2), 62; https://doi.org/10.3390/tropicalmed3020062 - 10 Jun 2018
Cited by 25 | Viewed by 5153
Abstract
Melioidosis is an often fatal infectious disease with a protean clinical spectrum, caused by the environmental bacterial pathogen Burkholderia pseudomallei. Although the disease has been reported from some African countries in the past, the present epidemiology of melioidosis in Africa is almost [...] Read more.
Melioidosis is an often fatal infectious disease with a protean clinical spectrum, caused by the environmental bacterial pathogen Burkholderia pseudomallei. Although the disease has been reported from some African countries in the past, the present epidemiology of melioidosis in Africa is almost entirely unknown. Therefore, the common view that melioidosis is rare in Africa is not evidence-based. A recent study concludes that large parts of Africa are environmentally suitable for B. pseudomallei. Twenty-four African countries and three countries in the Middle East were predicted to be endemic, but no cases of melioidosis have been reported yet. In this study, we summarize the present fragmentary knowledge on human and animal melioidosis and environmental B. pseudomallei in Africa and the Middle East. We propose that systematic serological studies in man and animals together with environmental investigations on potential B. pseudomallei habitats are needed to identify risk areas for melioidosis. This information can subsequently be used to target raising clinical awareness and the implementation of simple laboratory algorithms for the isolation of B. pseudomallei from clinical specimens. B. pseudomallei was most likely transferred from Asia to the Americas via Africa, which is shown by phylogenetic analyses. More data on the virulence and genomic characteristics of African B. pseudomallei isolates will contribute to a better understanding of the global evolution of the pathogen and will also help to assess potential differences in disease prevalence and outcome. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
8 pages, 1333 KiB  
Review
Melioidosis in South America
by Dionne B. Rolim, Rachel Ximenes R. Lima, Ana Karoline C. Ribeiro, Rafael M. Colares, Leoniti D. Q. Lima, Alfonso J. Rodríguez-Morales, Franco E. Montúfar and David A. B. Dance
Trop. Med. Infect. Dis. 2018, 3(2), 60; https://doi.org/10.3390/tropicalmed3020060 - 05 Jun 2018
Cited by 21 | Viewed by 5168
Abstract
Melioidosis is an emerging disease in the Americas. This paper reviews confirmed cases, the presence of Burkholderia pseudomallei and the organization of national surveillance policies for melioidosis in South America. Confirmed cases in humans have been reported from Ecuador, Venezuela, Colombia, Brazil, and [...] Read more.
Melioidosis is an emerging disease in the Americas. This paper reviews confirmed cases, the presence of Burkholderia pseudomallei and the organization of national surveillance policies for melioidosis in South America. Confirmed cases in humans have been reported from Ecuador, Venezuela, Colombia, Brazil, and Peru. The bacterium has been isolated from the environment in Brazil and Peru. The state of Ceará, northeastern region of Brazil, is the only place where specific public strategies and policies for melioidosis have been developed. We also discuss the urgent need for health authorities in South America to pay greater attention to this disease, which has the potential to have a high impact on public health, and the importance of developing coordinated strategies amongst countries in this region. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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15 pages, 5778 KiB  
Review
Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan)
by Chiranjay Mukhopadhyay, Tushar Shaw, George M. Varghese and David A. B. Dance
Trop. Med. Infect. Dis. 2018, 3(2), 51; https://doi.org/10.3390/tropicalmed3020051 - 22 May 2018
Cited by 62 | Viewed by 8588
Abstract
Despite the fact that South Asia is predicted to have the highest number of cases worldwide, melioidosis is a little-known entity in South Asian countries. It has never been heard of by the majority of doctors and has as yet failed to gain [...] Read more.
Despite the fact that South Asia is predicted to have the highest number of cases worldwide, melioidosis is a little-known entity in South Asian countries. It has never been heard of by the majority of doctors and has as yet failed to gain the attention of national Ministries of Health and country offices of the World Health Organization (WHO). Although a few centers are diagnosing increasing numbers of cases, and the mortality documented from these institutions is relatively high (nearly 20%), the true burden of the disease remains unknown. In India, most cases have been reported from southwestern coastal Karnataka and northeastern Tamil Nadu, although this probably simply reflects the presence of centers of excellence and researchers with an interest in the disease. As elsewhere, the majority of cases have type 2 diabetes mellitus and occupational exposure to the environment. Most present with community-acquired pneumonia and/or bacteremia, especially during heavy rainfall. The high seropositivity rate (29%) in Karnataka and isolation of B. pseudomallei from the environment in Tamil Nadu and Kerala confirm India as melioidosis-endemic, although the full extent of the distribution of the organism across the country is unknown. There are limited molecular epidemiological data, but, thus far, the majority of Indian isolates have appeared distinct from those from South East Asia and Australia. Among other South Asian countries, Sri Lanka and Bangladesh are known to be melioidosis-endemic, but there are no cases that have conclusively proved to have been acquired in Nepal, Bhutan, Afghanistan or Pakistan. There are no surveillance systems in place for melioidosis in South Asian countries. However, over the past two years, researchers at the Center for Emerging and Tropical Diseases of Kasturba Medical College, University of Manipal, have established the Indian Melioidosis Research Forum (IMRF), held the first South Asian Melioidosis Congress, and have been working to connect researchers, microbiologists and physicians in India and elsewhere in South Asia to raise awareness through training initiatives, the media, workshops, and conferences, with the hope that more patients with melioidosis will be diagnosed and treated appropriately. However, much more work needs to be done before we will know the true burden and distribution of melioidosis across South Asia. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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11 pages, 8629 KiB  
Review
Melioidosis in Bangladesh: A Clinical and Epidemiological Analysis of Culture-Confirmed Cases
by Fazle Rabbi Chowdhury, Md. Shariful Alam Jilani, Lovely Barai, Tanjila Rahman, Mili Rani Saha, Md. Robed Amin, Kaniz Fatema, K. M. Shahidul Islam, M. A. Faiz, Susanna J. Dunachie and David A. B. Dance
Trop. Med. Infect. Dis. 2018, 3(2), 40; https://doi.org/10.3390/tropicalmed3020040 - 09 Apr 2018
Cited by 13 | Viewed by 6315
Abstract
Melioidosis is known to occur in Bangladesh, but there are few reports about the condition in the published international literature. We set out to review all known cases of melioidosis in the country to date, using both retrospective and prospective data. A web-based [...] Read more.
Melioidosis is known to occur in Bangladesh, but there are few reports about the condition in the published international literature. We set out to review all known cases of melioidosis in the country to date, using both retrospective and prospective data. A web-based literature search was conducted to identify all published case reports, original articles and conference abstracts. Cases were also included from a prospective study conducted in 2017. Fifty-one cases were identified between 1961 and 2017. Cases have been reported from sixteen out of the 64 districts of Bangladesh. The median age of the patients at presentation was 45 years (IQR 37–52), with a significant male (77%) predominance. Many patients (14/39; 36%) were farmers and 83% had diabetes mellitus. A skin/soft tissue abscess was the most common primary clinical presentation (13/49; 27%), followed by septic arthritis (10/49; 20%), pneumonia, and a deep-seated abscess/organ abscess (7/49; 14%). The major challenges to the diagnosis and treatment of melioidosis in Bangladesh are the lack of resources and the lack of awareness of melioidosis. Capacity development programs are urgently required to define the burden of disease and to tackle the mortality rates. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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12 pages, 2038 KiB  
Review
Melioidosis in Vietnam: Recently Improved Recognition but still an Uncertain Disease Burden after Almost a Century of Reporting
by Trung T. Trinh, Linh D. N. Nguyen, Trung V. Nguyen, Chuong X. Tran, An V. Le, Hao V. Nguyen, Karoline Assig, Sabine Lichtenegger, Gabriel E. Wagner, Cuong D. Do and Ivo Steinmetz
Trop. Med. Infect. Dis. 2018, 3(2), 39; https://doi.org/10.3390/tropicalmed3020039 - 09 Apr 2018
Cited by 19 | Viewed by 6542
Abstract
The first cases of human melioidosis were described in Vietnam in the 1920s, almost a century ago. It was in Vietnam in the thirties that the saprophytic nature of B. pseudomallei was first recognized. Although a significant number of French and U.S. soldiers [...] Read more.
The first cases of human melioidosis were described in Vietnam in the 1920s, almost a century ago. It was in Vietnam in the thirties that the saprophytic nature of B. pseudomallei was first recognized. Although a significant number of French and U.S. soldiers acquired the disease during the Vietnam wars, indigenous cases in the Vietnamese population were only sporadically reported over many decades. After reunification in 1975, only two retrospective studies reported relatively small numbers of indigenous cases from single tertiary care hospitals located in the biggest cities in the South and the North, respectively. Studies from provincial hospitals throughout the country were missing until the Research Network on Melioidosis and Burkholderia pseudomallei (RENOMAB) project started in 2014. From then on seminars, workshops, and national scientific conferences on melioidosis have been conducted to raise awareness among physicians and clinical laboratory staff. This led to the recognition of a significant number of cases in at least 36 hospitals in 26 provinces and cities throughout Vietnam. Although a widespread distribution of melioidosis has now been documented, there are still challenges to understand the true epidemiology of the disease. Establishment of national guidelines for diagnosis, management, and reporting of the disease together with more investigations on animal melioidosis, genomic diversity of B. pseudomallei and its environmental distribution are required. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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16 pages, 4714 KiB  
Review
Melioidosis in Thailand: Present and Future
by Soawapak Hinjoy, Viriya Hantrakun, Somkid Kongyu, Jedsada Kaewrakmuk, Tri Wangrangsimakul, Siroj Jitsuronk, Weerawut Saengchun, Saithip Bhengsri, Thantapat Akarachotpong, Somsak Thamthitiwat, Ornuma Sangwichian, Siriluck Anunnatsiri, Rasana W Sermswan, Ganjana Lertmemongkolchai, Chayada Sitthidet Tharinjaroen, Kanya Preechasuth, Ratchadaporn Udpaun, Poomin Chuensombut, Nisarat Waranyasirikul, Chanihcha Anudit, Surapong Narenpitak, Yaowaruk Jutrakul, Prapit Teparrukkul, Nittaya Teerawattanasook, Kittisak Thanvisej, Alisa Suphan, Punchawee Sukbut, Kritchavat Ploddi, Poolsri Sirichotirat, Bongkoch Chiewchanyon, Kamolchanok Rukseree, Maliwan Hongsuwan, Gumphol Wongsuwan, Pornpan Sunthornsut, Vanaporn Wuthiekanun, Sandy Sachaphimukh, Prapass Wannapinij, Wirongrong Chierakul, Claire Chewapreecha, Janjira Thaipadungpanit, Narisara Chantratita, Sunee Korbsrisate, Apichai Taunyok, Susanna Dunachie, Prasit Palittapongarnpim, Stitaya Sirisinha, Rungrueng Kitphati, Sopon Iamsirithaworn, Wipada Chaowagul, Ploenchan Chetchotisak, Toni Whistler, Surasakdi Wongratanacheewin and Direk Limmathurotsakuladd Show full author list remove Hide full author list
Trop. Med. Infect. Dis. 2018, 3(2), 38; https://doi.org/10.3390/tropicalmed3020038 - 08 Apr 2018
Cited by 60 | Viewed by 11230
Abstract
A recent modelling study estimated that there are 2800 deaths due to melioidosis in Thailand yearly. The Thailand Melioidosis Network (formed in 2012) has been working closely with the Ministry of Public Health (MoPH) to investigate and reduce the burden of this disease. [...] Read more.
A recent modelling study estimated that there are 2800 deaths due to melioidosis in Thailand yearly. The Thailand Melioidosis Network (formed in 2012) has been working closely with the Ministry of Public Health (MoPH) to investigate and reduce the burden of this disease. Based on updated data, the incidence of melioidosis is still high in Northeast Thailand. More than 2000 culture-confirmed cases of melioidosis are diagnosed in general hospitals with microbiology laboratories in this region each year. The mortality rate is around 35%. Melioidosis is endemic throughout Thailand, but it is still not uncommon that microbiological facilities misidentify Burkholderia pseudomallei as a contaminant or another organism. Disease awareness is low, and people in rural areas neither wear boots nor boil water before drinking to protect themselves from acquiring B. pseudomallei. Previously, about 10 melioidosis deaths were formally reported to the National Notifiable Disease Surveillance System (Report 506) each year, thus limiting priority setting by the MoPH. In 2015, the formally reported number of melioidosis deaths rose to 112, solely because Sunpasithiprasong Hospital, Ubon Ratchathani province, reported its own data (n = 107). Melioidosis is truly an important cause of death in Thailand, and currently reported cases (Report 506) and cases diagnosed at research centers reflect the tip of the iceberg. Laboratory training and communication between clinicians and laboratory personnel are required to improve diagnosis and treatment of melioidosis countrywide. Implementation of rapid diagnostic tests, such as a lateral flow antigen detection assay, with high accuracy even in melioidosis-endemic countries such as Thailand, is critically needed. Reporting of all culture-confirmed melioidosis cases from every hospital with a microbiology laboratory, together with final outcome data, is mandated under the Communicable Diseases Act B.E.2558. By enforcing this legislation, the MoPH could raise the priority of this disease, and should consider implementing a campaign to raise awareness and melioidosis prevention countrywide. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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17 pages, 1796 KiB  
Review
Melioidosis in Singapore: Clinical, Veterinary, and Environmental Perspectives
by Siew Hoon Sim, Catherine Ee Ling Ong, Yunn Hwen Gan, Dongling Wang, Victor Wee Hong Koh, Yian Kim Tan, Michelle Su Yen Wong, Janet Seok Wei Chew, Sian Foong Ling, Brian Zi Yan Tan, Agnes Zhengyu Ye, Patrick Chuan Kiat Bay, Wai Kwan Wong, Charlene Judith Fernandez, Shangzhe Xie, Praveena Jayarajah, Tasha Tahar, Pei Yee Oh, Sonja Luz, Jaime Mei Fong Chien, Thuan Tong Tan, Louis Yi Ann Chai, Dale Fisher, Yichun Liu, Jimmy Jin Phang Loh and Gladys Gek Yen Tanadd Show full author list remove Hide full author list
Trop. Med. Infect. Dis. 2018, 3(1), 31; https://doi.org/10.3390/tropicalmed3010031 - 12 Mar 2018
Cited by 18 | Viewed by 7780
Abstract
Melioidosis is a notifiable infectious disease registered with the Ministry of Health (MOH) and Agri-Food & Veterinary Authority (AVA), Singapore. From a clinical perspective, increased awareness of the disease has led to early detection and treatment initiation, thus resulting in decreasing mortality rates [...] Read more.
Melioidosis is a notifiable infectious disease registered with the Ministry of Health (MOH) and Agri-Food & Veterinary Authority (AVA), Singapore. From a clinical perspective, increased awareness of the disease has led to early detection and treatment initiation, thus resulting in decreasing mortality rates in recent years. However, the disease still poses a threat to local pet, zoo and farm animals, where early diagnosis is a challenge. The lack of routine environmental surveillance studies also makes prevention of the disease in animals difficult. To date, there have been no reports that provide a complete picture of how the disease impacts the local human and animal populations in Singapore. Information on the distribution of Burkholderia pseudomallei in the environment is also lacking. The aim of this review is to provide a comprehensive overview of both published and unpublished clinical, veterinary and environmental studies on melioidosis in Singapore to achieve better awareness and management of the disease. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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14 pages, 383 KiB  
Review
Melioidosis in the Western Indian Ocean and the Importance of Improving Diagnosis, Surveillance, and Molecular Typing
by Andriniaina Rakotondrasoa, Mohammad Iqbal Issack, Benoît Garin, Fabrice Biot, Eric Valade, Pierre Wattiau, Nicolas Allou, Olivier Belmonte, Jastin Bibi, Erin P. Price and Jean-Marc Collard
Trop. Med. Infect. Dis. 2018, 3(1), 30; https://doi.org/10.3390/tropicalmed3010030 - 07 Mar 2018
Cited by 5 | Viewed by 4048
Abstract
Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an infectious disease of humans or animals, and the specific environmental conditions that are present in western Indian Ocean islands are particularly suitable for the establishment/survival of B. pseudomallei. Indeed, an increasing number [...] Read more.
Melioidosis, caused by the bacterium Burkholderia pseudomallei, is an infectious disease of humans or animals, and the specific environmental conditions that are present in western Indian Ocean islands are particularly suitable for the establishment/survival of B. pseudomallei. Indeed, an increasing number of new cases have been reported in this region (Madagascar, Mauritius, Réunion (France), and Seychelles, except Comoros and Mayotte (France)), and are described in this review. Our review clearly points out that further studies are needed in order to investigate the real incidence and burden of melioidosis in the western Indian Ocean and especially Madagascar, since it is likely to be higher than currently reported. Thus, research and surveillance priorities were recommended (i) to improve awareness of melioidosis in the population and among clinicians; (ii) to improve diagnostics, in order to provide rapid and effective treatment; (iii) to implement a surveillance and reporting system in the western Indian Ocean; and (iv) to investigate the presence of B. pseudomallei in environmental samples, since we have demonstrated its presence in soil samples originating from the yard of a Madagascan case. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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9 pages, 508 KiB  
Review
Melioidosis in Myanmar
by Mo Mo Win, Elizabeth A. Ashley, Khwar Nyo Zin, Myint Thazin Aung, Myo Maung Maung Swe, Clare L. Ling, François Nosten, Win May Thein, Ni Ni Zaw, May Yee Aung, Kyaw Myo Tun, David A. B. Dance and Frank M. Smithuis
Trop. Med. Infect. Dis. 2018, 3(1), 28; https://doi.org/10.3390/tropicalmed3010028 - 01 Mar 2018
Cited by 11 | Viewed by 5744
Abstract
Sporadic cases of melioidosis have been diagnosed in Myanmar since the disease was first described in Yangon in 1911. Published and unpublished cases are summarized here, along with results from environmental and serosurveys. A total of 298 cases have been reported from seven [...] Read more.
Sporadic cases of melioidosis have been diagnosed in Myanmar since the disease was first described in Yangon in 1911. Published and unpublished cases are summarized here, along with results from environmental and serosurveys. A total of 298 cases have been reported from seven states or regions between 1911 and 2018, with the majority of these occurring before 1949. Findings from soil surveys confirm the presence of Burkholderia pseudomallei in the environment in all three regions examined. The true epidemiology of the disease in Myanmar is unknown. Important factors contributing to the current gaps in knowledge are lack of awareness among clinicians and insufficient laboratory diagnostic capacity in many parts of the country. This is likely to have led to substantial under-reporting. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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11 pages, 570 KiB  
Review
Melioidosis: An Australian Perspective
by Simon Smith, Josh Hanson and Bart J. Currie
Trop. Med. Infect. Dis. 2018, 3(1), 27; https://doi.org/10.3390/tropicalmed3010027 - 01 Mar 2018
Cited by 34 | Viewed by 8643
Abstract
Burkholderia pseudomallei is endemic in northern Australia, with cases of melioidosis most commonly occurring during the wet season in individuals with diabetes, hazardous alcohol use, and chronic kidney disease. Pneumonia is the most common presentation and the majority of patients are bacteraemic—however, infection [...] Read more.
Burkholderia pseudomallei is endemic in northern Australia, with cases of melioidosis most commonly occurring during the wet season in individuals with diabetes, hazardous alcohol use, and chronic kidney disease. Pneumonia is the most common presentation and the majority of patients are bacteraemic—however, infection may involve almost any organ, with the skin and soft tissues, genitourinary system, visceral organs, and bone and joints affected most commonly. Central nervous system involvement is rarer, but has a high attributable mortality. Increased awareness of the disease amongst healthcare providers, ready access to appropriate antibiotic therapy and high-quality intensive care services has resulted in a sharp decline in the case fatality rate over the last 20 years. Further improvement in clinical outcomes will require a greater understanding of the disease′s pathophysiology, its optimal management, and more effective strategies for its prevention. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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10 pages, 569 KiB  
Review
Transmission Modes of Melioidosis in Taiwan
by Pei-Tan Hsueh, Wei-Tien Huang, Hsu-Kai Hsueh, Ya-Lei Chen and Yao-Shen Chen
Trop. Med. Infect. Dis. 2018, 3(1), 26; https://doi.org/10.3390/tropicalmed3010026 - 28 Feb 2018
Cited by 10 | Viewed by 4365
Abstract
In Taiwan, melioidosis is an emerging disease that suddenly increased in the Er-Ren River Basin, beginning in 2005 and in the Zoynan region during 2008–2012, following a typhoon. Additionally, the disease sporadically increased in a geography-dependent manner in 2016. Subcutaneous inoculation, ingestion, and [...] Read more.
In Taiwan, melioidosis is an emerging disease that suddenly increased in the Er-Ren River Basin, beginning in 2005 and in the Zoynan region during 2008–2012, following a typhoon. Additionally, the disease sporadically increased in a geography-dependent manner in 2016. Subcutaneous inoculation, ingestion, and the inhalation of soil or water contaminated with Burkholderia pseudomallei are recognized as the transmission modes of melioidosis. The appearance of environmental B. pseudomallei positivity in northern, central and southern Taiwan is associated with disease prevalence (cases/population: 0.03/100,000 in the northern region, 0.29/100,000 in the central region and 1.98/100,000 in the southern region). However, melioidosis-clustered areas are confined to 5 to 7.5 km2 hot spots containing high-density populations, but B. pseudomallei-contaminated environments are located >5 km northwestern of the periphery of these hot spots. The observation that the concentration of B. pseudomallei-specific DNA in aerosols was positively correlated with the incidence of melioidosis and the appearance of a northwesterly wind in a hot spot indicated that airborne transmission had occurred in Taiwan. Moreover, the isolation rate in the superficial layers of a contaminated crop field in the northwest was correlated with PCR positivity in aerosols collected from the southeast over a two-year period. The genotype ST58 was identified by multilocus sequence typing in human and aerosol isolates. The genotype ST1001 has increased in prevalence but has been sporadically distributed elsewhere since 2016. These data indicate the transmission modes and environmental foci that support the dissemination of melioidosis are changing in Taiwan. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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19 pages, 515 KiB  
Review
Melioidosis in Malaysia: Incidence, Clinical Challenges, and Advances in Understanding Pathogenesis
by Sheila Nathan, Sylvia Chieng, Paul Vijay Kingsley, Anand Mohan, Yuwana Podin, Mong-How Ooi, Vanitha Mariappan, Kumutha Malar Vellasamy, Jamuna Vadivelu, Sylvia Daim and Soon-Hin How
Trop. Med. Infect. Dis. 2018, 3(1), 25; https://doi.org/10.3390/tropicalmed3010025 - 27 Feb 2018
Cited by 46 | Viewed by 9673
Abstract
Malaysia is an endemic hot spot for melioidosis; however, a comprehensive picture of the burden of disease, clinical presentations, and challenges faced in diagnosis and treatment of melioidosis is not available. This review provides a nonexhaustive overview of epidemiological data, clinical studies, risk [...] Read more.
Malaysia is an endemic hot spot for melioidosis; however, a comprehensive picture of the burden of disease, clinical presentations, and challenges faced in diagnosis and treatment of melioidosis is not available. This review provides a nonexhaustive overview of epidemiological data, clinical studies, risk factors, and mortality rates from available literature and case reports. Clinical patterns of melioidosis are generally consistent with those from South and Southeast Asia in terms of common primary presentations with diabetes as a major risk factor. Early diagnosis and appropriate management of Malaysian patients is a key limiting factor, which needs to be addressed to reduce serious complications and high mortality and recurrence rates. Promoting awareness among the local healthcare personnel is crucial to improving diagnostics and early treatment, as well as educating the Malaysian public on disease symptoms and risk factors. A further matter of urgency is the need to make this a notifiable disease and the establishment of a national melioidosis registry. We also highlight local studies on the causative agent, Burkholderia pseudomallei, with regards to bacteriology and identification of virulence factors as well as findings from host–pathogen interaction studies. Collectively, these studies have uncovered new correlations and insights for further understanding of the disease. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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14 pages, 620 KiB  
Review
Melioidosis in Mexico, Central America, and the Caribbean
by Javier I. Sanchez-Villamil and Alfredo G. Torres
Trop. Med. Infect. Dis. 2018, 3(1), 24; https://doi.org/10.3390/tropicalmed3010024 - 26 Feb 2018
Cited by 24 | Viewed by 6486
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis, an endemic disease in tropical areas around the world. Cumulative human cases have demonstrated that melioidosis is prevalent and increasingly recognized in the American continent. Even though the first reports of melioidosis in Mexico, Central [...] Read more.
Burkholderia pseudomallei is the causative agent of melioidosis, an endemic disease in tropical areas around the world. Cumulative human cases have demonstrated that melioidosis is prevalent and increasingly recognized in the American continent. Even though the first reports of melioidosis in Mexico, Central America, and the Caribbean Islands date back to the late 1940s, the potential of the disease as a public health concern in the region has not been fully appreciated. Unfortunately, recent studies predicting the global distribution of the disease and the demonstration of melioidosis endemicity in Puerto Rico have not increased recognition of the disease by health professionals in this region. Furthermore, a lack of both diagnostic capacity and awareness of the disease has resulted in a limited number of studies that have attempted to accurately determine its prevalence and geographical distribution. In this review, a summary of reported cases in the countries of this region are presented, as well as recommendations to increase the diagnosis and awareness of the disease as an important public health problem in Mexico, Central America, and the Caribbean islands. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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7 pages, 610 KiB  
Review
Melioidosis in the Lao People’s Democratic Republic
by David A.B. Dance, Manophab Luangraj, Sayaphet Rattanavong, Noikaseumsy Sithivong, Oulayphone Vongnalaysane, Manivanh Vongsouvath and Paul N. Newton
Trop. Med. Infect. Dis. 2018, 3(1), 21; https://doi.org/10.3390/tropicalmed3010021 - 19 Feb 2018
Cited by 22 | Viewed by 5929
Abstract
Melioidosis is clearly highly endemic in Laos, although the disease has only been diagnosed regularly in humans (1359 cases) since 1999, and only a single animal case has been microbiologically confirmed. Burkholderia pseudomallei is extensively and abundantly present in soil and surface water [...] Read more.
Melioidosis is clearly highly endemic in Laos, although the disease has only been diagnosed regularly in humans (1359 cases) since 1999, and only a single animal case has been microbiologically confirmed. Burkholderia pseudomallei is extensively and abundantly present in soil and surface water in central and southern Laos, but the true distribution of the disease across the country remains to be determined. Surveillance is almost non-existent and diagnostic microbiology services are not yet well established, whilst awareness of melioidosis is low amongst policy-makers, healthcare providers, and the public. It is hoped that this situation will improve over the next decade as the country rapidly develops, especially as this is likely to be accompanied by a further increase in the prevalence of diabetes, meaning that more people in this predominantly agricultural population will be at risk of contracting melioidosis. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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12 pages, 718 KiB  
Review
Melioidosis in Brunei Darussalam
by Ketan Pande, Khairul Azmi Abd Kadir, Rosmonaliza Asli and Vui Heng Chong
Trop. Med. Infect. Dis. 2018, 3(1), 20; https://doi.org/10.3390/tropicalmed3010020 - 19 Feb 2018
Cited by 8 | Viewed by 4550
Abstract
Melioidosis continues to be a major health care problem in Brunei Darussalam. The age of patients, gender distribution, risk factors, and clinical presentations are similar to those reported from other countries in the region. The incidence of melioidosis was high during the wet [...] Read more.
Melioidosis continues to be a major health care problem in Brunei Darussalam. The age of patients, gender distribution, risk factors, and clinical presentations are similar to those reported from other countries in the region. The incidence of melioidosis was high during the wet months and in the Temburong district, which has the highest annual rainfall. In spite of adequate facilities for diagnosis and treatment, the mortality remains high (27%). Women and those presenting with septic shock had higher mortality. There is a case for making melioidosis a notifiable disease in Brunei Darussalam. Coordinated efforts between policy-makers and various stakeholders are required to effectively combat the disease. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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6 pages, 704 KiB  
Meeting Report
A Report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 2017
by Sotharith Bory, Frances Daily, Gaetan Khim, Joanne Letchford, Srun Sok, Hero Kol, Muy Seang Lak, Luciano Tuseo, Chan Vibol, Sopheap Oeng and Paul Turner
Trop. Med. Infect. Dis. 2018, 3(1), 23; https://doi.org/10.3390/tropicalmed3010023 - 23 Feb 2018
Cited by 10 | Viewed by 5032
Abstract
Melioidosis is an endemic infection in Cambodia, a lower middle income SE Asian country. Despite more laboratories isolating and identifying Burkholderia pseudomallei in recent years, the infection remains under-recognised and under-diagnosed, particularly in the adult population. Lack of knowledge about the disease and [...] Read more.
Melioidosis is an endemic infection in Cambodia, a lower middle income SE Asian country. Despite more laboratories isolating and identifying Burkholderia pseudomallei in recent years, the infection remains under-recognised and under-diagnosed, particularly in the adult population. Lack of knowledge about the disease and lack of utilization of microbiology laboratories contributes to this, along with laboratory capacity issues. Treatment costs often hamper optimal management. In response to these issues, a national one-health training event was held in October 2017 to raise awareness of the disease amongst clinical, laboratory, and public health professionals. The meeting format, findings, and outcomes are described here. Full article
(This article belongs to the Special Issue Global Burden and Challenges of Melioidosis)
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