Emergence of Melioidosis in Indonesia and Today’s Challenges

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 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.

Humoral Immune Responses to Burkholderia pseudomallei Antigens in Captive and Wild Macaques in the Western Part of Java, Indonesia

“…1 LPS: lipopolysaccharide, AhpC: alkyl hydroperoxide reductase subunit C, Hcp1: hemolysin-coregulated protein 1, OmpH: putative outer membrane porin protein. 2 Based on absorbance values in the previous investigation [31]. 3 Positivity to at least one assay.…”

Isolasi Dan Identifikasi Bakteri Tanah Burkholderia Pseudomalllei Penyebab Melioidosis Di Kota Makassar

“…pH optimum untuk pertumbuhan bakteri B. pseudomallei berkisar antara 6.5-7.5, dengan kelembaban relatif tanah berkisar 10-20%. 7,8,9,10 Koloni…”

Characterization of Burkholderia pseudomallei from spontaneous melioidosis in a Bornean orangutan

“…The fatality rate of melioidosis cases was 43% in Indonesia [ 6 ], 40% in Northeast Thailand, and even reached 90% in patients with severe sepsis [ 7 ]. In Indonesia, the case fatality rate was identified to be 43% [ 6 ]. Moreover, the causative agent was ­classified as Tier 1 Select Agent by the Centers for Disease Control and Prevention, USA due to its potential for bioterrorism [ 8 ], including its possibility to be transmitted through inhalation and ingestion routes, its high persistence in the environment, and the high prevalence of severe sepsis [ 9 ].…”

“…Moreover, the causative agent was ­classified as Tier 1 Select Agent by the Centers for Disease Control and Prevention, USA due to its potential for bioterrorism [ 8 ], including its possibility to be transmitted through inhalation and ingestion routes, its high persistence in the environment, and the high prevalence of severe sepsis [ 9 ]. The first case associated with melioidosis in Indonesia was discovered in the beginning of the 20 th century, and throughout the decades, melioidosis was reported in several main islands of Indonesia, including Java, Sumatra, and Sulawesi [ 6 ]. However, many melioidosis cases went unreported, including 55 melioidosis cases from only a few hospitals in Indonesia [ 6 ].…”

“…The first case associated with melioidosis in Indonesia was discovered in the beginning of the 20 th century, and throughout the decades, melioidosis was reported in several main islands of Indonesia, including Java, Sumatra, and Sulawesi [ 6 ]. However, many melioidosis cases went unreported, including 55 melioidosis cases from only a few hospitals in Indonesia [ 6 ]. Moreover, reports in association with veterinary melioidosis cases in Indonesia were also limited, and only included cases about three long-tailed macaques exported to the United Kingdom [ 10 ], one pig-tailed macaque exported to the United States [ 11 , 12 ], one cynomolgus macaque in a primate research center [ 13 ], and one Bornean orangutan in a rehabilitation center [ 14 ].…”