Endemic Melioidosis in Southern China: Past and Present

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 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.

Mycotic aneurysm secondary to melioidosis in China: A series of eight cases and a review of literature

“…Interestingly, in accordance to the literature review revealed in Fig 3, the preponderance of cases was amongst the developed country travelers from developing countries, which also suggests that mycotic aneurysm secondary to melioidosis is actually being missed in endemic areas and diagnosed only when patients are managed in countries that are better resourced and where imaging is more widely available [2,9,23,24,27,38].The literature review demonstrated that Hainan was the main epidemic focus of melioidosis in China. In 2011 the Institute for Communicable Disease Control and Prevention of China established a working group to monitor the epidemiology of melioidosis throughout China, revealing the overwhelming majority of culture-confirmed cases were from Hainan (99.0%, 392/396, 3 from Guangxi and 1 from Guangdong) between 2002 and 2016, and septicaemia was the most common clinical manifestation (153/277, 55.2%) [15].Taken together, the mycotic aneurysm cases collected in Hainan Province in the present study can represent the general epidemiological features in China. It is documented that most patients with infected mycotic aneurysm secondary to melioidosis are male and aged 60 years [1,2,12,19].…”

“…pseudomallei and other pathogens [ 12 ]. In the People’s Republic of China, the mycotic aneurysm cases were rarely documented [ 3 , 15 ]. However, this is an underestimated indigenous disease and should raise clinical concerns.…”

Osteomyelitis and Septic Arthritis Due to Burkholderia pseudomallei: A 10-Year Retrospective Melioidosis Study From South China

“…Burkholderia pseudomallei might cause melioidosis through inhalation or percutaneous inoculation, endemic in Southeast Asia and Northern Australia (Limmathurotsakul et al, 2016;Dance and Limmathurotsakul, 2018;Chakravorty A, 2019;Gassiep et al, 2020). In China, most melioidosis cases were reported in Hainan Province (Zheng et al, 2019;Wu et al, 2020;Zhu et al, 2020). B. pseudomallei can involve tissues and organs throughout the body and lead to variable clinical manifestations, ranging from mild localized abscess to invasive infections (Chanvitan et al, 2019;Gassiep et al, 2020;Wu et al, 2020).…”

“…Melioidosis has been studied in mainland China over the past twenty years, but there is a limited description in the literature of the infection involving bone, joints, and soft tissues (Dong et al, 2018;Wu et al, 2019;Zheng et al, 2019;Wu et al, 2020;Zhu et al, 2020). Herein, 44 cases of melioidotic osteomyelitis and septic arthritis were reported with the aim of determining the prevalence of rheumatological involvement in melioidosis patients in China, and describing their clinical characteristics in terms of demographic and clinical profiles, treatment, and outcomes (Teparrakkul et al, 2008).…”

The first imported case of melioidosis in a patient in central China

“…However, since it has not been reported in central China, its diagnosis is extremely challenging for local clinicians. The prevalence of melioidosis in China is unknown, although new endemic foci have been identified in Hainan province, southern China, and sporadic cases have been reported in China [4]. Here, we report a case of melioidosis in a traveller who returned to central China from Laos.…”