Global burden of melioidosis in 2015: a systematic review and data synthesis

Abstract

Background Melioidosis, caused by the environmental bacterium Burkholderia pseudomallei, is an oftenfatal infectious disease with a high prevalence across tropical areas. Clinical presentation can vary from abscess formation to pneumonia and septicaemia. We assessed the global burden of melioidosis, expressed in disability-adjusted life years (DALYs), for the year 2015. Methods A systematic review of the peer-reviewed literature for human melioidosis cases between 1990 and 2015 was performed. Using a broad search strategy, no language restrictions and combinations of search terms, Burkholderia spp. and disease names, all relevant articles were screened on title, abstract, and full text. Quantitative data from cases including mortality, age, sex, infectious and post-infectious sequelae, antibiotic treatment and symptom duration were extracted. This information was then combined with established disability weights and expert panel discussions to construct an incidence-based disease model. The disease model was integrated with established global incidence and mortality estimates to calculate global melioidosis DALYs. Findings 2 888 articles were screened, of which 475 eligible studies containing quantitative information were retained. Sepsis/septic shock and pneumonia were the most common outcomes, occurring in 18.0% (1526/8469), 12.1% (1004/8298) and 35.7% (3633/10175) of patients respectively. The male to female ratio of infection was 2:1. We estimate that in 2015, the global burden of melioidosis was 4•6 million DALYs (UI 3•2-6•6) or 84•3 per 100 000 people (UI 57•5-120•0). Years of life lost (YLL) accounted for 98•9% (UI 97•7-99•5) of the total DALYs. Interpretation Our estimates enable comparison with other tropical diseases which are already recognised as neglected and give policy makers the information necessary to reconsider melioidosis as a major neglected tropical disease.

Prioritising pathogens for the management of severe febrile patients to improve clinical care in low- and middle-income countries

“…While M. avium complex, Cryptococcus spp., Shigella spp., B. pseudomallei and O. tsutsugamushi infections ranked high based on the available data used in the data-derived process and the subsequent AHP ranking, the consulted stakeholders deprioritized these pathogens in favour of S. aureus, typhoidal and non-typhoidal Salmonella, E. coli and Rickettsia spp. This de-prioritization of B. pseudomallei (the causative agent of meliodosis) and O. tsutsugamushi (the causative agent of scrub typhus) was surprising in light of recent focus on the emergence of both pathogens and their potential global impact on morbidity and mortality [31,[37][38][39][40]. However, both diseases are currently strongly associated with the Asia Pacific region, hence Fig.…”

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia

“…9,18 Recent modeling and epidemiological studies estimated the global mortality at approximately 90,000 deaths/year, 9 contributing toward 4.6 million DALYs, higher than dengue or leptospirosis, clearly establishing it as an emerging neglected tropical disease. 7 These studies highlight the substantial underdiagnosis and underreporting of melioidosis. In 2010, only approximately 1,300 cases were reported annually worldwide, less than 1% of the estimated incidence.…”

“…9 India, Bangladesh, Vietnam, Nigeria, and Indonesia alone contribute toward 70.5% of the total DALY burden. 7 But new cases of melioidosis are also being reported in countries which previously only sporadically reported cases. As an examples, three patients with melioidosis were recently treated in Guadeloupe, an island in the French West Indies where only two cases had been reported in the previous 20 years.…”

“…18,38 The most important risk factors are diabetes, renal failure, alcoholic liver disease, and thalassemia. 6,7 Interestingly, human immunodeficiency virus does not appear to be a risk factor for melioidosis despite murine studies showing a role for the adaptive immune system in controlling the infection. [39][40][41] The highest risk association by far (12-fold) for an infectious disease and diabetes is seen for melioidosis.…”

“…In 2019, a systematic review and data synthesis approach estimated that the global burden of melioidosis, expressed in disability-adjusted life-years (DALYs) was 4.6 million DALYs (uncertainty interval [UI]: 3.2-6.6) or 84.3 per 100,000 people (57.5-120.0). 7 This would mean that melioidosis causes a larger disease burden than many other tropical diseases that are recognized by the World Health Organization (WHO) as neglected.…”