Imported melioidosis in the United Kingdom: Increasing incidence but continued under-reporting

Melioidosis Manifesting as Chronic Femoral Osteomyelitis in Patient from Ghana

“…Melioidosis is underreported in known disease-endemic foci, and modeling has suggested that it is probably endemic to 34 countries that have never reported cases, including 24 in Africa; West Africa was identified as the highest risk area, followed by Central Africa on the basis of environmental suitability ( 1 , 3 ). However, only a handful of sporadic cases have been reported from Africa, probably the result of underdiagnosis caused by resource-limited laboratories and public health systems ( 4 – 9 ).…”

A call to action: time to recognise melioidosis as a neglected tropical disease

“…42,43 Even in non-endemic countries such as the UK, where laboratory-based surveillance is well developed and notification of melioidosis is mandatory, a recent study showed that 41•3% of cases of melioidosis were not notified to the national surveillance system. 44…”

“…In addition, although cases of melioidosis imported into non-endemic countries across Europe are being reported with increasing frequency, the overall numbers remain low and the availability of better diagnostic resources and treatment options mean that the high mortality rates seen in resource-limited countries are not observed. 44,47,48 Altogether, the previous injection of biodefence-driven funding for melioidosis research has undoubtedly moved the field forward, particularly in high-income countries, but in reality this has had limited impact on incidence and mortality in most melioidosis-endemic regions. 49…”

Cutaneous thigh abscess secondary to melioidosis: a rare cause for a common presentation

“…It is associated with a mortality rate of up to 50% and over the last decade, has only been reported 46 times, within the UK. 1 This gram-negative bacterium is endemic to Southern China, South-East Asia and Northern Australia, being acquired via direct contact with contaminated water or soil, especially in those with risk factors such as diabetes mellitus, pre-existing renal disease and thalassaemia. 2 Melioidosis can commonly have a long latency period of a decade or more, presenting with a wide range of clinical manifestations, including fever, respiratory disease and sepsis, though is thought to be significantly underdiagnosed in the UK.…”

“…As the patient reported a history of travel to Hainan at age 16 and Palau in his early 20s, the isolate was forwarded to the rare and imported pathogens laboratory where B. pseudomallei was confirmed by PCR. 1 The patient was admitted to the regional infectious diseases unit where the abscess continued to discharge pus and B. pseudomallei was again confirmed from a wound swab. There were no clinical features of systemic infection and CT of thorax, abdomen, pelvis and lower limbs confirmed no evidence of disseminated disease or osteomyelitis.…”