Incidence, risk factors and clinical epidemiology of melioidosis: a complex socio-ecological emerging infectious disease in the Alor Setar region of Kedah, Malaysia

Abstract

BackgroundMelioidosis, a severe and fatal infectious disease caused by Burkholderia pseudomallei, is believed to an emerging global threat. However, data on the natural history, risk factors, and geographic epidemiology of the disease are still limited.MethodsWe undertook a retrospective analysis of 145 confirmed cases extracted from a hospital-based Melioidosis Registry set up from 2005 in Hospital Sultanah Bahiyah, Alor Setar, Kedah state, Malaysia, in order to provide a first description of the contemporary incidence, risk factors, and clinical epidemiology of the disease in this putatively high risk region of the country.ResultsThe incidence of melioidosis in Alor Setar is remarkably high at 16.35 per 100,000 population per year. The mean age of patients was 50.40 years, with infection varying nonlinearly with age. Males (75.2%; P < 0.0001) predominated and the majority of cases were Malays (88.9%). The overall, crude mortality rate among the study patients was 33.8%. The proportions of cases and deaths were significantly greater among patients involved in farming, forestry and fishing and the unemployed (χ2 = 30.57, P < 0.0001). A majority of cases (62.75%) were culture positive, with mortality in these patients being 45.05%. A large proportion (83.0%) of culture positives was also bacteremic. Pneumonia accounted for 42.06% of primary diagnoses followed in importance by soft tissue abscess. In patients with pneumonia and who were culture positive, the mortality rate was as high as 65.00%. Diabetes mellitus constituted the major underlying risk factor for developing and dying from melioidosis, occurring in 57% of all diagnosed cases. The age distribution of diabetes paralleled that of melioidosis cases. There were linear associations between cases and deaths with monthly rainfall.ConclusionsMelioidosis represents a complex socio-ecological public health problem in Kedah, being strongly related with age, occupation, rainfall and predisposing chronic diseases, such as diabetes mellitus. Among cases, bacteremic patients were associated with significantly high mortality despite provision of the recommended antibacterial therapy. The burden of this disease is likely to grow in this region unless better informed interventions targeted at high-risk groups and associated diseases are urgently implemented.

Rainfall drives hydrocephalus in East Africa

“…8,9 Environmental conditions including rainfall 5,6 and soil hydrology 26 have been shown to be important in the acquisition of Burkholderia pseudomallei infections in Southeast Asia and Australia, and the epidemiological rainfall interactions for this organism can be complex and vary by geographical region. 10 Meningococcal meningitis is the cause of seasonal dry-season epidemics in regions of sub-Saharan Africa north of Uganda, 18 and such cases can produce PIH.…”

Socio-demographic, Clinical and Laboratory Characteristics of Melioidosis: Four-Year Experience of Managing Consecutive 11 Cases in a Tertiary Care Hospital of Bangladesh

“…Melioidosis has been observed in patients associated with recreational activities resulting in exposure to environmental B. pseudomallei in Northern Australia in 75 % cases. 23 Although surveys have shown the disease occurring in middle-aged patients 23,24 , 63.6% of our patients belonged to the 20-40 years age group. All 11 cases in this study were diabetic and had uncontrolled blood sugar level.…”

“…The maleto-female ratio for melioidosis was also higher in all studies performed in Malaysia, Australia, and Singapore. [23][24][25] Almost one-third of our patients were farmers. Majority of cases with melioidosis were also diagnosed in farmers in studies from Thailand and Malaysia 5,24 .…”

“…[23][24][25] Almost one-third of our patients were farmers. Majority of cases with melioidosis were also diagnosed in farmers in studies from Thailand and Malaysia 5,24 . Melioidosis has been also been reported in construction workers in a study from Singapore 25 and one of our patients was a returned construction worker from Singapore.…”

Melioidosis Presenting as Fever and Jaundice: A Rare Presentation

“…6 The bacteria reach the body by inhalation or ingestion of contaminated water or food. Peak incidence occurs in the 4 and 5 decade and studies from different parts of world have shown a distinct male predominance, that is 69%, 75%, and 62% of patients, respectively from Australia, 6 Malaysia, 7 and Thailand. 8 Although healthy people may get melioidosis, the major risk factors include diabetes (present in 23-60% of patients), heavy alcohol use (in 12-39%), chronic pulmonary disease (in 12-27%), chronic renal disease (in 10-27%), thalassemia (in 7%), glucocorticoid therapy (in <5%), and cancer (in <5%).…”