Melioidosis in lower provincial Cambodia: A case series from a prospective study of sepsis in Takeo Province

Abstract

Melioidosis is a severe infectious disease caused by the gram-negative soil bacterium Burkholderia pseudomallei. Melioidosis is well known to be a major cause of morbidity and mortality in Southeast Asia, particularly in Thailand. However, melioidosis remains underreported in surrounding areas such as Cambodia. We report a case series of melioidosis in seven patients from Takeo Province, Cambodia. The patients, aged 24–65 years, were enrolled from May 2014 to May 2015 during a one year prospective study of sepsis at Takeo Provincial Hospital. They presented with fever, rigors, dyspnea, fatigue, diaphoresis, productive cough, and skin abscesses. Six of the seven patients were also hyponatremic. B. pseudomallei was cultured from the blood of six patients and the sputum of one patient. In this manuscript, we provide a detailed description of the clinical presentation, case management and laboratory confirmation of B. pseudomallei, as well as discuss the difficulties of identifying and treating melioidosis in low resource settings.

Retrospective Analysis of Fever and Sepsis Patients from Cambodia Reveals Serological Evidence of Melioidosis

“…We analyzed 1,316 samples from 10 provinces and found serological evidence of B. pseudomallei infection in approximately 163 individuals. This work, coupled with recent prospective and retrospective studies, [19][20][21][22][23][24][25][26] demonstrates that melioidosis represents a considerably higher burden in Cambodia than the present scientific literature would suggest. More studies are needed to raise awareness of melioidosis and continue to define the actual morbidity and mortality of this severe infectious disease.…”

“…An additional 140 serum samples, including patients with culture-confirmed melioidosis, were derived from an observational study of sepsis in a single hospital in Takeo province, Cambodia, between 2014 and 2015. 26 The confirmed melioidosis patients were experiencing symptoms between 4 and 15 days (median: 5 days) before serum collection and have been thoroughly described. 26 Finally, 198 samples were also obtained from healthy volunteers with poultry contact who participated in a serosurvey of avian influenza A in Kampong Cham province.…”

“…26 The confirmed melioidosis patients were experiencing symptoms between 4 and 15 days (median: 5 days) before serum collection and have been thoroughly described. 26 Finally, 198 samples were also obtained from healthy volunteers with poultry contact who participated in a serosurvey of avian influenza A in Kampong Cham province. In all cases, patients or -volunteers or their legal authorized representatives provided written informed consent and granted permission to store samples for future studies.…”

“…To date, only a few 100 cases of melioidosis in Cambodia have been described from a handful of studies since 2007, leaving the true distribution of B. pseudomallei and the burden of melioidosis unclear. [19][20][21][22][23][24][25][26] Serology studies have proven useful in providing epidemiological characterization of B. pseudomallei distribution. 27 The only recognized, clinically validated method of determining antibody titer is the indirect hemagglutination assay (IHA).…”

A Report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 2017

“…However, it was not until 2005, that human melioidosis cases began to be regularly identified in-country, initially in children following the establishment of a diagnostic microbiology laboratory at Angkor Hospital for Children, Siem Reap [ 4 ]. Since then, significant laboratory capacity building has occurred nationally and several hundred cases in both children and adults have been described [ 5 , 6 , 7 , 8 , 9 ]. Not unexpectedly, mortality is higher in adults (more than 50%) than in children [ 4 , 6 , 7 , 8 ]; however, as with adults, children who are bacteraemic have higher mortality (72%) [ 8 ].…”