Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis

Abstract

Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia1,2. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods3. The bacterium is intrinsically resistant to a wide range of antimicrobials, and treatment with ineffective antimicrobials may result in case fatality rates (CFRs) exceeding 70%4,5. The importation of infected animals has, in the past, spread melioidosis to non-endemic areas6,7. The global distribution of B. pseudomallei and burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases, and the presence of environmental B. pseudomallei, and combine this in a formal modelling framework8-10 to estimate the global burden of melioidosis. We estimate there to be 165,000 (95% credible interval 68,000-412,000) human melioidosis cases per year worldwide, of which 89,000 (36,000-227,000) die. Our estimates suggest that melioidosis is severely underreported in the 45 countries in which it is known to be endemic and that melioidosis is likely endemic in a further 34 countries which have never reported the disease. The large numbers of estimated cases and fatalities emphasise that the disease warrants renewed attention from public health officials and policy makers.

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

“…7 Moreover, clinical, radiological and pathological similarities with tuberculosis may result in overlooking newly emerging diseases like melioidosis in tuberculosis endemic areas. In such circumstances, the role of the microbiologists and supportive equipments to diagnose the organism in the department of a hospital or health care delivery center is crucial.…”

“…[3][4][5][6] South Asia, including Bangladesh, is predicted to bear 44% of the overall burden, as the large populations living here in areas harboring B. pseudomallei. 7 Moreover, the burden of melioidosis in many tropical developing countries like ours is hidden and masked by underdevelopment of microbiological facilities, lack of relevant clinical and laboratory expertise 8 , and poor reporting systems. 7 Furthermore, a delay in diagnosis and treatment with inappropriate antimicrobials may result in case fatality rates exceeding 70%.…”

“…7 Moreover, the burden of melioidosis in many tropical developing countries like ours is hidden and masked by underdevelopment of microbiological facilities, lack of relevant clinical and laboratory expertise 8 , and poor reporting systems. 7 Furthermore, a delay in diagnosis and treatment with inappropriate antimicrobials may result in case fatality rates exceeding 70%. 9,10 Since the isolation of the bacterium in the soil of Gazipur district, Bangladesh in 2013, 11 there have been an increasing number of reported cases of melioidosis in Bangladesh.…”

Melioidosis: a neglected tropical disease

“…The case load for Sri Lanka was predicted as 1881 (705-4488) cases with 619 (230-1501) deaths. The authors emphasised that melioidosis is probably grossly underreported in the 45 known endemic countries and in a further 34 countries that have still to report a single case [9].…”

An interesting year

“…To pick just a few of the many highlights from our 2016 issues, January saw a modelling study that revealed that the global distribution of Burkholderia pseudomallei and the burden of melioidosis has been severely under-reported 2 . In March, we learned how Toxoplasma gondii accesses the central nervous system through the infection and lysis of endothelial cells in the brain vasculature 3 .…”