Travel-associated melioidosis: a narrative review

Abstract

Background: Melioidosis, caused by Burkholderia pseudomallei, may be considered a neglected tropical disease which remains underdiagnosed in many geographical areas. Travelers can act as sentinels of disease activity and data from imported cases may help complete the global map of melioidosis. Methods: A literature search for imported melioidosis for the period 2016-2022 was performed in PubMed and Google Scholar. Results: In total, 137 reports of melioidosis associated with travel were identified. The majority were males (71%) and associated with exposure in Asia (77%) (mainly Thailand, 41%, and India, 9%). A minority acquired the infection in the Americas-Caribbean area (6%), Africa (5%) and Oceania (2%). The most frequent comorbidity was diabetes mellitus (25%) followed by underlying pulmonary, liver or renal disease (8%, 5% and 3%, respectively). Alcohol/tobacco use were noted for 7 and 6 patients, respectively (5%). Five patients (4%) had associated non-HIV related immunosuppression and 3 patients (2%) had HIV infection. One patient (0.8%) had concomitant COVID-19. A proportion (27%) had no underlying diseases. The most frequent clinical presentations included pneumonia (35%), sepsis (30%), and skin/soft tissue infections (14%). Most developed symptoms <1 week after return (55%) and 29% developed symptoms >12 weeks after. Ceftazidime and meropenem were the main treatments used during the intensive intravenous phase (52% and 41% of patients, respectively) and the majority (82%) received co-trimoxazole alone/combination, for the eradication phase. Most patients had a favorable outcome/survived (87%). The search also retrieved cases in imported animals or cases secondary to imported commercial products. Conclusions: As post-pandemic travel soars, health professionals should be aware of the possibility of imported melioidosis with its diverse presentations. Currently no licensed vaccine is available so prevention in travelers should focus on protective measures (avoiding contact with soil/stagnant water in endemic areas). Biological samples from suspected cases require processing in biosafety level 3 facilities.

Artificial intelligence for the optimal management of community-acquired pneumonia

“…Melioidosis, attributed to Burkholderia pseudomallei , is an infectious disease affecting multiple organs, including the lungs, leading to severe pneumonia-like manifestations [16].…”

“…(2) Tuberculosis, caused by Mycobacterium tuberculosis, is a well known infection initiating severe pulmonary disease [14,15]. (3) Melioidosis, attributed to Burkholderia pseudomallei, is an infectious disease affecting multiple organs, including the lungs, leading to severe pneumonia-like manifestations [16]. (4) Zoonotic diseases transmitted from animals to humans present additional risks for pneumonia [17].…”

Pulmonary infections in the returning traveler

“…As postpandemic travel soars, health professionals should once again be aware of the possibility of travel-acquired infections. Special groups of travelers, such as those with immunosuppression or comorbidities, may present with atypical and severe pulmonary disease, or even with reactivation and dissemination of infections such as tuberculosis (TB), melioidosis, histoplasmosis or strongyloidiasis, years after travel, and exposure in an endemic country [6,7 ▪ ]. Specific epidemiological risk factors or history of exposures may provide clues for the diagnosis of ‘exotic’ and infrequent causes of pneumonia in travelers.…”