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Melioidosis, unknown disease, high mortality, much more prevalent than previously thought - 89,000 deaths in 2015

Gert van der Hoek

In Memoriam - Editor, Senior Moderator
TUESDAY 12 JANUARY 2016

BANGKOK ? An often deadly and difficult to treat bacterial disease is much more prevalent than previously thought and kills tens of thousands of people worldwide each year, researchers said today (Jan 11).


Melioidosis, also known as Whitmore?s disease, has long been known to be endemic in parts of South and East Asia, the Pacific and northern Australia.

But a new analysis by a team of international researchers suggests the disease is also present across swathes of South America and sub-Saharan Africa and likely present in parts of Central America, southern Africa and the Middle East.

?Our estimates suggest that melioidosis is severely under-reported in the 45 countries in which it is known to be endemic and that melioidosis is probably endemic in a further 34 countries that have never reported the disease,? researchers led by Oxford University, the Mahidol Oxford Tropical Medicine Research Unit (MORU) in Bangkok and the University of Washington in Seattle wrote in a report.
It was published today in Nature Microbiology.

It is the first time scientists have attempted to map the disease?s global spread using computer modelling based on data from known outbreaks going back to 1910.

The disease, which often affects the rural poor working in fields, is notoriously difficult to diagnose because it mimics many other bacterial infections but only responds to a handful of antibiotics. As a result, misdiagnosis is common.

The mortality rate ? around 70 per cent ? is shockingly high, greater even than the H5N1 bird flu.

Researchers estimated that as many as 89,000 people out of the the 165,000 people who caught melioidosis in 2015 died from the disease.
They noted that annual global deaths from the disease were nearly as high as measles (95,000) and greater than deaths from leptospirosis (50,000) and dengue (12,500) ? ?two current health priorities for many international health organisations?.


The disease is caused by the bacteria burkholderia pseudomallei, which is present in soil and can enter the body through cuts in the skin as well as through inhalation. In Thailand it is often caught by rice farmers who toil for hours in paddy fields.

?This is an under-appreciated and under-reported disease,? Dr Direk said. ?The bacteria is difficult to diagnose, difficult to treat and resistant to many antibiotics. We need more awareness and diagnostic tools.?

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Predicted global distribution ofBurkholderia pseudomallei and burden of melioidosis[/h] Published online: 11 January 2016

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 the 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,​9,​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, from which 89,000 (36,000?227,000) people 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 probably endemic in a further 34 countries that have never reported the disease. The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers.

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