Melioidosis: Clinical impact and public health threat in the tropics

PLoS Negl Trop Dis. 2017 May 11;11(5):e0004738. doi: 10.1371/journal.pntd.0004738. eCollection 2017 May.

Abstract

This review briefly summarizes the geographical distribution and clinical impact of melioidosis, especially in the tropics. Burkholderia pseudomallei (a gram-negative bacterium) is the major causative agent for melioidosis, which is prevalent in Singapore, Malaysia, Thailand, Vietnam, and Northern Australia. Melioidosis patients are increasingly being recognized in other parts of the world. The bacteria are intrinsically resistant to many antimicrobial agents, but prolonged treatment, especially with combinations of antibiotics, may be effective. Despite therapy, the overall case fatality rate of septicemia in melioidosis remains significantly high. Intracellular survival of the bacteria within macrophages may progress to chronic infections, and about 10% of patients suffer relapses. In the coming decades, melioidosis will increasingly afflict travelers throughout many global regions. Clinicians managing travelers returning from the subtropics or tropics with severe pneumonia or septicemia should consider acute melioidosis as a differential diagnosis. Patients with open skin wounds, diabetes, or chronic renal disease are at higher risk for melioidosis and should avoid direct contact with soil and standing water in endemic regions. Furthermore, there are fears that B. pseudomallei may be used as a biological weapon. Technological advancements in molecular diagnostics and antibiotic therapy are improving the disease outcomes in endemic areas throughout Asia. Research and development efforts on vaccine candidates against melioidosis are ongoing.

Publication types

  • Review
  • Retracted Publication

MeSH terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use*
  • Australia / epidemiology
  • Bacterial Vaccines / therapeutic use
  • Biological Warfare Agents
  • Burkholderia pseudomallei / pathogenicity*
  • Chronic Disease
  • Drug Resistance, Bacterial*
  • Humans
  • Malaysia / epidemiology
  • Melioidosis / diagnosis
  • Melioidosis / epidemiology*
  • Melioidosis / prevention & control
  • Mice
  • Public Health
  • Singapore / epidemiology
  • Soil Microbiology
  • Thailand / epidemiology
  • Vietnam / epidemiology
  • Virulence
  • Water Microbiology

Substances

  • Anti-Bacterial Agents
  • Bacterial Vaccines
  • Biological Warfare Agents

Grants and funding

This work is supported by the “Economic Development Board (EDB), Singapore” by the Proof Of Concept (Research grant WBS No:. R-181-000-110-414). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.