Abstract
A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.
Highlights
Melioidosis in Indonesia was first diagnosed in Cikande, on Java island, in 1929 [1]
A total of 10 isolates reported as B. pseudomallei were sent to the Indonesia Research Partnership on Infectious Disease (INA-RESPOND) reference laboratory at Tangerang Regional General Hospital for further characterisation
We are certain that the 146 culture-confirmed melioidosis cases observed to date are just the tip of the iceberg, and continuing and enhancing the reporting system will provide a better understanding of the true burden and distribution of the disease
Summary
Melioidosis in Indonesia was first diagnosed in Cikande, on Java island, in 1929 [1]. We performed (1) a retrospective review of published or reported melioidosis cases in Indonesia, (2) a retrospective study to identify unpublished culture-confirmed melioidosis cases in hospitals in which the microbiology laboratories had isolated B. pseudomallei from clinical specimens, and (3) a retrospective study to evaluate clinical manifestations of recent culture-confirmed patients from 2012 to 2017. A total of 10 isolates (five from Samarinda and five from Makassar) reported as B. pseudomallei were sent to the Indonesia Research Partnership on Infectious Disease (INA-RESPOND) reference laboratory at Tangerang Regional General Hospital for further characterisation. The positive blood culture was obtained 19 days after hospital admission due to a lack of clinical improvement of alteration of consciousness, and the patient had no other signs and symptoms of sepsis, suggesting that B. stabilis was probably a contaminant This case was not included in the list of melioidosis cases described above. Year Presented (References) 1929 [1] 1934 [2] 1935 [3] 1936 [4,16] 1937 [4] 1938 [14] * 1950 [5] 1958 [15] * 2005 [6] 2011–2013 [7] 2012 [17] * 2013–2014 [8] 2013 [19] * 2014 [18] * 2017 [22] *
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