Abstract
BackgroundBurkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present.Methodology/Principal findingsWe collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70–7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19–2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21–6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant.Conclusion/SignificanceThis study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar.
Highlights
Melioidosis is a serious tropical infection caused by the Gram-negative bacterium Burkholderia pseudomallei
We did not isolate B. pseudomallei in samples from the northern and southernmost parts of the country. This was unexpected, as these locations have been predicted to be environmentally suitable for B. pseudomallei [1] and we are aware of a confirmed case of melioidosis most likely acquired in Kachin in the north of Myanmar (Tun Tun Win pers. comm. 2018)
We did not isolate B. pseudomallei in the southernmost province, Tanintharyi, which is located in the coastal area between the Andaman Sea and Thailand, a number of culture-confirmed human and animal cases of melioidosis have been reported in neighbouring provinces in western Thailand in recent years
Summary
Melioidosis is a serious tropical infection caused by the Gram-negative bacterium Burkholderia pseudomallei. It is endemic in tropical areas of South and South-east Asia and Northern Australia and is increasingly being detected in many other tropical regions.[1] It often presents with life threatening sepsis, pneumonia or abscesses in the internal organs, [2,3] but the presentation can be uncharacteristic making it very difficult to differentiate from other diseases clinically, its nickname “the remarkable imitator”.[4,5,6,7,8,9,10] In addition, laboratory diagnosis is not straightforward and the organism is often dismissed as a contaminant or misidentified.[11,12]. Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present
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