Abstract
Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative environmental bacterium Burkholderia pseudomallei. A prospective cohort study identified 2,243 patients admitted to Sappasithiprasong Hospital in northeast Thailand with culture-confirmed melioidosis between 1997 and 2006. These data were used to calculate an average incidence rate for the province of 12.7 cases of melioidosis per 100,000 people per year. Incidence increased incrementally from 8.0 (95% confidence interval [CI] = 7.2–10.0) in 2000 to 21.3 (95% CI = 19.2–23.6) in 2006 (P < 0.001; χ2 test for trend). Male sex, age ≥ 45 years, and either known or undiagnosed diabetes were independent risk factors for melioidosis. The average mortality rate from melioidosis over the study period was 42.6%. The minimum estimated population mortality rate from melioidosis in 2006 was 8.63 per 100,000 people (95% CI = 7.33–10.11), the third most common cause of death from infectious diseases in northeast Thailand after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis.
Highlights
Melioidosis is a severe community-acquired infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei
Our data suggest that melioidosis is the third most common cause of death from an infectious disease in our region after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis
The population mortality rate for melioidosis is more than from malaria and diarrheal illness combined in this setting, diseases that are usually considered to be of high priority by funding agencies and global health organizations
Summary
Melioidosis is a severe community-acquired infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei This organism is present in the environment in a defined geographic distribution, and infection is acquired through bacterial inoculation or contamination of wounds, inhalation, and ingestion.[1] Melioidosis is most frequently reported from northeast Thailand where it is the most common cause of community-acquired bacteremia,[2] and from Darwin, northern Australia where it is the most common cause of fatal community-acquired septicemic pneumonia.[3] Melioidosis occurs across much of South and East Asia and parts of South America;[4,5] infection may be grossly underreported in these areas, because diagnostic confirmation relies on a microbiological culture that is often unavailable in resource-restricted regions of the world. Infection in adulthood usually occurs in people with one or more pre-disposing factors, and the strongest risk factor is diabetes mellitus.[2,6] Overall mortality has been reported to be 50% in northeast Thailand and 19% in Australia,[7,8] a difference most likely caused by the inequity in availability of intensive-care facilities.[9]
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