Melioidosis: A Neglected Bacterial Infection Associated with High Mortality

Abstract

Melioidosis is a neglected tropical bacterial infection of international importance. Burkholderia pseudomallei, the bacterium that causes melioidosis, is widely distributed in soil and water in endemic areas which include many countries within the Oceania region. Infection can arise following percutaneous inoculation, inhalation or ingestion of B. pseudomallei. Clinical manifestations of melioidosis vary greatly, and the disease spectrum is believed to reflect the virulence and inoculating dose of the B. pseudomallei strain, the route of infection and host risk factors. Diabetes has been recognised as the single most common risk factor for melioidosis. The case mortality rate associated with melioidosis remains high, even in countries where it is well recognised. Treatment remains a challenge due to the inherent multidrug resistance of B. pseudomallei resulting in the need for systemic administration of antibiotics, followed by extended eradication therapy. Currently no safe, effective vaccine exists for melioidosis. Progress in the delivery of affordable prevention, detection and treatment modalities is reliant on improved understanding of basic concepts related to host-pathogen interactions, with particular relevance to the increased susceptibility of individuals with diabetes to B. pseudomallei infection.