Abstract
Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium Burkholderia pseudomallei. Globally, more than 35,000 human melioidosis cases have been reported since 1911. Soil acts as the natural reservoir of B. pseudomallei. Humans may become infected by this pathogen through direct contact with contaminated soil and/or water. Melioidosis commonly occurs in patients with diabetes mellitus, who increase the occurrence of melioidosis in a population. We carried out a systematic review and meta-analysis to investigate to what extent diabetes mellitus affects the patient in getting melioidosis. We selected 39 articles for meta-analysis. This extensive review also provided the latest updates on the global distribution, clinical manifestation, preexisting underlying diseases, and risk factors of melioidosis. Diabetes mellitus was identified as the predominant predisposing factor for melioidosis in humans. The overall proportion of melioidosis cases having diabetes was 45.68% (95% CI: 44.8–46.57, p < 0.001). Patients with diabetes mellitus were three times more likely to develop melioidosis than patients with no diabetes (RR 3.40, 95% CI: 2.92–3.87, p < 0.001). The other potential risk factors included old age, exposure to soil and water, preexisting underlying diseases (chronic kidney disease, lung disease, heart disease, and thalassemia), and agricultural activities. Evidence-based clinical practice guidelines for melioidosis in patients with diabetes mellitus may be developed and shared with healthcare professionals of melioidosis endemic countries to reduce morbidity.
Highlights
Melioidosis is an infectious disease in humans caused by the soil-borne, Gramnegative, facultative, intracellular bacterium Burkholderia pseudomallei [1]
Diabetes mellitus was identified by many studies as the predominant underlying risk factor associated with melioidosis in humans
This study provided the latest updates on the global distribution, clinical manifestation, microbiological and immunological characteristics, preexisting underlying diseases, and risk factors of melioidosis
Summary
Melioidosis is an infectious disease in humans caused by the soil-borne, Gramnegative, facultative, intracellular bacterium Burkholderia pseudomallei [1]. Melioidosis is endemic in Southeast Asia and Australia [1]. Soil is the natural reservoir of B. pseudomallei. The organism was isolated from soil and water from many countries including, Thailand, Malaysia, Australia, China, and Bangladesh [1,2]. The first few cases of melioidosis were reported from Myanmar in 1911 [3]. As of 19 July 2020, more than 35,000 human cases were reported globally [4]. The estimated incidence rate varies from country to country; 19.6 per 100,000 person-years in Australia and 12.7 per 100,000 person-years in Thailand [5]
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