The hidden burden of melioidosis in Nepal: A paradigm for the urgent need to implement a simple laboratory algorithm to detect melioidosis in low-resource endemic areas

Abstract

Melioidosis, an emerging infectious disease caused by the gram-negative bacillus Burkholderia pseudomallei, is massively underdiagnosed in many low- and middle-income countries. The disease is clinically extremely variable, has a high case fatality rate and assumed to be highly endemic in South Asian countries, including Nepal. The reasons for underdiagnosis include lack of awareness among clinicians and laboratory staff and limited microbiological capacities. Since costly laboratory equipment and consumables are likely to remain a significant challenge in many melioidosis-endemic countries in the near future it will be necessary to make optimum use of available tools and promote their stringent implementation. Therefore, we suggest that health facilities in resource-poor countries such as Nepal introduce a simple and low-cost diagnostic laboratory algorithm for the identification of B. pseudomallei cultures. This screening algorithm should be applied specifically to samples from patients with fever of unknown origin and risk factors for melioidosis such as diabetes. Additionally, there could also be a role of low-cost novel promising serological point-of-care tests, which are currently under research and development.