Global Burden and Challenges of Melioidosis

Abstract

"A recent spatial modelling study estimated that there are about 165,000 human melioidosis cases per year worldwide, of which 89,000 (54%) end in death. Globally, mortality due to melioidosis (89,000 per year) is comparable to measles, and higher than that for leptospirosis and dengue infections.

Nonetheless, melioidosis is so neglected that it is missing from all the lists of neglected tropical diseases. The spatial modelling study suggested that melioidosis is severely under-reported in the 45 countries in which it is known to be endemic, and likely to be present in a further 34 countries, which have never reported the disease. It is crucial, now, to carefully compare the numbers predicted by the model and the numbers confirmed by researchers, clinicians and diagnostic laboratories, and to identify gaps in the current surveillance of melioidosis in each country. This will be essential for both national and international policy makers to help determine the allocation of the limited resources available for public health to save lives from melioidosis.

National surveillance data for melioidosis are non-existent in most countries. It is likely that there are many different gaps in surveillance systems in different melioidosis-endemic tropical countries. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations, the limited availability of microbiological laboratories serving the rural poor who are most likely to contract the disease, a lack of familiarity of doctors and laboratory staff with the clinical and bacteriological features, and the inadequacy of conventional bacterial identification methods. Furthermore, Burkholderia pseudomallei is intrinsically resistant to a wide range of commonly used antimicrobials, and treatment with ineffective antimicrobials results in high mortality. Access, availability and rational usage of effective antimicrobials for melioidosis in resource-limited countries are rarely discussed. Awareness and commitment from policy makers and all stakeholders for melioidosis are crucial, and availability of relevant information is limited."