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Simplified Whole Body Plethysmography to Characterize Lung Function During Respiratory Melioidosis
Published on: February 24, 2023
Melioidosis in the Philippines
Peter Franz M San Martin1, Joseph C Chua2, Ralph Louie P Bautista3
1Department of Physiology, College of Medicine, University of the East-Ramon Magsaysay Memorial Medical Center Inc., Aurora Boulevard, Quezon City 1113, Philippines. petersanmartinmd@gmail.com.
Abstract:
The first documented case of melioidosis in the Philippines occurred in 1948. Since then, there have been sporadic reports in the literature about travelers diagnosed with melioidosis after returning from the Philippines. Indigenous cases, however, have been documented rarely, and under-reporting is highly likely. This review collated all Philippine cases of melioidosis published internationally and locally, as well as unpublished case series and reports from different tertiary hospitals in the Philippines. In total, 25 papers and 41 cases were identified. Among these, 23 were indigenous cases (of which 20 have not been previously reported in the literature). The most common co-morbidity present was diabetes mellitus, and the most common presentations were pulmonary and soft tissue infections. Most of the cases received ceftazidime during the intensive phase, while trimethoprim-sulfamethoxazole was given during the eradication phase. The known mortality rate was 14.6%, while 4.9% of all cases were reported to have had recurrence. The true burden of melioidosis in the country is not well defined. A lack of awareness among clinicians, a dearth of adequate laboratories, and the absence of a surveillance system for the disease are major challenges in determining the magnitude of the problem.
Insights
Melioidosis is underreported in the Philippines, with diabetes mellitus a common comorbidity. This review highlights challenges in defining the true burden of this serious bacterial infection.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is endemic in Southeast Asia.
- Sporadic cases and traveler-associated diagnoses of melioidosis in the Philippines have been reported since 1948.
- Indigenous cases are rarely documented, suggesting significant under-reporting.
Purpose of the Study:
- To collate and review all documented and unpublished cases of melioidosis in the Philippines.
- To assess the epidemiology, clinical presentation, treatment, and outcomes of melioidosis in the country.
- To identify challenges in understanding the true burden of melioidosis in the Philippines.
Main Methods:
- Systematic review of international and local literature.
- Inclusion of unpublished case series and reports from Philippine tertiary hospitals.
- Data extraction on case demographics, comorbidities, clinical presentation, treatment, and outcomes.
Main Results:
- A total of 41 cases were identified from 25 papers, including 23 indigenous cases (20 previously unreported).
- Diabetes mellitus was the most common comorbidity; pulmonary and soft tissue infections were the most frequent presentations.
- Ceftazidime was the primary intensive phase treatment, followed by trimethoprim-sulfamethoxazole for eradication. Mortality was 14.6%, with a 4.9% recurrence rate.
Conclusions:
- The true burden of melioidosis in the Philippines remains undefined due to under-reporting.
- Key challenges include lack of clinician awareness, inadequate laboratory facilities, and absence of a national surveillance system.
- Enhanced surveillance and diagnostic capacity are crucial for accurate assessment and management of melioidosis in the Philippines.
