Melioidosis in the Philippines

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• To collate and review all documented and unpublished cases of melioidosis in the Philippines.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• Inclusion of unpublished case series and reports from Philippine tertiary hospitals.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.