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Published on: February 24, 2023
Melioidosis: A Neglected Cause of Community-Acquired Pneumonia
Harjeet Singh Virk1, Chiranjay Mukhopadhyay2, W Joost Wiersinga1,3
1Center for Experimental and Molecular Medicine, Amsterdam Infection & Immunity Institute, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Abstract:
Melioidosis, caused by the facultative intracellular gram-negative pathogen Burkholderia pseudomallei, is an emerging cause of community-acquired pneumonia across the tropics. The majority of patients present with pneumonia with or without sepsis, but localized and asymptomatic infection is also well recognized. Recent modeling and epidemiological studies have demonstrated the widespread presence of B. pseudomallei in otherwise unrecognized regions with a predicted mortality of 90,000 deaths worldwide. Innovative environmental studies are also uncovering how hydrodynamic, pedology, fauna, and weather events influence geographic distribution and incidence of melioidosis cases. Of concern is the changes associated with global warming, which will be conducive to B. pseudomallei in combination with the global diabetes pandemic. In fact, over 80% of patient developing melioidosis have underlying comorbidities. For this great mimicker, culture remains the mainstay of diagnosis and despite availability of other assays, challenges still remain in reducing time to diagnosis and avoiding misdiagnosis. With institution of timely antimicrobials such as ceftazidime and supportive intensive care, overall mortality can be reduced to 10%, although this can still be as high as 50% in poorly resourced areas. Promise is on the horizon with the first human vaccine trials being planned for 2021. Meanwhile new multiomics techniques are giving us a better understanding of the role of virulence and host-pathogen interactions on patient outcomes.
Insights
Melioidosis, a pneumonia caused by Burkholderia pseudomallei, is a growing global threat, especially in tropical regions. Rising temperatures and diabetes rates increase risk, necessitating improved diagnostics and treatments for this deadly bacterial infection.
Area of Science:
- Infectious Diseases
- Environmental Microbiology
- Global Health
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is an emerging cause of community-acquired pneumonia in tropical areas.
- B. pseudomallei is increasingly found in new regions, with an estimated 90,000 global deaths annually.
- Environmental factors like climate change and comorbidities such as diabetes exacerbate melioidosis risk.
Purpose of the Study:
- To highlight the emerging threat of melioidosis globally.
- To discuss the influence of environmental factors and comorbidities on disease incidence.
- To review diagnostic challenges and treatment outcomes for melioidosis.
Main Methods:
- Literature review of epidemiological and environmental studies on melioidosis.
- Analysis of diagnostic methods, including culture and newer assays.
- Examination of treatment strategies and outcomes, including antimicrobial therapy and intensive care.
Main Results:
- Melioidosis presents mainly as pneumonia, often with sepsis, but can be localized or asymptomatic.
- Environmental factors and global warming are expanding the geographic range of B. pseudomallei.
- Culture remains the primary diagnostic method, but challenges persist in timely and accurate diagnosis.
Conclusions:
- Melioidosis is a significant and growing global health concern, exacerbated by climate change and comorbidities.
- Improved diagnostics and timely treatment with antimicrobials like ceftazidime can reduce mortality.
- Vaccine development and multiomics research offer future hope for better understanding and control of melioidosis.
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