Melioidosis in Timor-Leste: First Case Description and Phylogenetic Analysis

Area of Science:

• Infectious Diseases
• Microbiology
• Clinical Medicine

Background:

• Melioidosis, caused by Burkholderia pseudomallei, is endemic in Southeast Asia and Australia but had not been previously reported in Timor-Leste.
• Improved diagnostic resources and clinical networks in the Australasian region facilitate the identification of infectious diseases in previously under-diagnosed areas.

Purpose of the Study:

• To report the first culture-confirmed cases of melioidosis in Timor-Leste.
• To characterize the clinical presentations and phylogenetic origins of B. pseudomallei isolates from Timor-Leste.
• To emphasize the need for enhanced diagnostic capacity and awareness of melioidosis in Timor-Leste.

Main Methods:

• Case identification and clinical data collection for three patients with culture-confirmed melioidosis.
• Bacterial culture and identification of Burkholderia pseudomallei.
• Phylogenetic analysis of B. pseudomallei isolates to determine their geographic clade.

Main Results:

• Three cases of culture-confirmed melioidosis were identified in Timor-Leste, presenting with sepsis, pneumonia, multifocal abscesses, and cutaneous infection.
• Phylogenetic analysis placed the Timor-Leste isolates within the Australasian clade of B. pseudomallei.
• The findings are consistent with the known phylogeographic distribution of B. pseudomallei across the Wallace Line.

Conclusions:

• This study reports the first cases of melioidosis in Timor-Leste, expanding the known geographic distribution of this disease.
• Increased awareness, improved diagnostic laboratory capacity, and updated clinical guidelines are crucial for managing melioidosis in Timor-Leste.
• The phylogenetic data support the biogeographic separation of B. pseudomallei clades.