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Published on: February 24, 2023
Understanding The Mimicker: Epidemiological Pattern and Determinant of Melioidosis Mortality in Negeri Sembilan,
Shahrul Azhar Md Hanif1, Mohd Rohaizat Hassan1,2, Muhammad Ridzwan Rafi'i1
1Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia.
Background:
Melioidosis, a tropical infectious disease caused by Burkholderia pseudomallei, is epidemic in most region in Southeast Asia with high case fatality. However, there is scanty information regarding the disease's epidemiological pattern, demographics, and underlying risk factors.
Method:
This 5-year retrospective study of 185 confirmed cases which were taken from the Negeri Sembilan Melioidosis Registry between 2018 and 2022. We aim to describe the incidence, mortality rate, case fatality, relationship with meteorology, and factors that influence mortality in this central region of Peninsular Malaysia.
Results:
Incidence rate (IR) of melioidosis in Negeri Sembilan is varied at 1.9 to 5.1 with mean of 3.1 in 100,000 population per year. IR varied between districts in the state from zero to 22.01 in 100,000 population per year. Mortality rate were ranged from 0.17 to 0.74 cases with mean of 0.44 cases in 100,000 population per year. The case fatality rate of this state scattered from 8.70% to 16.67%. There were no significant linear associations between cases and deaths with monthly rainfall and humidity. The mean age of patients was 52.8 years, predominated with age around 41-60 years old. Males (77.8%) predominated, and the majority of cases were Malays (88.9%) and had exposed to soil related activities (74.6%). Mortality from melioidosis was more likely in Bumiputera and non-Malaysians (p<0.05). Patients who had at least one comorbidity were at a higher risk of death from melioidosis (p<0.05). Diabetes mellitus was found in 41.1% of all identified cases, making it a major underlying risk factor for both developing and dying from melioidosis (aOR:19.32, 95%CI:1.91-195.59, p<0.05). Hypertension and mortality status in melioidosis are also significantly correlated (aOR: 7.75, 95% CI: 2.26-26.61, p<0.05).
Conclusion:
The epidemiological patterns of cases reported from Negeri Sembilan are consistent for the most part from previous studies in other states in Malaysia and global with regard to its incidence, case fatality, demographic and predisposing chronic diseases. Diabetes mellitus and hypertension were significantly linked to increased mortality among all determinants.
Insights
Melioidosis, a serious tropical disease, shows specific epidemiological patterns in Negeri Sembilan, Malaysia. Diabetes and hypertension significantly increase the risk of mortality from this infection.
Area of Science:
- Tropical infectious diseases
- Epidemiology
- Public health
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a prevalent tropical infectious disease in Southeast Asia with high mortality.
- Limited data exists on its epidemiological patterns, demographics, and risk factors in Malaysia.
Purpose of the Study:
- To describe the incidence, mortality, and case fatality rates of melioidosis in Negeri Sembilan, Malaysia.
- To investigate the relationship between meteorological factors and melioidosis cases and deaths.
- To identify demographic and clinical factors influencing melioidosis mortality.
Main Methods:
- A 5-year retrospective study (2018-2022) of 185 confirmed melioidosis cases from the Negeri Sembilan Melioidosis Registry.
- Analysis of incidence, mortality rates, case fatality, and correlation with meteorological data.
- Statistical analysis to identify risk factors for mortality, including comorbidities.
Main Results:
- Incidence varied by district (0-22.01/100,000/year), with a mean of 3.1/100,000/year. Case fatality ranged from 8.70% to 16.67%.
- No significant association found between melioidosis cases/deaths and rainfall or humidity.
- Male predominance (77.8%), Malay ethnicity (88.9%), and soil-related activities (74.6%) were common. Diabetes mellitus (41.1%) and hypertension were significant risk factors for mortality (aOR:19.32 and 7.75, respectively).
Conclusions:
- Epidemiological patterns in Negeri Sembilan align with previous studies in Malaysia and globally.
- Diabetes mellitus and hypertension are critical determinants of increased melioidosis mortality.
- Findings highlight the importance of managing comorbidities for melioidosis patient outcomes.
