Epidemiology Melioidosis

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global map showing distribution of melioidosis 1910 2014


melioidosis endemic in parts of southeast asia (including thailand, laos, singapore, brunei, malaysia, burma , vietnam), china, taiwan , northern australia. flooding can increase extent, including flooding in central australia. multiple cases have been described in hong kong , brunei india, , sporadic cases in central , south america, middle east, pacific , several african countries. although 1 case of melioidosis has ever been reported in bangladesh, @ least 5 cases have been imported uk country. recent news reports indicate b. pseudomallei has been isolated soil in bangladesh, remains verified scientifically. suggests melioidosis endemic bangladesh , problem of underdiagnosis or under-reporting exists there. due lack of adequate laboratory facilities in affected rural areas. high isolation frequency (percentage of positive soil samples) found in east saravan in rural lao pdr distant mekong river, thought investigators highest geometric mean concentration in world (about 464 (25-10,850 cfu/g soil).


a statistical model indicated incidence 165,000 cases per year in 2016 (95% confidence interval, 68,000 412,000), 138,000 of occurring in east , south asia , pacific. in half of cases, people die. northeast thailand has highest incidence of melioidosis recorded in world (an average incidence of 12.7 cases per 100,000 people per year). in northeast thailand, 80% of children positive antibodies against b. pseudomallei age of 4; figures lower in other parts of world.


melioidosis recognised disease in animals, including cats, goats, sheep, , horses. cattle, water buffalo, , crocodiles considered relatively resistant melioidosis despite constant exposure mud. outbreak @ paris zoo in 1970s ( l’affaire du jardin des plantes ) thought have originated imported panda.


b. pseudomallei found in soil , surface water; history of contact soil or surface water is, therefore, invariable in patients melioidosis; said, majority of patients have contact infected soil suffer no ill effects. within area, distribution of b. pseudomallei within soil can extremely patchy, , competition other burkholderia species has been suggested possible reason. contaminated ground water implicated in 1 outbreak in northern australia. implicated severe weather events such flooding tsunamis , typhoons.


based on whole genome sequencing, humans may play role in moving b. pseudomallei place place.


the single important risk factor developing melioidosis diabetes mellitus, followed hazardous alcohol use, chronic kidney disease, , chronic lung disease. other risk factors include thalassaemia, occupation (rice paddy farmers), , cystic fibrosis. mode of infection believed through either break in skin, or inhalation of aerosolized b. pseudomallei cells. person-to-person spread has been described, extremely unusual. hiv infection not predispose melioidosis.


the disease associated increased rainfall, number (and severity) of cases rising following increased precipitation.








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