A Report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 2017

Bory, Sotharith; Daily, Frances; Khim, Gaetan; Letchford, Joanne; Srun, Sok; Kol, Hero; Lak, Muy Seang; Tuseo, Luciano; Chan, Vibol; Oeng, Sopheap; Turner, Paul

doi:10.3390/tropicalmed3010023

Cited by 11 publications

(15 citation statements)

References 17 publications

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“…Recent training initiatives in Cambodia and Laos have been undertaken in order to raise awareness of this disease and similar events should be considered in Myanmar. [ 63 , 64 ]…”

Section: Discussionmentioning

confidence: 99%

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

et al. 2021

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Background Burkholderia pseudomallei is a Gram-negative bacterium found in soil and water in many tropical countries. It causes melioidosis, a potentially fatal infection first described in 1911 in Myanmar. Melioidosis is a common cause of sepsis and death in South and South-east Asia, but it is rarely diagnosed in Myanmar. We conducted a nationwide soil study to identify areas where B. pseudomallei is present. Methodology/Principal findings We collected soil samples from 387 locations in all 15 states and regions of Myanmar between September 2017 and June 2019. At each site, three samples were taken at each of three different depths (30, 60 and 90 cm) and were cultured for B. pseudomallei separately, along with a pooled sample from each site (i.e. 10 cultures per site). We used a negative binomial regression model to assess associations between isolation of B. pseudomallei and environmental factors (season, soil depth, soil type, land use and climate zones). B. pseudomallei was isolated in 7 of 15 states and regions. Of the 387 sites, 31 (8%) had one or more positive samples and of the 3,870 samples cultured, 103 (2.7%) tested positive for B. pseudomallei. B. pseudomallei was isolated more frequently during the monsoon season [RR-2.28 (95% CI: 0.70–7.38)] and less in the hot dry season [RR-0.70 (95% CI: 0.19–2.56)] compared to the cool dry season, and in the tropical monsoon climate zone [RR-2.26; 95% CI (0.21–6.21)] compared to the tropical dry winter climate zone. However, these associations were not statistically significant. B. pseudomallei was detected at all three depths and from various soil types (clay, silt and sand). Isolation was higher in agricultural land (2.2%), pasture land (8.5%) and disused land (5.8%) than in residential land (0.4%), but these differences were also not significant. Conclusion/Significance This study confirms a widespread distribution of B. pseudomallei in Myanmar. Clinical studies should follow to obtain a better picture of the burden of melioidosis in Myanmar.

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“…Recent training initiatives in Cambodia and Laos have been undertaken in order to raise awareness of this disease and similar events should be considered in Myanmar. [ 63 , 64 ]…”

Section: Discussionmentioning

confidence: 99%

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

et al. 2021

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“…Prior to this, a case report described a Cambodian refugee in Canada who presented with pulmonary melioidosis in 1983 (107). Notably, regular identification of B. pseudomallei in Cambodian hospitals commenced only following the establishment of a microbiology laboratory at Angkor Hospital for Children in 2005, and while the laboratory was becoming established, it is possible that cases of melioidosis were misidentified for some time, prior to the correct identification of B. pseudomallei (105,106,108). A prospective adult sepsis study of 139 patients in Takeo Province reported that 5% were culture positive for B. pseudomallei over a duration of 1 year (109).…”

Section: Southeast Asiamentioning

confidence: 99%

“…A recent pediatric study estimated the annual incidence of melioidosis at 28 to 35 cases per 100,000 children per year (110). This may be an underestimate due to several limitations of the study, including collection of microbiological samples at the discretion of attending clinicians from only one of two pediatric referral centers in Siem Reap and a limited ability to account for children who may have died prior to hospitalization (108,110). A seroprevalence survey of children demonstrated a 16% seropositivity rate, and furthermore, 30% of soil samples from rice fields were culture positive (111).…”

Section: Southeast Asiamentioning

confidence: 99%

Human Melioidosis

2020

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SUMMARY The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.

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“…In another study reported in 2013, only three B. pseudomallei isolates were obtained from 85 pus and wound swab samples (3.5%) in YGH [ 12 ]. Overall, the incidence of confirmed melioidosis in Yangon was not high compared with parts of neighbouring endemic countries such as Thailand, Cambodia and Laos [ 29 – 31 ]. It thus appears that melioidosis may not now be as common in Yangon as it was in the time of Krishnaswamy, who in 1917 reported seeing more than 200 cases over 6 years in the mortuary of YGH, accounting for one in every 20 autopsies he performed [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Enhanced melioidosis surveillance in patients attending four tertiary hospitals in Yangon, Myanmar

Win

Wah

et al. 2021

Epidemiol. Infect.

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In order to investigate the current epidemiology of melioidosis in Yangon, Myanmar, between June 2017 and May 2019 we conducted enhanced surveillance for melioidosis in four tertiary hospitals in Yangon, where the disease was first discovered in 1911. Oxidase-positive Gram negative rods were obtained from the microbiology laboratories and further analyzed at the Department of Medical Research. Analysis included culture on Ashdown agar, the three disc sensitivity test (gentamicin, colistin and co-amoxiclav), latex agglutination, API 20 NE, antibiotic susceptibility testing, and a subset underwent molecular confirmation with a Burkholderia pseudomallei-specific assay. Twenty one of 364 isolates (5.7%) were confirmed as B. pseudomallei and were mostly susceptible to the antibiotics used in standard therapy for melioidosis. Ten patients were from Yangon Region, nine were from Ayeyarwaddy region, and one each was from Kayin and Rakhine States. A history of soil contact was given by seven patients, five had diabetes mellitus and one had renal insufficiency. The patients presented with septicaemia (twelve cases), pneumonia (three cases), urinary tract infection (two cases) and wound infection (four cases). Eighteen patients survived to hospital discharge. This study highlights the likelihood that melioidosis may be far more common, but underdiagnosed, in more rural parts of Myanmar as in other countries in SE Asia.

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A Report from the Cambodia Training Event for Awareness of Melioidosis (C-TEAM), October 2017

Cited by 11 publications

References 17 publications

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

Geographical distribution of Burkholderia pseudomallei in soil in Myanmar

Human Melioidosis

Enhanced melioidosis surveillance in patients attending four tertiary hospitals in Yangon, Myanmar

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