Melioidosis: Bridging the gap from bedside to bench in Bangladesh

Abstract

The potentially fatal infectious disease "Melioidosis", caused by the saprophyte Burkholderia pseudomallei, has remained in the shadows for far too long. Although, the bacterium has been described almost a century ago in Myanmar, and considerable progress in terms of diagnosis and treatment was achieved, B.pseudomallei is still "the unbeatable foe", for several reasons like under-recognition, high case-fatality rate, unacceptable relapse rate and a "time-bomb" effect for sero-positive individuals. Just like Mycobacterium tuberculosis, the organism can remain latent for decades before the onset of clinical signs and symptoms. The first case of melioidosis from Bangladesh was reported in 1964, in a 29 year old British sailor who was travelling through Bangladesh. Since then, around 68 culture proven melioidosis cases have been sporadically detected in Bangladesh over last several decades. However, the true melioidosis burden is unknown in this region due to lack of awareness and absence of systematic surveillance and research. The reasons for its under-recognition are unavailability of diagnostic microbiology laboratories serving the rural poor in the tropics, who are most likely to acquire melioidosis, and a lack of familiarity and awareness amongst medical and laboratory staff, where such laboratories are available. Clinical diagnosis is exceptionally challenging due to the varied clinical presentations, as the disease can mimic other infections. The most striking reason for this unawareness is that, melioidosis is still considered as one of the most neglected tropical diseases (NTDs), so much so that it is not even included in the WHO list of NTDs. The burden of melioidosis reveals the gaps in dealing with the disease, whereas the prevention mechanism clearly demands public health action in Bangladesh. Without early diagnosis and treatment and exploring better ways to prevent transmission, melioidosis will spread exponentially and claim more lives in the year to come. Therefore, clinicians and microbiologists should be made aware about this pathogen and its frequent misdiagnosis. Availability of validated diagnostic reagents for immunological and molecular tests and expansion of databases of commercial identification systems will likely remove the major hurdles in correct identification of B. pseudomallei. In conclusion, a high level of suspicion on the part of clinicians along with vigilant microbiologists and availability of discerning diagnostic assays may help in identification, reporting, and subsequent management of this "mimicker of maladies".