Melioidosis in Africa: Time to Uncover the True Disease Load

Abstract

Melioidosis is an often fatal infectious disease with a protean clinical spectrum, caused by the environmental bacterial pathogen Burkholderia pseudomallei. Although the disease has been reported from some African countries in the past, the present epidemiology of melioidosis in Africa is almost entirely unknown. Therefore, the common view that melioidosis is rare in Africa is not evidence-based. A recent study concludes that large parts of Africa are environmentally suitable for B. pseudomallei. Twenty-four African countries and three countries in the Middle East were predicted to be endemic, but no cases of melioidosis have been reported yet. In this study, we summarize the present fragmentary knowledge on human and animal melioidosis and environmental B. pseudomallei in Africa and the Middle East. We propose that systematic serological studies in man and animals together with environmental investigations on potential B. pseudomallei habitats are needed to identify risk areas for melioidosis. This information can subsequently be used to target raising clinical awareness and the implementation of simple laboratory algorithms for the isolation of B. pseudomallei from clinical specimens. B. pseudomallei was most likely transferred from Asia to the Americas via Africa, which is shown by phylogenetic analyses. More data on the virulence and genomic characteristics of African B. pseudomallei isolates will contribute to a better understanding of the global evolution of the pathogen and will also help to assess potential differences in disease prevalence and outcome.

The Burkholderia Type VI Secretion System 5: Composition, Regulation and Role in Virulence

“…Southeast Asia and Northern Australia are hyperendemic regions (Cheng and Currie, 2005). However, reports of environmental B. pseudomallei isolates or melioidosis cases from Central and South America, Africa and South Asia indicate that the bacteria are found in the tropics worldwide (Mukhopadhyay et al, 2018; Rolim et al, 2018; Steinmetz et al, 2018; Torres et al, 2018). Furthermore, a recent comprehensive modeling study suggests vast underreporting of melioidosis cases and highlights the need to assess the true global burden and epidemiology of the disease (Limmathurotsakul et al, 2016).…”

Investigation of Melioidosis Using Blood Culture and Indirect Hemagglutination Assay Serology among Patients with Fever, Northern Tanzania

“… 20 To our knowledge, there have not been data published on B. pseudomallei seropositivity in Tanzania. 21 In Uganda, a study by Frazer 22 identified 25 (5.9%) of 426 individuals as seropositive to B. pseudomallei using IHA. The Frazer study surveyed healthy adults from the capital, Kampala, as well as rural areas, and most seropositive participants had reciprocal antibody titers ≤ 160.…”

Melioidosis and sickle cell disease: Description of a rare association

“…A notion of play in a marshy area was found at home. The environmental study 2 years in the screen isolated positive signals for Burkholderia pseudomallei in the vicinity [2] . This same case has been under a transfusion exchange program for 11 months and in addition he was transfused twice during his hospital stay.…”

“…The clinical manifestation varies from mild localized infection to fulminant sepsis. Melioidosis and its germ are increasingly reported on the African continent and particularly in Central Africa, possibly due to the increased awareness of clinicians and microbiologists and the growing recognition of the organism [2] . Burkholderia pseudomallei is a Gram-negative bacillus found in soil.…”