Melioidosis in Sri Lanka

Abstract

Until recently, Sri Lanka was not considered a country with endemic melioidosis. However, an increasing number of cases is being reported. National surveillance for melioidosis was instituted after 2008. A total of 250 culture-positive cases was recorded between 2006 and May 2017. Males predominated (71.6%). The age range was wide (2–92 years) reflecting a ubiquity of exposure. The majority (201/250, 80%) lived in rural areas. All provinces were affected. Case load increased during the two monsoonal periods (67%). There was representation of every population group including farmers (n = 44), housewives (n = 24), school children (n = 10), professionals (n = 5), businesspersons (n = 6), white-collar workers (n = 10) and blue-collar workers (n = 8). Diabetes was the predominant risk factor (n = 163, 65.2%). Clinical presentations included community-acquired sepsis and pneumonia, superficial and deep abscesses, and septic arthritis. Mortality was 20.4% (51/250). A majority (n = 212) of isolates belonged to the YLF (Yersinia-like fimbrial) clade but 38 were BTFC (B. thailandensis-like flagellum and chemotaxis). A total of 108 isolates was genotyped and 46 sequence types (STs) were identified, 40 being novel. It is clear that melioidosis is endemic in Sri Lanka with a wide geographic and demographic distribution. There is an urgent need to extend surveillance of melioidosis to under-resourced parts of the country and to populations at high risk.

Melioidosis after a long silence in Sri Lanka: an environmental hazard and dilemma in diagnosis, with recovery and longitudinal follow-up for 13 years: a case report

“…Since this index case, melioidosis has been considered as an emerging infection in Sri Lanka and has created renewed interest among clinicians and microbiologists, leading to an increased case detection rate [11,12]. However, we assume that lack of awareness of the disease leading to underdetection of cases and underreporting has underestimated the true burden of the disease.…”

Melioidosis with a subdural collection – a case report

“…Indirect hemagglutination assay (IHA) is the most widely used serological test, with the sensitivity ranging from 56 to 80% [26, 27] and specificity ranging from 75 to 91% [27, 28]. According to recent data, the background sero-positivity for melioidosis in Sri Lanka is estimated to be 7.4% at a titre of 1/40 [29]. This contrasts with the background sero-positivity in populations with a higher exposure to melioidosis such as Thailand which can be as high as 80% [30] and could have a negative impact on the sensitivity of serological tests.…”

Melioidosis: A Neglected Cause of Community-Acquired Pneumonia

“…Since institution of the national surveillance program, over 250 cases had been identified up until 2017. 24 Clearly, the next step will be to verify the large numbers of predicted but unrecognized cases in areas where endemic melioidosis has not yet been documented. 25…”