Melioidosis in Thailand: Present and Future

Abstract

A recent modelling study estimated that there are 2800 deaths due to melioidosis in Thailand yearly. The Thailand Melioidosis Network (formed in 2012) has been working closely with the Ministry of Public Health (MoPH) to investigate and reduce the burden of this disease. Based on updated data, the incidence of melioidosis is still high in Northeast Thailand. More than 2000 culture-confirmed cases of melioidosis are diagnosed in general hospitals with microbiology laboratories in this region each year. The mortality rate is around 35%. Melioidosis is endemic throughout Thailand, but it is still not uncommon that microbiological facilities misidentify Burkholderia pseudomallei as a contaminant or another organism. Disease awareness is low, and people in rural areas neither wear boots nor boil water before drinking to protect themselves from acquiring B. pseudomallei. Previously, about 10 melioidosis deaths were formally reported to the National Notifiable Disease Surveillance System (Report 506) each year, thus limiting priority setting by the MoPH. In 2015, the formally reported number of melioidosis deaths rose to 112, solely because Sunpasithiprasong Hospital, Ubon Ratchathani province, reported its own data (n = 107). Melioidosis is truly an important cause of death in Thailand, and currently reported cases (Report 506) and cases diagnosed at research centers reflect the tip of the iceberg. Laboratory training and communication between clinicians and laboratory personnel are required to improve diagnosis and treatment of melioidosis countrywide. Implementation of rapid diagnostic tests, such as a lateral flow antigen detection assay, with high accuracy even in melioidosis-endemic countries such as Thailand, is critically needed. Reporting of all culture-confirmed melioidosis cases from every hospital with a microbiology laboratory, together with final outcome data, is mandated under the Communicable Diseases Act B.E.2558. By enforcing this legislation, the MoPH could raise the priority of this disease, and should consider implementing a campaign to raise awareness and melioidosis prevention countrywide.

Successful Treatments and Management of A Case of Canine Melioidosis

“…pseudomallei, a soil-dwelling Gram-negative bacterium, causes melioidosis, a deadly, infectious disease in the tropics. Melioidosis is highly endemic in Thailand with approximately 2800 deaths or 35% mortality in treated patients throughout the country annually [3]. Although melioidosis is known to be endemic in most parts of Thailand, information about this disease, especially in southern Thailand where the canine infection described here occurred, is still limited.…”

Sensitivity and specificity of a lateral flow immunoassay (LFI) in serum samples for diagnosis of melioidosis

“… 1 Misuse of the IHA to diagnose melioidosis has led to a large number of false-positive melioidosis cases with low case fatality rates (CFRs) in the national surveillance system in Thailand. 8 The incorrect CFRs have led to a false sense of security in the country and have limited priority setting by policymakers. 8 A test such as the LFI, with high specificity and potentially high positive predictive value (likelihood that a patient with a positive test result actually has melioidosis), could replace the IHA to diagnose melioidosis patients in health facilities that do not have microbiology facilities, as is the case for many community hospitals in Thailand and elsewhere where melioidosis is endemic.…”

Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan)

“…Overall, 48% of patients were bacteremic, and bacteremia (22/27; 81.4%) along with renal dysfunction (13/27, 48%) were significantly associated with mortality ( p = 0.004). Mortality appears to have declined over the past decade ( Figure 2 ) and at present the rate is surprisingly low (27, 12%) compared with that in Thailand (35%) [ 17 ], and equivalent to that in northern Australia (14%) [ 18 ]. In fact, melioidosis causes a relatively small proportion of all deaths attributable to infectious diseases in Manipal.…”