Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes

Abstract

Background Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. Methods A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [Mycobacterium tuberculosis/resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. Results Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. Conclusions TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.

Comparative Analysis of Burden of Topmost Disorders Requiring Rehabilitation Services – a Systematic Review and Meta-analysis

“…The low proportion of included studies compared to the total initial studies could be a reflection of the well-defined inclusion criteria based on the WHO criteria of GBD. The inclusion of several highquality studies in the review, [13][14][15][16][17][20][21][22][23][24][25][26][27][28][29]30,[34][35][36][50][51][52][53][78][79][80][98][99][100][101][111][112][113]119 would mean that the outcome of this review can be relied upon to make policies on rehabilitation in the selected conditions, especially the neurological conditions. A major observation is the very few high-quality publication on diarrhoea and low back pain.…”

Melioidosis and Burkholderia pseudomallei: progress in epidemiology, diagnosis, treatment and vaccination

“…Melioidosis was first described in Myanmar in 1911, but it was not recognized as a continuing cause of sepsis in that country for decades until recently. A nationwide soil study has confirmed the widespread presence of B. pseudomallei in Myanmar [38], but a study from Yangon has shown that the burden of tuberculosis is far greater than that of melioidosis [39].…”

“…In a second investigation, another melioidosis case in the USA with no international travel history was linked by genotyping of environmental B. pseudomallei to infection from a freshwater home aquarium that had contained imported tropical fish [35 & ]. [38], but a study from Yangon has shown that the burden of tuberculosis is far greater than that of melioidosis [39].…”

Improving the management of hospitalized presumptive Xpert MTB/RIF-negative tuberculosis cases in Ethiopia

“…This study used a real-time PCR assay to detect the presence of specific viral pathogens, including influenza A virus, influenza B virus, and respiratory syncytial virus (RSV). The results showed that among the 299 participants, 5.2% were positive for influenza A virus, 6.6% were positive for influenza B virus, and 4.4% were positive for RSV [128].…”