The Epidemiology of Melioidosis and Its Association with Diabetes Mellitus: A Systematic Review and Meta-Analysis

Abstract

Melioidosis is an under-recognized fatal disease in humans, caused by the Gram-negative bacterium Burkholderia pseudomallei. Globally, more than 35,000 human melioidosis cases have been reported since 1911. Soil acts as the natural reservoir of B. pseudomallei. Humans may become infected by this pathogen through direct contact with contaminated soil and/or water. Melioidosis commonly occurs in patients with diabetes mellitus, who increase the occurrence of melioidosis in a population. We carried out a systematic review and meta-analysis to investigate to what extent diabetes mellitus affects the patient in getting melioidosis. We selected 39 articles for meta-analysis. This extensive review also provided the latest updates on the global distribution, clinical manifestation, preexisting underlying diseases, and risk factors of melioidosis. Diabetes mellitus was identified as the predominant predisposing factor for melioidosis in humans. The overall proportion of melioidosis cases having diabetes was 45.68% (95% CI: 44.8–46.57, p < 0.001). Patients with diabetes mellitus were three times more likely to develop melioidosis than patients with no diabetes (RR 3.40, 95% CI: 2.92–3.87, p < 0.001). The other potential risk factors included old age, exposure to soil and water, preexisting underlying diseases (chronic kidney disease, lung disease, heart disease, and thalassemia), and agricultural activities. Evidence-based clinical practice guidelines for melioidosis in patients with diabetes mellitus may be developed and shared with healthcare professionals of melioidosis endemic countries to reduce morbidity.

Near-Complete Whole-Genome Sequencing of Two Burkholderia pseudomallei Strains Harbouring Novel Molecular Class D Beta-Lactamase Genes, Isolated from Malaysia

“… Burkholderia pseudomallei is a pathogenic saprophyte that causes melioidosis ( 1 ). The disease is endemic in Malaysia, with various clinical presentations ( 2 , 3 ), and its management includes 6 months of antibiotic regimen administration ( 4 ). Clinical specimens were collected from patients suspected of bacteremia in accordance with ethical approvals (International Islamic University Malaysia [IIUM] Research Ethics Committee [IREC] and National Medical Research Register [NMRR] via IREC 2021-193, NMRR-17-3238-39448, and NMRR-21-360-58751).…”

Risk Factors for Melioidosis Mortality and Epidemics: A Multicentre, 10-Year Retrospective Cohort Study in Northern Hainan

“…Patients with diabetes are three times more likely to develop melioidosis than patients without diabetes, which is related to the fact that hyperglycaemia can damage neutrophils and lymphocytes and destroy phagocytes and immune function. As persistent hyperglycaemia further worsens the condition of melioidosis, the aggravation of melioidosis also leads to poor blood sugar control, forming a vicious cycle [ 17 , 18 ]. Most of the cases in our study also occurred in coastal areas and during the rainy season in summer and fall, which is consistent with the case reports in Hainan, China [ 19 , 20 ].…”

Burden and Risk Factors of Melioidosis in Southeast Asia: A Scoping Review

“…This finding was supported by a recent study in Perak, Malaysia, which found that 71.1% of patients have diabetes mellitus [ 67 ]. Patients with diabetes mellitus were three times more likely to be infected by melioidosis than non-diabetic patients [ 68 ]. Interestingly, diabetes mellitus with soil and water exposure results in higher OR values compared with single variables, which highlights those individuals exposed to more risk factors are highly vulnerable to B. pseudomallei infection.…”