India is among countries at high risk from melioidosis, a disease that mimics others and is difficult to diagnose without access to a good microbiology laboratory, according to a new study led by experts at the University of Oxford.
Published on Tuesday in the journal Nature Microbiology, the study predicts the disease is present in 79 countries, including 34 that have never reported it. It expects a rise in those infected as the number of diabetes cases also increases, especially among the poor.
“Our study predicts high infection rates in countries like India and Vietnam, where the disease is gradually being recognised more frequently,” said Direk Limmathurotsakul, co-author of the study. Awareness of the disease is low even among health workers, it says.
An Oxford release said the study was the first to provide an evidence-based estimate of the global extent of melioidosis, caused by Burkholderia pseudomallei, a highly pathogenic bacterium commonly found in soil and water in South and Southeast Asia and northern Australia.
Contracted through the skin and lungs or by drinking contaminated water, melioidosis mimics other diseases. The bacterium is resistant to a wide range of antimicrobials, and inadequate treatment may result in fatality rates exceeding 70%.
High-risk melioidosis groups include patients with diabetes mellitus, chronic kidney disease or excessive alcohol intake.
“Melioidosis is a great mimicker of other diseases and you need a good microbiology laboratory for bacterial culture and identification to make an accurate diagnosis,” Limmathurotsakul said.
“It especially affects the rural poor in the tropics who often do not have access to microbiology labs, which means that it has been greatly under estimated as an important public health problem across the world.”
The study predicts the burden of melioidosis is likely to increase in future because the incidence of diabetes mellitus is increasing and the movements of people and animals could lead to new endemic areas.
The study estimated that melioidosis killed 89,000 of the 165,000 people who got it in 2015 – nearly as many as the annual global mortality from measles (95,000 deaths a year) and greater than deaths from leptospirosis (50,000 a year) or dengue (12,500 a year), which are two current health priorities for many international health organisations.
“We hope that this paper will help to raise awareness of the disease among all healthcare workers in endemic areas, as the disease can be treated if it is caught early enough,” said Oxford researcher David Dance, one of the contributors to the report, who first highlighted the under-recognition of melioidosis 25 years ago.