Burden of melioidosis in India and South Asia: Challenges and ways forward

Abstract

Melioidosis is caused by the environmental bacterium Burkholderia pseudomallei. South Asia is estimated to have 44% of the global disease burden. Among South Asian countries, Bangladesh and Sri Lanka are considered endemic for melioidosis; a few cases have been reported from Nepal, and a few imported cases from Pakistan have also been reported. India has experienced an increase in numbers of melioidosis cases in the recent years. The bacteria is inherently present in the soil and enters the human body via skin abrasions, inhalation, or ingestion. As clinicians are often ignorant about the similar characteristics of this disease and several other common tropical diseases, it causes a major delay in the timely diagnosis and management. The organism is easily mistaken as Pseudomonas spp in microbiology laboratories and may be dismissed as a common laboratory contaminant. The poor diagnostic sensitivity of blood culture also leads to missed diagnosis. Hence, both clinical ignorance and missed laboratory diagnosis have misrepresented melioidosis as a rare entity. The key preventive interventions are avoiding contact with loose and muddy soils of meliodosis-endemic areas, and provision of safe drinking water. The present article describes the various possible attributes for melioidosis underdiagnosis and the challenges of improving the diagnosis in conjunction with viable solutions.

Funding: None.

Keywords: Burkholderia pseudomallei; Challenges; India; Melioidosis; Prevention; South Asia.

Figure 1

Publications in PubMed on melioidosis from India. Since the last decade, there has been an increasing trend of case reports, case series, and publications. Nearly half of the reports from India have been reported in the previous five years and over 70% during the last decade.

Figure 2

Challenges of melioidosis control in South Asia^,,,,, Lack of actual data, favourable climatic factors, a swift increase of cases, underdiagnosis, delay in diagnosis, economic burden due to morbidity, mortality and long duration of antimicrobial treatment are some of the challenges.

Figure 3

Key approaches for melioidosis control. Increasing awareness among clinicians and microbiologists, early point-of-care diagnosis, appropriate case management, and disease prevention are fundamental approaches for controlling melioidosis.