"Melioidosis in Antioquia, Colombia: an emerging or endemic disease? A cases series"

Geographic Distribution and Incidence of Melioidosis, Panama1

Melioidosis is an infection caused by Burkholderia pseudomallei. Most cases occur in Southeast Asia and northern Australia; <100 cases have been reported in the Americas. We conducted a retrospective study and identified 12 melioidosis cases in Panama during 2007–2017, suggesting possible endemicity and increased need for surveillance.

Case Series Study of Melioidosis, Colombia

We report 7 cases of melioidosis in Colombia and comparision of 4 commercial systems for identifying Burkholderia pseudomallei. Phoenix systems were not a definitive method for identifying B. pseudomallei. For accurate identification, we recommend including this bacterium in the library databases of matrix-assisted laser desorption/ionization mass spectrometry systems in Latin America.

Melioidosis in Colombia, description of a clinical case and epidemiological considerations

Melioidosis is an infectious disease caused by Burkholderia pseudomallei whose clinical diagnosis can be difficult due not only to its varied clinical presentation but also to the difficulties in the microbiological diagnosis.Thus, it may be necessary to use molecular techniques for its proper identification once it is suspected. There are few antibiotics available for the treatment of this disease, which must be used over a long period of time. Although it is known to be endemic in Thailand, Malaysia, Singapore, Vietnam, and Australia, in Colombia there are few reported cases. We describe a case of melioidosis in the northern region of Colombia. Additionally, we review its clinical characteristics and treatment and we describe the local epidemiology of this disease.

Melioidosis is in the Americas: A Call to Action for Diagnosing and Treating the Disease

Melioidosis, a disease caused by the pathogen Burkholderia pseudomallei, is a significant underreported endemic disease found in tropical countries worldwide. Recent studies have demonstrated that human melioidosis cases have been increasingly recognized in the Americas. Therefore, the first Scientific Reunion of Melioidosis in the Americas was organized in Colombia, with the participation of health authorities of 11 Latin American countries and the United States. This report summarizes the topics reviewed during the meeting, including how to identify human infections and properly diagnose them, with the goal of increasing recognition of the disease in the Americas.

Melioidosis in South America

Melioidosis is an emerging disease in the Americas. This paper reviews confirmed cases, the presence of Burkholderia pseudomallei and the organization of national surveillance policies for melioidosis in South America. Confirmed cases in humans have been reported from Ecuador, Venezuela, Colombia, Brazil, and Peru. The bacterium has been isolated from the environment in Brazil and Peru. The state of Ceará, northeastern region of Brazil, is the only place where specific public strategies and policies for melioidosis have been developed. We also discuss the urgent need for health authorities in South America to pay greater attention to this disease, which has the potential to have a high impact on public health, and the importance of developing coordinated strategies amongst countries in this region.

Phylogenomic Analysis Reveals an Asian Origin for African Burkholderia pseudomallei and Further Supports Melioidosis Endemicity in Africa

Burkholderia pseudomallei, an environmental bacterium that causes the deadly disease melioidosis, is endemic in northern Australia and Southeast Asia. An increasing number of melioidosis cases are being reported in other tropical regions, including Africa and the Indian Ocean islands. B. pseudomallei first emerged in Australia, with subsequent rare dissemination event(s) to Southeast Asia; however, its dispersal to other regions is not yet well understood. We used large-scale comparative genomics to investigate the origins of three B. pseudomallei isolates from Madagascar and two from Burkina Faso. Phylogenomic reconstruction demonstrates that these African B. pseudomallei isolates group into a single novel clade that resides within the more ancestral Asian clade. Intriguingly, South American strains reside within the African clade, suggesting more recent dissemination from West Africa to the Americas. Anthropogenic factors likely assisted in B. pseudomallei dissemination to Africa, possibly during migration of the Austronesian peoples from Indonesian Borneo to Madagascar ~2,000 years ago, with subsequent genetic diversity driven by mutation and recombination. Our study provides new insights into global patterns of B. pseudomallei dissemination and adds to the growing body of evidence of melioidosis endemicity in Africa. Our findings have important implications for melioidosis diagnosis and management in Africa. IMPORTANCE Sporadic melioidosis cases have been reported in the African mainland and Indian Ocean islands, but until recently, these regions were not considered areas where B. pseudomallei is endemic. Given the high mortality rate of melioidosis, it is crucial that this disease be recognized and suspected in all regions of endemicity. Previous work has shown that B. pseudomallei originated in Australia, with subsequent introduction into Asia; however, the precise origin of B. pseudomallei in other tropical regions remains poorly understood. Using whole-genome sequencing, we characterized B. pseudomallei isolates from Madagascar and Burkina Faso. Next, we compared these strains to a global collection of B. pseudomallei isolates to identify their evolutionary origins. We found that African B. pseudomallei strains likely originated from Asia and were closely related to South American strains, reflecting a relatively recent shared evolutionary history. We also identified substantial genetic diversity among African strains, suggesting long-term B. pseudomallei endemicity in this region.

Melioidosis in Travelers: Review of the Literature

BACKGROUND

Melioidosis is a bacterial infection endemic essentially in Southeast Asia and northern Australia. In temperate areas, the infection is extremely rare and is almost always imported by travelers or immigrants. The infection may affect almost any organ in the body, with various degrees of severity.

METHODS

We reviewed the literature on melioidosis in travelers. For this purpose we searched PubMed and Google for relevant articles up to July 2015.

RESULTS

We have identified 72 cases of melioidosis in travelers published in the literature. Melioidosis in travelers was acquired mostly in Thailand (46% of cases). The mean duration of stay in the endemic area was 36 days (range 7-330 days). Symptoms usually started at 23 days (range 1-360 days) after leaving the endemic area. The clinical presentation was varied, sepsis being the most common (34%) followed by pneumonia (29%) and abscess formation (25%). Melioidosis in travelers was less often associated with predisposing risk factors (37.5%), diabetes mellitus being the most common (21%), and had lower mortality (17%) than had the infection in autochthonous cases in Southeast Asia.

CONCLUSIONS

Melioidosis in travelers has its own characteristics, which distinguish it from other autochthonous diseases in indigenous populations. The possibility of melioidosis should be considered not only in patients originating from endemic areas, but also in patients returning from travel in those regions.