Melioidosis : Not Gone, Not Forgotten

Yuwana, Podin (2023) Melioidosis : Not Gone, Not Forgotten. In: ASIA PACIFIC CONFERENCE ON ZOONOTIC AND NEGLECTED TROPICAL DISEASES (APCZNTD) 2023, 27-29 September 2023, Kingwood Hotel, Sibu.

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Abstract

MELIOIDOSIS: NOT GONE, NOT FORGOTTEN Podin, Yuwana Institute of Health and Community Medicine, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia. ABSTRACT Burkholderia pseudomallei, a saprophytic Gram-negative environmental bacteria which causes melioidosis, was first described in what was known then as Burma in 1911. It is able to survive in extreme pH, temperature and even low nutrient conditions, rendering it a hardy environmental bacteria. Ever since it was first reported, melioidosis which was initially only known endemically in the tropical and sub-tropical regions has since been reported in more countries in other regions. Based on a study published in 2014 which collated and analyzed historical data, there is an estimation of 165,000 human melioidosis cases annually worldwide where 89,000 are potentially fatal. Yet, melioidosis remains underreported in the 45 endemic countries in addition to the 34 countries with newly reported cases. In Malaysia, melioidosis is yet to be gazetted as a notifiable disease under the Prevention and Control of Infectious Diseases Act 1988. Hence, despite approximately 1,000 cases reported annually nationwide with mortality rate of up to 55%, the true incidence and burden of disease of melioidosis in the country remains to be determined. In Sarawak of Malaysian Borneo, melioidosis has been recognized as an endemic disease especially in the central regions including Kapit and Bintulu, caused predominantly by the unique B. pseudomallei strain of ST881 which is unconventionally susceptible to aminoglycoside and macrolide. Contrary to what is known thus far, the medical and scientific communities were shocked by the recently reported outbreak of melioidosis in Kota Samarahan; which raises the question of how widespread melioidosis is in Sarawak and the timeliness of environmental investigation for a non-notifiable disease. Apart from epidemiological perspective, since B. pseudomallei is known to be resistant to a myriad of antibiotics, the biphasic treatment regime of melioidosis is important in preventing recurrent infection. Due to this too that antibiotics susceptibility continues to be monitored in the clinical and laboratory setting. The aim of this paper is to present the latest research updates on melioidosis which provide new insights into the biogeography of the disease and the antibiotics susceptibility work in Sarawak. It is hoped that this paper is able to inform public health that melioidosis is still and will not be forgotten, or else we will continue to be haunted by the bacteria from the underground. Keywords Melioidosis, Burkholderia pseudomallei, Sarawak, Malaysian Borneo Corresponding author Yuwana Podin (PhD), Senior Lecturer, Institute of Health and Community Medicine, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sarawak, Malaysia. pyuwana@unimas.my

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