Melioidosis in India and Bangladesh: A review of case reports

Objective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further compared the clinical epidemiology of the melioidosis cases in India with case series...

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Main Authors:	Meghan Tipre, Paul Vijay Kingsley, Tamika Smith, Mark Leader, Nalini Sathiakumar
Format:	Article
Language:	English
Published:	Wolters Kluwer Medknow Publications 2018-01-01
Series:	Asian Pacific Journal of Tropical Medicine
Subjects:	Melioidosis India Bangladesh Burkholderia pseudomallei Environmental
Online Access:	http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=5;spage=320;epage=329;aulast=Tipre

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spelling	doaj-art-f6734e0799504fad974c7df8e8352a9c2018-09-06T11:04:25ZengWolters Kluwer Medknow PublicationsAsian Pacific Journal of Tropical Medicine2352-41462018-01-0111532032910.4103/1995-7645.233179Melioidosis in India and Bangladesh: A review of case reportsMeghan TiprePaul Vijay KingsleyTamika SmithMark LeaderNalini SathiakumarObjective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further compared the clinical epidemiology of the melioidosis cases in India with case series from highly endemic areas in Northern Australia and Southeast Asia to elucidate any differences in presentations and risk factors between the regions. Results: We identified a total of 99 cases published between 1953 and June 2016, originating from India (n=85) or Bangladesh (n=14). Cases were predominantly male and ranged in age from 1 month to 90 years. Diabetes mellitus was the most common risk factor reported (58%). About 28% of the cases had history of exposure via high-risk occupations or exposure to contaminated water. The overall case fatality rate (CFR) was 26%. Factors influencing mortality included the occurrence of septic shock (CFR, 80%), environmental exposure (CFR, 39%), primary presentation of pneumonia (CFR, 38%), misdiagnosed and/or mistreated cases (CFR, 33%) or the presence of a risk factor (CFR, 29%). Because of the small number of cases in Bangladesh, pattern of clinical epidemiology is limited to India. Soft tissue abscess (37%) was the most common clinical presentation reported from India followed by pneumonia (24%) and osteomyelitis/septic arthritis (18%). Neurological melioidosis (n=10, 12%) presented as pyemic lesions of the brain or meninges. A few cases of prostatic abscess (n=4) in men and parotid abscess (n=4) were also noted. The above patterns were consistent with case series from Southeast Asia and Northern Australia for the most part, in terms of risk factors associated with infection and factors influencing mortality. Differences included clinical presentation of pneumonia which was notably lower than that reported in Southeast Asia and Northern Australia; a higher proportion of neurological and parotid abscess presentation; and a lower CFR compared to that reported in case series in Southeast Asia. About 39% of the cases were misdiagnosed and/or mistreated, suggesting underreporting and under estimation of the true disease burden. Conclusions: The concentration of melioidosis cases in southern and eastern states in India and in Bangladesh, which share climatic conditions and rice farming activities with known endemic areas in Southeast Asia, suggests an endemicity of melioidosis in this region. Thus, increased awareness among healthcare personnel, particularly among clinicians and nurses practicing in rural areas, and improved surveillance through case registries is essential to guide early diagnosis and prompt treatment.http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=5;spage=320;epage=329;aulast=TipreMelioidosisIndiaBangladeshBurkholderia pseudomalleiEnvironmental
institution	Open Data Bank
collection	Open Access Journals
building	Directory of Open Access Journals
language	English
format	Article
author	Meghan Tipre Paul Vijay Kingsley Tamika Smith Mark Leader Nalini Sathiakumar
spellingShingle	Meghan Tipre Paul Vijay Kingsley Tamika Smith Mark Leader Nalini Sathiakumar Melioidosis in India and Bangladesh: A review of case reports Asian Pacific Journal of Tropical Medicine Melioidosis India Bangladesh Burkholderia pseudomallei Environmental
author_facet	Meghan Tipre Paul Vijay Kingsley Tamika Smith Mark Leader Nalini Sathiakumar
author_sort	Meghan Tipre
title	Melioidosis in India and Bangladesh: A review of case reports
title_short	Melioidosis in India and Bangladesh: A review of case reports
title_full	Melioidosis in India and Bangladesh: A review of case reports
title_fullStr	Melioidosis in India and Bangladesh: A review of case reports
title_full_unstemmed	Melioidosis in India and Bangladesh: A review of case reports
title_sort	melioidosis in india and bangladesh: a review of case reports
publisher	Wolters Kluwer Medknow Publications
series	Asian Pacific Journal of Tropical Medicine
issn	2352-4146
publishDate	2018-01-01
description	Objective: To conduct an epidemiological and clinical review of published case reports of melioidosis from India and Bangladesh. Methods: Data from published case reports were abstracted and summarized. We further compared the clinical epidemiology of the melioidosis cases in India with case series from highly endemic areas in Northern Australia and Southeast Asia to elucidate any differences in presentations and risk factors between the regions. Results: We identified a total of 99 cases published between 1953 and June 2016, originating from India (n=85) or Bangladesh (n=14). Cases were predominantly male and ranged in age from 1 month to 90 years. Diabetes mellitus was the most common risk factor reported (58%). About 28% of the cases had history of exposure via high-risk occupations or exposure to contaminated water. The overall case fatality rate (CFR) was 26%. Factors influencing mortality included the occurrence of septic shock (CFR, 80%), environmental exposure (CFR, 39%), primary presentation of pneumonia (CFR, 38%), misdiagnosed and/or mistreated cases (CFR, 33%) or the presence of a risk factor (CFR, 29%). Because of the small number of cases in Bangladesh, pattern of clinical epidemiology is limited to India. Soft tissue abscess (37%) was the most common clinical presentation reported from India followed by pneumonia (24%) and osteomyelitis/septic arthritis (18%). Neurological melioidosis (n=10, 12%) presented as pyemic lesions of the brain or meninges. A few cases of prostatic abscess (n=4) in men and parotid abscess (n=4) were also noted. The above patterns were consistent with case series from Southeast Asia and Northern Australia for the most part, in terms of risk factors associated with infection and factors influencing mortality. Differences included clinical presentation of pneumonia which was notably lower than that reported in Southeast Asia and Northern Australia; a higher proportion of neurological and parotid abscess presentation; and a lower CFR compared to that reported in case series in Southeast Asia. About 39% of the cases were misdiagnosed and/or mistreated, suggesting underreporting and under estimation of the true disease burden. Conclusions: The concentration of melioidosis cases in southern and eastern states in India and in Bangladesh, which share climatic conditions and rice farming activities with known endemic areas in Southeast Asia, suggests an endemicity of melioidosis in this region. Thus, increased awareness among healthcare personnel, particularly among clinicians and nurses practicing in rural areas, and improved surveillance through case registries is essential to guide early diagnosis and prompt treatment.
topic	Melioidosis India Bangladesh Burkholderia pseudomallei Environmental
url	http://www.apjtm.org/article.asp?issn=1995-7645;year=2018;volume=11;issue=5;spage=320;epage=329;aulast=Tipre
_version_	1612614431257133056

Melioidosis in India and Bangladesh: A review of case reports

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