It can kill almost as many people as measles probably close to 0 000 in 2015, but few have heard of him, even among doctors in areas where deaths occur. It can occur decades after infection and in many different ways: as an abscess; as a fulminant infection of the blood with fever, headache, and pain; or as a lung infection with cough and chest pain which is easily confused with tuberculosis.
The obscure disease melioidosis and a research team now seems the alarm about this in a document that provides the first global estimates of the prevalence and the number of deaths it causes. "I am very pleased to see this published document," said Alfredo Torres, a microbiologist at the University of Texas Medical Branch in Galveston who was not involved in the work. "It is very clear that this disease has been underestimated and we must pay more attention to it. "
melioidosis is caused by the bacterium Burkholderia pseudomallei , which normally lives in the soil. People and a range of animals can be infected through skin lesions or during inhalation of contaminated dust or drinking contaminated water. The microbe can lead to an acute illness or slumber immediately before exploding in decades fledged melioidosis later, a trait that, once obtained the nickname of melioidosis is resistant to many antibiotics "Vietnamese time bomb." even when treated, up to half of patients can die.
discovered there are over a hundred years in the Burmese capital Yangon, then called Rangoon, the disease has traditionally been considered endemic to South Asia and the most northern regions of Australia . It is on the US list of potential bioterrorism agents ;. B pseudomallei can be aerosolized and had been studied as a bioweapon by the United States and other countries There was a growing recognition that melioidosis is more widespread than people had thought ... Recently, there have been case reports of several states in Africa and Latin America, for example Wherever people seemed to disease, they found, Torres said: "Brazil, India . It's the same story again and again. "in 2014, a survey conducted by the Centers for disease Control and Prevention (CDC) showed that the disease is endemic in parts of Puerto Rico as well.
To estimate the true global burden of disease, researcher Direk Limmathurotsakul Oxford Tropical Medicine Research Unit, Mahidol in Bangkok used a model that cuts the land mass of the planet in 8 million square 5 by 5 kilometers. From the data on soil characteristics, temperature and rainfall, and more than 22,000 cases of human or animal infections recorded during the last 100 years, he calculated how appropriate the ground in each square is B. pseudomallei . Using data from endemic areas known as Thailand, he then estimated the probability that the disease was really present. The model suggests that the disease is common in tropical areas, including 34 countries where it has never been reported, Limmathurotsakul and colleagues wrote online today Nature Microbiology . They estimate that there were 165,000 cases in 2015, including 89,000 deaths. As with any modeling effort, prediction comes with uncertainties, the authors give 68000-4100 case as a credible interval and 36,000 to 227,000 deaths.
"I have long suspected that B. pseudomallei is present in many countries where it was not previously identified," says David Speert, an infectious disease specialist at University of British Columbia in Vancouver, Canada. Not only is melioidosis often misdiagnosed as another illness, but the bacteria is also difficult to culture in the laboratory and difficult to identify. "Add to these problems the fact that B. pseudomallei is the most sensitive to extremely expensive antimicrobials and it is possible that appropriate therapy is not available, even if the diagnosis was made," said Speert .
In many countries where melioidosis has never been reported, clinicians have simply not learned to look. Limmathurotsakul and colleagues have prioritized 79 countries as needing their diagnostic capabilities of the disease and the enhanced microbe. "If the technicians are not aware that they need to test for it, they will just throw away culture because it looks like a contaminant of soil," says Limmathurotsakul.
Only melioidodis few cases occur in the US each year, almost all of them in people who have traveled to areas where the bacteria is endemic. But in a report last year summarizing the 08 data 2013, CDC noted that "three cases of melioidosis have occurred among US residents with no history or travel outside the United States or in areas where melioidosis is endemic, perhaps indicating sources not recognized exhibition in the United States. " Limmathurotsakul T model suggests that the more southern states have the appropriate environmental characteristics for the survival of the bacteria in the soil. "This sets the stage for subsequent infections if the body is to be introduced," says Speert. In fact, in November 2014 an outbreak occurred at Tulane Primate Research Center in Louisiana when the pathogen was spread from mice that were experimentally infected primates. Although the ground level around the fitness center is very small, the bacteria can settle in areas otheher in Lousiana, such as New Orleans, the authors write.
"This study is important," said Peter Hotez, dean of the national school of tropical medicine at Baylor College of medicine in Houston, Texas. "It confirms a high number of deaths in the world, so that melioidosis ranks with visceral leishmaniasis as one of the leading causes of death by a neglected tropical disease." Melioidosis is so neglected, however, it is even not on the list of the World Organisation of the health of neglected tropical diseases, said Torres. this must change, he said. "I really hope that this document will open the eyes of some people involved in health policy."
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