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Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis


Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia1,2. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods3. The bacterium is intrinsically resistant to a wide range of antimicrobials, and treatment with ineffective antimicrobials may result in case fatality rates (CFRs) exceeding 70%4,5. The importation of infected animals has, in the past, spread melioidosis to non-endemic areas6,7. The global distribution of B. pseudomallei and the burden of melioidosis, however, remain poorly understood. Here, we map documented human and animal cases and the presence of environmental B. pseudomallei and combine this in a formal modelling framework810 to estimate the global burden of melioidosis. We estimate there to be 165,000 (95% credible interval 68,000–412,000) human melioidosis cases per year worldwide, from which 89,000 (36,000–227,000) people die. Our estimates suggest that melioidosis is severely underreported in the 45 countries in which it is known to be endemic and that melioidosis is probably endemic in a further 34 countries that have never reported the disease. The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers.

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Figure 1: Global evidence consensus and geographic locations of occurrence data from 1910 to 2014.
Figure 2: Predicted environmental suitability for B. pseudomallei persistence at 5 × 5 km2 spatial resolution.
Figure 3: Priority countries where microbiological diagnostic facilities and disease reporting systems for melioidosis should be strengthened.

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  1. Wiersinga, W. J., Currie, B. J. & Peacock, S. J. Melioidosis. N. Engl. J. Med. 367, 1035–1044 (2012).

    Article  Google Scholar 

  2. Aldhous, P. Tropical medicine: melioidosis? Never heard of it… Nature 434, 692–693 (2005).

    Article  Google Scholar 

  3. Hoffmaster, A. R. et al. Melioidosis diagnostic workshop, 2013. Emerg. Infect. Dis. 21(2) (2015).

  4. White, N. J. et al. Halving of mortality of severe melioidosis by ceftazidime. Lancet 2, 697–701 (1989).

    Article  Google Scholar 

  5. Lipsitz, R. et al. Workshop on treatment of and postexposure prophylaxis for Burkholderia pseudomallei and B. mallei infection, 2010. Emerg. Infect. Dis. 18, e2 (2012).

    Article  Google Scholar 

  6. Galimand, M. & Dodin, A. Repartition de Pseudomonas pseudomallei en France et dans le monde la melioidose. Bull. Soc. Vet. Prat de France 66, 651–657 (1982).

    Google Scholar 

  7. Mollaret, H. L'affaire du jardin des plantes. Med. Maladies Infect. 18(Suppl. 4), 643–654 (1988).

    Article  Google Scholar 

  8. Bhatt, S. et al. The global distribution and burden of dengue. Nature 496, 504–507 (2013).

    Article  Google Scholar 

  9. Gilbert, M. et al. Predicting the risk of avian influenza A H7N9 infection in live-poultry markets across Asia. Nature Commun. 5, 4116 (2014).

    Article  Google Scholar 

  10. Pigott, D. M. et al. Mapping the zoonotic niche of Ebola virus disease in Africa. eLife 3, e04395 (2014).

    Article  Google Scholar 

  11. Currie, B. J., Dance, D. A. & Cheng, A. C. The global distribution of Burkholderia pseudomallei and melioidosis: an update. Trans. R. Soc. Trop. Med. Hyg. 102(Suppl. 1), S1–S4 (2008).

    Article  PubMed  Google Scholar 

  12. Limmathurotsakul, D. et al. Increasing incidence of human melioidosis in northeast Thailand. Am. J. Trop. Med. Hyg. 82, 1113–1117 (2010).

    Article  Google Scholar 

  13. Liu, X. et al. Association of melioidosis incidence with rainfall and humidity, Singapore, 2003–2012. Emerg. Infect. Dis. 21, 159–162 (2015).

    Article  Google Scholar 

  14. Limmathurotsakul, D. et al. Activities of daily living associated with acquisition of melioidosis in northeast Thailand: a matched case-control study. PLoS Negl. Trop. Dis. 7, e2072 (2013).

    Article  Google Scholar 

  15. Chen, P. S. et al. Airborne transmission of melioidosis to humans from environmental aerosols contaminated with B. pseudomallei. PLoS Negl. Trop. Dis. 9, e0003834 (2015).

    Article  Google Scholar 

  16. Cheng, A. C., Jacups, S. P., Gal, D., Mayo, M. & Currie, B. J. Extreme weather events and environmental contamination are associated with case-clusters of melioidosis in the Northern Territory of Australia. Int. J. Epidemiol. 35, 323–329 (2006).

    Article  Google Scholar 

  17. Limmathurotsakul, D. et al. Melioidosis caused by Burkholderia pseudomallei in drinking water, Thailand, 2012. Emerg. Infect. Dis. 20, 265–268 (2014).

    Article  Google Scholar 

  18. Currie, B. J. et al. Melioidosis epidemiology and risk factors from a prospective whole-population study in northern Australia. Trop. Med. Int. Health 9, 1167–1174 (2004).

    Article  Google Scholar 

  19. Katangwe, T. et al. Human melioidosis, Malawi, 2011. Emerg. Infect. Dis. 19, 981–984 (2013).

    Article  Google Scholar 

  20. Centers for Disease Control and Prevention Conclusion of Select Agent Inquiry into Burkholderia pseudomallei release at Tulane National Primate Research Center (2015);

  21. FAO/IIASA/ISRIC/ISSCAS/JRC. Harmonized World Soil Database (version 1.2) (FAO and IIASA, 2012).

  22. Pumirat, P. et al. Global transcriptional profiling of Burkholderia pseudomallei under salt stress reveals differential effects on the Bsa type III secretion system. BMC Microbiol. 10, 171 (2010).

    Article  Google Scholar 

  23. Stopnisek, N. et al. Genus-wide acid tolerance accounts for the biogeographical distribution of soil Burkholderia populations. Environ. Microbiol. 16, 1503–1512 (2013).

    Article  Google Scholar 

  24. The World Bank World Bank open data (2013);

  25. International Diabetes Federation Diabetes Atlas 5th edn. Country summary table: estimates for 2012 (2013);

  26. Rattanavong, S. et al. Randomized soil survey of the distribution of Burkholderia pseudomallei in rice fields in Laos. Appl. Environ. Microbiol. 77, 532–536 (2011).

    Article  Google Scholar 

  27. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171 (2015).

    Article  Google Scholar 

  28. World Health Organization Report of the first meeting of the leptospirosis burden epidemiology reference group (2010);

  29. World Health Organization Dengue and severe dengue. (2015).

  30. Newbold, T. et al. Global effects of land use on local terrestrial biodiversity. Nature 520, 45–50 (2015).

    Article  Google Scholar 

  31. Elith, T., Leathwick, J. R. & Hastie, T. A working guide to boosted regression trees. J. Anim. Ecol. 77, 802–813 (2008).

    Article  Google Scholar 

  32. Hijmans, R. J. Cross-validation of species distribution models: removing spatial sorting bias and calibration with a null model. Ecology 93, 679–688 (2012).

    Article  Google Scholar 

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The authors thank P. Wannapinij for technical support and N. J. White and K. Schaecher for comments on the final draft. The authors also thank M. Devine for proofreading. This work was funded by the Wellcome Trust (grant no. 101103). S.I.H. is funded by a Senior Research Fellowship from the Wellcome Trust (grant no. 095066) and grants from the Bill & Melinda Gates Foundation (nos. OPP1119467, OPP1106023 and OPP1093011). S.I.H. acknowledges funding support from the RAPIDD programme of the Science & Technology Directorate, Department of Homeland Security, and the Fogarty International Center, National Institutes of Health.

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Authors and Affiliations



D.L., D.D., E.B., N.P.J.D., S.J.P. and S.I.H. conceived the research. D.L. and S.I.H. drafted the manuscript. D.L. and D.D. reviewed all the occurrence data. D.L. and N.G. carried out the modelling and analysis with advice from S.I.H. D.L., N.G., J.M. and D.P. created the maps and figures. All authors discussed the results and contributed to the revision of the final manuscript.

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Correspondence to Direk Limmathurotsakul.

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The authors declare no competing financial interests.

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Supplementary Methods, References, Table 1 and Figures 1–9. (PDF 8877 kb)

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Limmathurotsakul, D., Golding, N., Dance, D. et al. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 1, 15008 (2016).

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