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Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis

Abstract

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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Acknowledgements

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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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.

Corresponding author

Correspondence to Direk Limmathurotsakul.

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The authors declare no competing financial interests.

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Supplementary Information

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). https://doi.org/10.1038/nmicrobiol.2015.8

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