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      Emergence of melioidosis in Brazil: a case series

      case-report

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          Abstract

          Background

          Melioidosis is a serious disease caused by the bacterium Burkholderia pseudomallei which affects humans and animals. It results in a wide spectrum of clinical manifestations, mainly in the respiratory tract, progressing to septic shock and death.

          Case presentation

          Herein, we present a series of seven patients (median age: 41 years) with confirmed melioidosis, treated at a public hospital in Piauí State, Brazil between 2019 and 2021. The most common clinical presentations were fever, cough, pneumonia, and abdominal pain. The mean duration of antibacterial therapy with 1 g of meropenem was 28.6 ± 1.1 days. Six patients recovered and one died. The mean hospitalization time was 51.0 ± 39.2 days.

          Conclusions

          Melioidosis is an emerging infectious disease in Brazil. Health professionals in endemic areas need to be aware of the clinical presentation and appropriate clinical management of the disease because early diagnosis and early initiation of antibiotic therapy can be life-saving.

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          Most cited references11

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          Increasing Incidence of Human Melioidosis in Northeast Thailand

          Direk Limmathurotsakul, Surasakdi Wongratanacheewin, Nittaya Teerawattanasook … (2010)
          Melioidosis is a serious community-acquired infectious disease caused by the Gram-negative environmental bacterium Burkholderia pseudomallei. A prospective cohort study identified 2,243 patients admitted to Sappasithiprasong Hospital in northeast Thailand with culture-confirmed melioidosis between 1997 and 2006. These data were used to calculate an average incidence rate for the province of 12.7 cases of melioidosis per 100,000 people per year. Incidence increased incrementally from 8.0 (95% confidence interval [CI] = 7.2–10.0) in 2000 to 21.3 (95% CI = 19.2–23.6) in 2006 (P < 0.001; χ2 test for trend). Male sex, age ≥ 45 years, and either known or undiagnosed diabetes were independent risk factors for melioidosis. The average mortality rate from melioidosis over the study period was 42.6%. The minimum estimated population mortality rate from melioidosis in 2006 was 8.63 per 100,000 people (95% CI = 7.33–10.11), the third most common cause of death from infectious diseases in northeast Thailand after human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) and tuberculosis.
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            Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis.

            David Dance, Eric Bertherat, David M. Pigott … (2016)
            Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia(1,2). Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods(3). 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 areas(6,7). 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 framework(8-10) 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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              Melioidosis.

              W. Joost Wiersinga, Bart Currie, Sharon Peacock (2012)
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                Author and article information

                Contributors
                Marco Aurélio Pereira Horta:
                ORCID: http://orcid.org/0000-0003-4117-5379
                marco.horta@fiocruz.br
                Journal
                Journal ID (nlm-ta): J Med Case Rep
                Journal ID (iso-abbrev): J Med Case Rep
                Title: Journal of Medical Case Reports
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1752-1947
                Publication date (Electronic): 23 August 2023
                Publication date PMC-release: 23 August 2023
                Publication date Collection: 2023
                Volume: 17
                Electronic Location Identifier: 362
                Affiliations
                [1 ]GRID grid.412380.c, ISNI 0000 0001 2176 3398, University Hospital/Federal University of Piaui, ; Teresina, Brazil
                [2 ]GRID grid.8395.7, ISNI 0000 0001 2160 0329, Federal University of Ceará, ; Fortaleza, Brazil
                [3 ]GRID grid.418068.3, ISNI 0000 0001 0723 0931, Laboratório de Hantaviroses e Rickettsioses/Instituto Oswaldo Cruz/Fundação Oswaldo Cruz, ; Rio de Janeiro, Brazil
                Author information
                http://orcid.org/0000-0003-4117-5379
                Article
                Publisher ID: 4093
                DOI: 10.1186/s13256-023-04093-8
                PMC ID: 10463497
                PubMed ID: 37608318
                SO-VID: 6fcc7d16-dfe1-4257-a8f4-a2a302855d5e
                Copyright © © BioMed Central Ltd., part of Springer Nature 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 23 June 2023
                Date accepted : 20 July 2023
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Medicine
                Keywords: burkholderia pseudomallei,melioidosis,brazil
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: burkholderia pseudomallei, melioidosis, brazil

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