Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford OX3 7BN, UK.
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand.
Nat Microbiol. 2016 Jan 11;1:15008. doi: 10.1038/nmicrobiol.2015.8.
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.
类鼻疽伯克霍尔德菌是一种高致病性细菌,可引起类鼻疽病,常见于东南亚和澳大利亚北部的土壤中(1,2)。由于其临床表现多样,常规细菌鉴定方法不足,类鼻疽病的诊断较为困难(3)。该细菌对多种抗生素具有固有耐药性,使用无效的抗生素治疗可能导致病死率 (CFR) 超过 70%(4,5)。过去,受感染动物的进口曾将类鼻疽病传播到非流行地区(6,7)。然而,类鼻疽伯克霍尔德菌的全球分布和类鼻疽病的负担仍知之甚少。在这里,我们对有记录的人类和动物病例以及环境中类鼻疽伯克霍尔德菌的存在进行了绘图,并将其结合在一个正式的建模框架中(8-10),以估计全球范围内类鼻疽病的负担。我们估计,全世界每年有 165,000 例(95%可信区间 68,000-412,000)人类类鼻疽病病例,其中 89,000 例(36,000-227,000)人死亡。我们的估计表明,在已知该病流行的 45 个国家中,类鼻疽病的报告严重不足,而在从未报告过该病的另外 34 个国家中,该病可能也在流行。估计的大量病例和死亡人数强调,该疾病需要公共卫生官员和政策制定者重新关注。