Kao Ly Moua Biology 1615

Increasing Incidence of Human Melioidosis in Northeast Thailand

Scientists decided to do research on the increasing incidence of human Melioidosis in Northeast Thailand because in a previous study performed in northeast Thailand, it was reported that the incidence of Melioidosis was relatively constant at 4.4 per 100,000 people per year in the years between 1987 and 1991. This was relatively low compared with the recent reports of incidence rates per year in northern Australia. Scientists believed that the study reports here were undertaken in response to the growing suspicions in northeast Thailand that the incidence of Melioidosis is still increasing over time. The scientists goal in doing this research was to recalculate the incident rate of Melioidosis in the region, evaluate factors that are associated with the varying incident rate, and then compare the rate of death from Melioidosis with other infectious diseases in the population. Melioidosis is a severe infectious disease that is also known as the Whitmore's disease. This disease can infect both humans and animals and is usually caused by a bacterium called Burkholderia pseudomellei. This disease usually comes from tropical climates and is usually found widespread in southeast Asia or the northern parts of Australia. Melioidosis is a bacterium that is found in contaminated water and soil, and spreads through direct contact by humans and animals with the contaminated source. It is in northeast Thailand that Melioidosis is most frequently reported to have caused this community-acquired bacteremia. In northern Australia is where it is the most common cause of fatal community-acquired septicemic pneumonia. The scientists first decided to identify which area and population would be most helpful to their research so they put up surveillance to identify all patients in the hospital due to Melioidosis between

the dates of January 1, 1997 and December 31, 2006. They conducted daily procedures to find whether the patients had one or more cultures with positive B. pseudomellei. Patients that were suspected of having of having this disease was taken to have samples for culture, including blood, throat, swab, sputum, pus, and surface swab. Scientist also conducted research on patients with presence of diabetes mellitus. They were split into two groups: (1) patients with pre-existing history of diabetes or (2) patients that didn't have a history of diabetes but had hyperglycemia at the time of their admission with Melioidosis. Between 1997 and 2006, there was a total of 2,243 patients that were admitted to the Sappasithiprasong Hospital and confirmed with Melioidosis. The results showed that during the 10 year study period, there was a total of 12.7 cases per 100,000 people per year, but the rate seemed to show that it had considerable variability over time. The results for the incidents of Melioidosis for patients with diabetes were confirmed that 27 patients were excluded from this analysis because of some underlying disease that was not recorded at the time. There were a total of 222 patients that were defined as previously undiagnosed diabetes that survived their episode of Melioidosis and were confirmed with diabetes, and 148 patients who were hyperglycemic at the time had died from Melioidosis before the presence of diabetes could be studied. The scientists found that Melioidosis was more common in males between the ages 55 to 64 years of age. The results showed that there was a decrease in mortality rate over time from 49% in 1997 to 40.5% in 2006. The scientists found that the mortality rate attributed to Melioidosis was comparable to the rate of tuberculosis. With all the data collected, the data reported that Melioidosis is the third most common cause of death from an infectious disease in the region after HIV/AIDS and tuberculosis.

Although there could be many possible explanations for the increase of Melioidosis over the period of time studied, they believe that the method they used of case ascertainment did not change during their study, but that most of the patients they worked with and that were admitted to the hospital in Thailand could be the patterns that had changed over the time period. There were limits to this study of the instances of Melioidosis and the population mortality rate; providing only a minimum estimate for a single province and could not be accurate for the rest of northeast Thailand, because these results were based on active surveillance at a single hospital. To complete their study they contacted 19 provincial hospital laboratories in northern Thailand to collect more data to support the study. With all the information collected, they came to an estimate of an annual incidence rate for northeast Thailand of 8.7 per 100,000 people, meaning that the minimum estimate was significantly higher than the rate that was previously reported. The results of the incidence of Melioidosis in Thailand seem to have a poor outcome due to being grossly underestimated because of the lack of diagnostic microbiology facilities. With that said, the study predicted that Melioidosis will soon become a recognized pathogen throughout this region.