Deadly Tropical Disease Threatens Millions

Melioidosis killed 89,000 of the 165,000 people who contracted it in 2015

Melioidosis, a difficult to diagnose deadly bacterial disease, is probably  present in many more countries than previously thought, says a paper published online in the journal Nature Microbiology. The study estimates that melioidosis is present in 79 countries, including 34 that have never reported the disease.

Melioidosis killed 89,000 of the 165,000 people [fatality rate of 54%] who contracted it last year – equivalent to the annual global mortality from measles (95,000 deaths per year) and greater than fatalities from leptospirosis (50,000 per year) or dengue (12,500 per year), two current health priorities for global health organizations.

Country colouring is based on evidence-based consensus, with green representing a complete consensus on absence of B. pseudomallei and red a complete consensus on presence of B. pseudomallei. Black dots represent geo-located records of melioidosis cases or presence of B. pseudomallei. Source: Nature Microbiology ISSN 2058-5276 (online)

“Melioidosis is a great mimicker of other diseases and you need a good microbiology laboratory for bacterial culture and identification to make an accurate diagnosis. It especially affects the rural poor in the tropics who often do not have access to microbiology labs, which means that it has been greatly under estimated as an important public health problem across the world,” said the report’s lead author.

“Our study predicts high infection rates in countries like India and Vietnam, where the disease is gradually being recognized more frequently.”

Melioidosis is a disease of public health importance in areas of Southeast Asia and Australia. It’s contracted through the skin, lungs or by drinking contaminated water and is difficult to diagnose because it mimics other diseases.

The bacterium is resistant to a wide range of antimicrobials and inadequate treatment could lead to fatality rates exceeding 70%.

Besides humans, many other animal species are susceptible to melioidosis including sheep, goats, swine, horses, cats, dogs and cattle. [CDC]

Bioterrorism Agents/Diseases

CDC considers melioidosis as a Bioterrorism Agent among four dozen other lethal diseases.

Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis

Abstract [selected excerpts]

Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis, is commonly found in soil in Southeast Asia and Northern Australia. Melioidosis can be difficult to diagnose due to its diverse clinical manifestations and the inadequacy of conventional bacterial identification methods. 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%. The importation of infected animals has, in the past, spread melioidosis to non-endemic areas. 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 framework8,​9,​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.

Melioidosis is a disease of public health importance in areas of Southeast Asia and Australia, and is considered a potential emerging infectious disease in many tropical developing countries.

Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis is published in
Nature Microbiology (DOI: 10.1038/nmicrobiol.2015.8).

 

Superbugs Invasion Has Begun

Post-antibiotic era emerging

A wide range of infectious bacteria are evolving, which even the most potent medicines cannot treat.

The Super Superbug C. difficile

The deadliest superbug is the antibiotic-resistant bacterium, Clostridium difficile, which a new super superbug on the rise, killing three times as many people as MRSA.

C. difficile infections have increased since 2007, according to a report.

“During a 24-month period, there were 847 cases of C. difficile infections in the 28 hospitals and the rate of C. difficile infection was 25 percent higher than the rate of infection due to MRSA.”

Latest figures from the Health Protection Agency show there were 55,681 cases of Clostridium difficile infection reported in patients aged 65 years and above in England in 2006. (Source: SIMeL Italy)

The bacteria are naturally present in the intestine but kept under control by other bacteria. Antibiotics can kill some of these, allowing C.difficile to take hold. Image source and other images. Click image to enlarge.

Related Links:

• Quarterly UK Clostridium difficile and MRSA figures
• Education on MRSA, C-Difficile, Latest news and infection related articles
• Infection Prevention and Control (IPAC)

• “Flesh Eating Bacteria” Linked to NSAIDs
• Should We Be Afraid of MRSA?
• MRSA: ACT II
• NZ Sees Surge in Flesh-Eating Disease Cases

Staphylococcus Aureus

The best known SUPERBUG is the methicillin-resistant Staphylococcus aureus, MRSA. About 2 percent of the population in the U.S.  carry an antibiotic-resistant strain of staph, the National Institutes of Health has reported.

MRSA was discovered in the United Kingdom in 1961, but it is now a global concern. MRSA (also known as CA-MRSA, community-acquired MRSA, and HA-MRSA, hospital-acquired MRSA) is a variation of a common bacterium, which has evolved as a “superbug” with the ability to resist treatment with antibiotics, including methicillin and penicillin.

According to Centers for Disease Control and Prevention (CDC), MRSA is responsible for 94,000 serious infections and nearly 19,000 deaths each year in the United States. [In comparison, the AIDS virus killed about 12,500 Americans  in 2005. ]

Necrotizing fasciitis

Necrotizing fasciitis is a complication of severe group A streptococcal infection (GAS) (Streptococci pyogenes), which could lead to additional complications resulting in shock, organ failure and death.

CDC has estimated that necrotizing fasciitis causes about 15,000 infections each year in the United States, resulting in up to 3,000 deaths. UNFORTUNATELY,  “intensive surveillance efforts for necrotizing fasciitis in the United States have not been conducted since 1991,” according to the Department of Health Services.

“It usually begins with a cut or maybe a major surgery or just some trauma we experience in our everyday life,” according to a doctor.

“Necrotizing fasciitis can spread through touch contact from person to person or if you touch something that is contaminated,” said the doctor, adding that up to 50% of people “have no known entrance point.” That is  the victim does not need an open sore to acquire the deadly bacteria.

NEW NT-MRSA Strains

The Emerging Infectious Diseases of U.S. Centers for Disease Control and Prevention discovered a new strain of methicillin-resistant Staphylococcus aureus (MRSA), which is responsible to more than 20 percent of all human MRSA infections in the Netherlands.

“Persons working or living in close contact with pigs or cows are at increased risk of becoming colonized and infected with MRSA. Infections can be severe, as is indicated by the hospital admission rate.”

According to other research MRSA was also prevalent in Canadian pigs and pig farmers. Full report

H041

H041 is a superbug strain of gonorrhea which was discovered by a Swedish researcher, Magnus Unemo, who received the samples from his colleagues in Kyoto, Japan.

The strain is said to be extremely resistant to all cephalosporin-class antibiotics—the only antibiotics still effective in treating gonorrhea.

He described the discovery as “alarming” and “predictable.”

“Since antibiotics became the standard treatment for gonorrhea in the 1940s, this bacterium has shown a remarkable capacity to develop resistance mechanisms to all drugs introduced to control it,” he said.

The fact that the new strain had been found in Japan also follows an alarming pattern, he told reporters.

“Japan has historically been the place for the first emergence and subsequent global spread of different types of resistance in gonorrhea [more than 600,000 new cases recorded annually,]” he said.

In the past few years trends of gonorrhea drug resistance have emerged in Australia, China, Hong Kong and other Asian countries.

The H041 “first emerged in Japan in 1999 and began spreading around the globe from there, arriving in California in 2008 and moving across to the East Coast by last year.”

Gonorrhea

Gonorrhea is a common sexually-transmitted disease (STD), caused by the bacteria Neisseria gonorrhoeae.

An electron micrograph of gonorrhea bacteria. Image courtesy http://women.webmd.com/slideshow-pelvic-pain-causes

Related Links

• Antibiotic-Resistant Gonorrhea (ARG)
• NZ women are world’s most promiscuous

Other Superbugs on the Move

Tuberculosis (TB). The once cured by antibiotics, about 5 percent of the reported cases of TB [12 million cases reported in 2010, including 1.4 million fatalities] have become multidrug resistant, according to WHO.

The Food-borne Bugs: Escherichia Coli (E. coli) and Salmonella

“During the past decade, the emergence of drug-resistant E. coli has dramatically increased. As a consequence, the management of [urinary tract infections] UTIs, which was previously straightforward, has become more complicated; the risks for treatment failure are higher, and the cost of UTI  treatment is increasing,” said a report.

Hospital-borne pathogens: ESKAPE

The six hospital-bourne bacteria, Enterococcus, Staphylococcus, Klebsiella, Acinetobacter, Pseudomonas and Enterobacter, are escaping antibiotics.

These pathogens are associated with vulnerable patients which acquire the infections from hospital equipment and surgical implants.

Global Disasters: Links, Forecasts and Background

• The First Wave of World’s Collapsing Cities
• Back to the Primordial Future
• The Fate of Energy Dinosaurs
• Mass Die-offs

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