Melioidosis, Singapore | CDC EID

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Volume 15, Number 10–October 2009
Dispatch
Melioidosis in a Tropical City State, Singapore
Tong Jen Lo, Li Wei Ang, Lyn James, and Kee Tai Goh
Author affiliation: Ministry of Health, Singapore

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Abstract
The incidence of melioidosis in Singapore decreased during 1998–2007, with the exception of the first quarter of 2004. After heavy rainfalls, an increase in pneumonic cases with a high case-fatality rate was detected. We show that melioidosis has the potential to reemerge following adverse climate events.

Melioidosis is a tropical infectious disease caused by a gram-negative bacillus, Burkholderia pseudomallei. It is endemic to southeast Asia and northern Australia, and cases are increasingly being reported in countries elsewhere in Asia, the Pacific, the Americas, the Caribbean, Africa, and the Middle East, and in travelers returning from tropical countries (1).

B. pseudomallei is a saprophytic bacterium that can be found in soil and water samples in melioidosis-endemic countries. Transmission is generally by direct inoculation from exposure to soil or water, or through inhalation of aerosolized particles. The disease often affects persons with underlying conditions such as diabetes mellitus (1,2). Clinical manifestations are protean and may range from chronic abscesses to fulminant pneumonia and septicemia with high death rates (1).

Singapore is a tropical island city state in southeast Asia. More than 80% of the population lives in high-rise public housing estates. Although the first case of melioidosis in Singapore was reported in 1920 (3), little is known about the incidence of the disease before it was made notifiable in 1989 when 3 apparently healthy young men died from melioidosis (4). We studied the epidemiology and clinical features of melioidosis in Singapore over a 10-year period (1998–2007). Our study assessed the trends in the epidemiology of the disease, clinical features, case-fatality rates, and risk factors associated with death.

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