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Clinical, Environmental, and Serologic Surveillance Studies of Melioidosis in Gabon, 2012–2013 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

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Clinical, Environmental, and Serologic Surveillance Studies of Melioidosis in Gabon, 2012–2013 - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

EMERGING INFECTIOUS DISEASES

Volume 21, Number 1—January 2015

Research

Clinical, Environmental, and Serologic Surveillance Studies of Melioidosis in Gabon, 2012–2013

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W. Joost Wiersinga1Comments to Author , Emma Birnie1, Tassili A.F. Weehuizen, Abraham S. Alabi, Michaëla A.M. Huson, Robert A. G. Huis in ’t Veld, Harry K. Mabala, Gregoire K. Adzoda, Yannick Raczynski-Henk, Meral Esen, Bertrand Lell, Peter G. Kremsner, Caroline E. Visser, Vanaporn Wuthiekanun, Sharon J. Peacock, Arie van der Ende, Direk Limmathurotsakul, and Martin P. Grobusch
Author affiliations: University of Amsterdam, Amsterdam, the Netherlands (W.J. Wiersinga, E. Birnie, T.A.F. Weehuizen, M.A.M. Huson, R.A.G. in ’t Veld, C.E. Visser, A. van der Ende, M.P. Grobusch); Albert Schweitzer Hospital, Lambaréné, Gabon (A.S. Alabi, H.K. Mabala, G.K. Adzoda, M. Esen, B. Lell, P.G. Kremsner, M.P. Grobusch); Ex-Situ Silex Geoarchaeology, Leiden, the Netherlands (Y. Raczynski-Henk); University of Tübingen, Tübingen, Germany (M. Esen, B. Lell, P.G. Kremsner, M.P. Grobusch); Mahidol University, Bangkok, Thailand (V. Wuthiekanun, D. Limmathurotsakul); University of Cambridge, Cambridge, UK (S.J. Peacock)

Abstract

Burkholderia pseudomallei, an environmental gram-negative bacillus, is the causative agent of melioidosis and a bio-threat agent. Reports of B. pseudomallei isolation from soil and animals in East and West Africa suggest that melioidosis might be more widely distributed than previously thought. Because it has been found in equatorial areas with tropical climates, we hypothesized that B. pseudomallei could exist in Gabon. During 2012–2013, we conducted a seroprevalance study in which we set up microbiology facilities at a large clinical referral center and prospectively screened all febrile patients by conducting blood cultures and testing for B. pseudomallei and related species; we also determined whether B. pseudomallei could be isolated from soil. We discovered a novel B. pseudomallei sequence type that caused lethal septic shock and identified B. pseudomallei and B. thailandensis in the environment. Our data suggest that melioidosis is emerging in Central Africa but is unrecognized because of the lack of diagnostic microbiology facilities.
The Tier 1 bio-threat agent Burkholderia pseudomallei is an environmental gram-negative bacillus and the cause of melioidosis, a disease characterized by sepsis, pneumonia, and abscess formation in almost any organ (1–3). B. thailandensis is closely related to B. pseudomallei but rarely causes disease in humans or animals; it is usually distinguished from B. pseudomallei by its ability to assimilate arabinose (4–6). Melioidosis mainly affects those who are in regular contact with soil and water and is associated with a mortality rate of up to 40% in resource-poor environments. The major regions to which melioidosis is endemic are Southeast Asia and tropical Australia (1,2). The northern tip of the Northern Territory in Australia and northeast Thailand represent hot spots, where annual incidence is up to 50 cases per 100,000 persons (1,7).
The emergence of melioidosis in Brazil is an example of increasing recognition of the disease in areas where it is probably endemic, and cases have become apparent as a result of enhanced awareness and diagnostics (1,8). Human B. pseudomallei infection has been reported from Malawi, Nigeria, The Gambia, Kenya, and Uganda; however, human cases in Africa seem to be few and isolated, although this finding could be the result of underrecognition and underreporting (1,9–12). Although reports of B. pseudomallei isolation from soil and animals in East and West Africa are limited, they suggest that melioidosis could be widely distributed across this region (13,14).
Given the equatorial tropical distribution of B. pseudomallei and B. thailandensis, we hypothesized that these bacteria are present in the central African country of Gabon, potentially causing disease. By conducting a seroprevalence study, an environmental survey, and setting up microbiology facilities for B. pseudomallei detection at a large referral hospital, we detected B. pseudomallei in soil and identified it as a cause of lethal infection in Gabon. We also detected B. thailandensis in environmental soil samples, indicating that this organism is also present in Gabon.

Dr. Wiersinga divides his time between patient care, teaching, and research at the Academic Medical Center, Amsterdam. His research focus is sepsis.

Acknowledgments


We thank our colleagues in the field for fruitful discussions leading towards this project, Sebastiaan Stolp for help with the logistics concerning the soil sampling study, Katja de Jong and Jacqueline Lankelma for help in the laboratory, and Matt T. Holden for help with the genetic analysis.
This study was supported by the Netherlands Organization for Scientific Research (Veni grant no. 91610008 to W.J.W.) and the Netherlands Organization for Health Research and Development (ZonMW clinical fellowship grant no. 90700424 to W.J.W.). V.W. and D.L. work at Mahidol-Oxford Tropical Medicine Research Unit funded by the Wellcome Trust of Great Britain (no. 089275/Z/09/Z).

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Suggested citation for this article: Wiersinga WJ, Birnie E, Weehuizen TA, Alabi AS, Huson MA, Huis in ’t Veld RAG, et al. Clinical, environmental, and serologic surveillance studies of melioidosis in Gabon, 2012–2013. Emerg Infect Dis [Internet]. 2015 Jan [date cited].http://dx.doi.org/10.3201/eid2101.140762
DOI: 10.3201/eid2101.140762
1These authors contributed equally to this article.
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