Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis
Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis
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DOI：
10.1038/nmicrobiol.2015.8
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发表时间：
2016-01-01
影响因子：
28.3
通讯作者：
Hay, Simon I.
中科院分区：
文献类型：
--
作者：
Limmathurotsakul, Direk;Golding, Nick;Hay, Simon I.
假鼻疽伯克霍尔德氏菌是一种引起类鼻疽病的高致病性细菌，在东南亚和澳大利亚北部的土壤中普遍存在(1，2)。类鼻疽病很难诊断，因为它的临床表现多种多样，而且常规细菌鉴定方法的不足(3)。这种细菌对多种抗菌剂具有内在的耐药性，使用无效的抗菌剂治疗可能会导致病死率超过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，假鼻疽的全球分布和类鼻疽病的负担仍然知之甚少。在这里，我们绘制了记录在案的人类和动物病例以及环境假鼻疽杆菌的存在，并将其结合在一个正式的建模框架中(8-10)，以估计类鼻疽病的全球负担。我们估计，全世界每年有165,000例(95%可信区间68,000-412,000)人类类鼻疽病例，其中89,000人(36,000-227,000人)死亡。我们的估计表明，在已知是地方病的45个国家中，类鼻疽病的报告严重不足，在另外34个从未报告这种疾病的国家中，类鼻疽病可能是地方病。大量的估计病例和死亡人数表明，这种疾病值得公共卫生官员和政策制定者重新关注。
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.