Global burden of melioidosis in 2015: a systematic review and data synthesis - Birnie, E.; Virk, H. S.; Savelkoel, J.; Spijker, R.; Bertherat, E.; Dance, D. A. B.; Limmathurotsakul, D.; Devleesschauwer, B.; Haagsma, J. A.; Wiersinga, W. J. (Lancet Infect Dis, 2019)
BACKGROUND: Melioidosis is an infectious disease caused by the environmental bacterium Burkholderia pseudomallei. It is often fatal, with a high prevalence in tropical areas. Clinical presentation can vary from abscess formation to pneumonia and sepsis. We assessed the global burden of melioidosis, expressed in disability-adjusted life-years (DALYs), for 2015. METHODS: We did a systematic review of the peer-reviewed literature for human melioidosis cases between Jan 1, 1990, and Dec 31, 2015. Quantitative data for cases of melioidosis were extracted, including mortality, age, sex, infectious and post-infectious sequelae, antibiotic treatment, and symptom duration. These data were combined with established disability weights and expert panel discussions to construct an incidence-based disease model. The disease model was integrated with established global incidence and mortality estimates to calculate global melioidosis DALYs. The study is registered with PROSPERO, number CRD42018106372. FINDINGS: 2888 articles were screened, of which 475 eligible studies containing quantitative data were retained. Pneumonia, intra-abdominal abscess, and sepsis were the most common outcomes, with pneumonia occurring in 3633 (35.7%, 95% uncertainty interval [UI] 34.8-36.6) of 10 175 patients, intra-abdominal abscess in 1619 (18.3%, 17.5-19.1) of 8830 patients, and sepsis in 1526 (18.0%, 17.2-18.8) of 8469 patients. We estimate that in 2015, the global burden of melioidosis was 4.6 million DALYs (UI 3.2-6.6) or 84.3 per 100 000 people (57.5-120.0). Years of life lost accounted for 98.9% (UI 97.7-99.5) of the total DALYs, and years lived with disability accounted for 1.1% (0.5-2.3). INTERPRETATION: Melioidosis causes a larger disease burden than many other tropical diseases that are recognised as neglected, and so it should be reconsidered as a major neglected tropical disease. FUNDING: European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Research Grant 2018, AMC PhD Scholarship, The Netherlands Organisation for Scientific Research (NWO), H2020 Marie Sklodowska-Curie Innovative Training Network European Sepsis Academy.
Keywords: journalArticle; *Quality-Adjusted Life Years; Burkholderia pseudomallei/isolation & purification; Global Burden of Disease/*statistics & numerical data; Humans; Incidence; Melioidosis/*epidemiology/mortality; Neglected Diseases