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Md Hanif SA, Hassan MR, Rafi’i MR, Abdul Halim AFN, Ahmad Zamzuri M‘AI, Ismail M, Ibrahim SS, Mihat M, Rejali L, Zubir MH, Mahadi MS, Ahmad Ismail S, Ganesan V, Mohd Fadzil MF. Understanding The Mimicker: Epidemiological Pattern and Determinant of Melioidosis Mortality in Negeri Sembilan, Malaysia. PLoS Negl Trop Dis 2024; 18:e0012147. [PMID: 38709822 PMCID: PMC11098469 DOI: 10.1371/journal.pntd.0012147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/16/2024] [Accepted: 04/15/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Melioidosis, a tropical infectious disease caused by Burkholderia pseudomallei, is epidemic in most region in Southeast Asia with high case fatality. However, there is scanty information regarding the disease's epidemiological pattern, demographics, and underlying risk factors. METHOD This 5-year retrospective study of 185 confirmed cases which were taken from the Negeri Sembilan Melioidosis Registry between 2018 and 2022. We aim to describe the incidence, mortality rate, case fatality, relationship with meteorology, and factors that influence mortality in this central region of Peninsular Malaysia. RESULTS Incidence rate (IR) of melioidosis in Negeri Sembilan is varied at 1.9 to 5.1 with mean of 3.1 in 100,000 population per year. IR varied between districts in the state from zero to 22.01 in 100,000 population per year. Mortality rate were ranged from 0.17 to 0.74 cases with mean of 0.44 cases in 100,000 population per year. The case fatality rate of this state scattered from 8.70% to 16.67%. There were no significant linear associations between cases and deaths with monthly rainfall and humidity. The mean age of patients was 52.8 years, predominated with age around 41-60 years old. Males (77.8%) predominated, and the majority of cases were Malays (88.9%) and had exposed to soil related activities (74.6%). Mortality from melioidosis was more likely in Bumiputera and non-Malaysians (p<0.05). Patients who had at least one comorbidity were at a higher risk of death from melioidosis (p<0.05). Diabetes mellitus was found in 41.1% of all identified cases, making it a major underlying risk factor for both developing and dying from melioidosis (aOR:19.32, 95%CI:1.91-195.59, p<0.05). Hypertension and mortality status in melioidosis are also significantly correlated (aOR: 7.75, 95% CI: 2.26-26.61, p<0.05). CONCLUSION The epidemiological patterns of cases reported from Negeri Sembilan are consistent for the most part from previous studies in other states in Malaysia and global with regard to its incidence, case fatality, demographic and predisposing chronic diseases. Diabetes mellitus and hypertension were significantly linked to increased mortality among all determinants.
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Affiliation(s)
- Shahrul Azhar Md Hanif
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Muhammad Ridzwan Rafi’i
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Ahmad Farid Nazmi Abdul Halim
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | | | - Muhammad Ismail
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Siti Salwa Ibrahim
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Massitah Mihat
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Lokman Rejali
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | - Muhammad Habiruddin Zubir
- State Health Department of Negeri Sembilan, Ministry of Health Malaysia, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia
| | | | - Shazwanis Ahmad Ismail
- Department of Public Health Medicine, Faculty of Medicine, National University of Malaysia Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, Malaysia
| | - Veshny Ganesan
- Universiti Malaysia Sabah, Jalan UMS, Kota Kinabalu, Sabah, Malaysia
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Arushothy R, Mohd Ali MR, Zambri HF, Muthu V, Hashim R, Chieng S, Nathan S. Assessing the national antibiotic surveillance data to identify burden for melioidosis in Malaysia. IJID REGIONS 2024; 10:94-99. [PMID: 38179416 PMCID: PMC10764260 DOI: 10.1016/j.ijregi.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
Objectives A leading cause of morbidity and mortality in Southeast Asia, the epidemiological data on melioidosis disease occurrence and mortality in Malaysia is not comprehensive. The aim of this study is to determine the burden of melioidosis and assess the National Surveillance for Antibiotic Resistance (NSAR) data as a potential tool melioidosis surveilance in Malaysia. Methods We performed a retrospective analysis on the B. pseudomallei reposited data submitted to the NSAR network between January 2014 and December 2020. The data were screened for information on patient demographics and specimen types. Additional patient comorbidities and outcomes were drawn from parallel surveillance for bacteremic melioidosis. Results The average annual incidence rate of melioidosis between 2014-2020 was 3.41 per 100,000 population and was significantly different between states (P <0.001). The highest incidence was observed in Pahang at 11.33 per 100,000 population. Individuals of Malay ethnicity, from the states of Pahang, Johor, Perak, and Negeri Sembilan aged 40-49, who were diabetic and working in agriculture-related sectors had a higher risk of succumbing to the infection. Conclusion Assessing the NSAR data proved to be a useful tool for the determination of the incidence and socio-demographic risk factors attributed to melioidosis in Malaysia.
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Affiliation(s)
- Revathy Arushothy
- Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | | | - Hana Farizah Zambri
- Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Vickneshwaran Muthu
- Disease Control Division, Ministry of Health Malaysia, Federal Government Administrative Centre, Putrajaya, Malaysia
| | - Rohaidah Hashim
- Institute for Medical Research, National Institutes of Health, Shah Alam, Malaysia
| | - Sylvia Chieng
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - Sheila Nathan
- Department of Biological Sciences and Biotechnology, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Deng L, He X, Liu K, Li Y, Xia H, Qian H, Lu X, Mao X, Xiang Y. One-pot RPA-Cas12a assay for instant and visual detection of Burkholderia pseudomallei. Anal Chim Acta 2023; 1252:341059. [PMID: 36935157 DOI: 10.1016/j.aca.2023.341059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023]
Abstract
Burkholderia pseudomallei is the causative agent of melioidosis, a potentially life-threatening infectious disease, and poses public health risks in endemic areas. Due to the high mortality, intrinsic antibiotic resistance, and atypical manifestations, establishing a rapid, accurate, and sensitive identification of B. pseudomallei enables earlier diagnosis, proper treatments, and better outcomes of melioidosis. Herein, we present a One-Pot CRISPR-integrated assay for Instant and Visual Detection (termed OPC-IVD) of B. pseudomallei. The integration of recombinase polymerase amplification and CRISPR-Cas12a recognition-activated trans-cleavage, achieved a true all-in-one single-tube reaction system, initiating the amplification and cleavage simultaneously, which realized a facile sample-to-answer assay. This approach could be performed with simplified DNA extraction and completed around 30 min by holding the reaction tube in the hand. The detection limit of our OPC-IVD was determined to be 2.19 copy/uL of plasmid DNA, 12.5 CFU/mL of B. pseudomallei, and 61.5 CFU/mL of bacteria in spiked blood samples, respectively. Furthermore, the introduction of internal amplification control effectively reduced the occurrence of false negatives, which was incorporated in the reaction system, and amplified simultaneously with the target and read by naked eyes. The assay exhibited 100% accuracy when evaluated in clinical isolates and samples. The streamlined workflow of our OPC-IVD of B. pseudomallei enables a field-deployable, instrument-free, and ultra-fast approach that can be utilized by non-expert personnel in the field of molecular diagnosis of melioidosis especially in under-resourced setting.
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Affiliation(s)
- Ling Deng
- Department of Clinical Microbiology and Immunology, College of Pharmacy and Laboratory Medicine Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaoyi He
- Department of Clinical Microbiology and Immunology, College of Pharmacy and Laboratory Medicine Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Ke Liu
- College of Basic Medical Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yuanli Li
- Department of Clinical Laboratory, Sanya People's Hospital, Sanya, Hainan Province, 570100, China
| | - Han Xia
- Department of Clinical Laboratory, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Hang Qian
- Department of Clinical Microbiology and Immunology, College of Pharmacy and Laboratory Medicine Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaoxue Lu
- Department of Clinical Microbiology and Immunology, College of Pharmacy and Laboratory Medicine Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xuhu Mao
- Department of Clinical Microbiology and Immunology, College of Pharmacy and Laboratory Medicine Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Yang Xiang
- Department of Clinical Microbiology and Immunology, College of Pharmacy and Laboratory Medicine Science, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
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Mariappan V, Vellasamy KM, Anpalagar RR, Lim YM, Zainal Abidin N, Subramaniam S, Nathan S. One Health surveillance approaches for melioidosis and glanders: The Malaysian perspective. Front Vet Sci 2022; 9:1056723. [PMID: 36590813 PMCID: PMC9798326 DOI: 10.3389/fvets.2022.1056723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The One Health concept was initiated to promote the integration of human, animal, and environmental ecosystems into healthcare to ensure effective control and the sustainable governance of multifaceted health matters. Climate change, deforestation, and rigorous farming disrupt the environment, which serves as the natural habitat for many animals and microbes, increasing the likelihood of disease transmission between humans and animals. Melioidosis (neglected tropical diseases) and glanders are of humans and animals caused by the gram-negative bacteria Burkholderia pseudomallei and its close relative Burkholderia mallei, respectively. In Malaysia, although melioidosis is endemic, it is not a notifiable disease. Hence, the true prevalence of melioidosis in Malaysia is unknown and varies in different regions of the country, with reported hotspots associated with agriculture-related activities. To date, no incidence of human glanders has been reported in Malaysia, although occupational exposure for equine handlers and veterinary professionals remains a concern. Additionally, antibiotics are widely used in the healthcare and veterinary sectors to treat or prevent B. pseudomallei and B. mallei infections, leading to the emergence of resistance in B. pseudomallei. Lack of surveillance, research, assessment, and management of glanders and melioidosis is a major issue in Malaysia. Proper assessment systems and cross-discipline cooperation are vital to recognize and manage both diseases. Experts and practitioners from clinical and veterinary disciplines, environmentalists, law enforcement, policymakers, researchers, local communities, and other experts need to communicate, collaborate, and coordinate activities to fill the knowledge gap on glanders and melioidosis to reduce morbidity and mortality rates in the country. This review aims to define the organizational and functional characteristics of One Health surveillance approaches for glanders and melioidosis from a Malaysian perspective.
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Affiliation(s)
- Vanitha Mariappan
- Center for Toxicology and Health Risk Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kumutha Malar Vellasamy
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rohan Raaj Anpalagar
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yue-Min Lim
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nurhamimah Zainal Abidin
- Faculty of Applied Sciences, School of Biology, Universiti Teknologi MARA (UiTM), Cawangan Negeri Sembilan, Kuala Pilah, Negeri Sembilan, Malaysia
| | - Sreeramanan Subramaniam
- School of Biological Sciences, Universiti Sains Malaysia (USM), Georgetown, Penang, Malaysia
- Chemical Centre Biology, Universiti Sains Malaysia (USM), Bayan Lepas, Penang, Malaysia
- National Poison Centre, Universiti Sains Malaysia (USM), Georgetown, Penang, Malaysia
| | - Sheila Nathan
- Faculty of Science and Technology, School of Biosciences and Biotechnology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
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Selvam K, Ganapathy T, Najib MA, Khalid MF, Abdullah NA, Harun A, Wan Mohammad WMZ, Aziah I. Burden and Risk Factors of Melioidosis in Southeast Asia: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15475. [PMID: 36497549 PMCID: PMC9741171 DOI: 10.3390/ijerph192315475] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
This scoping review aims to provide a comprehensive overview of human melioidosis in Southeast Asia as well as to highlight knowledge gaps in the prevalence and risk factors of this life-threatening disease using available evidence-based data for better diagnosis and treatment. Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) was used as the guideline for this review. The literature search was conducted on 23 March 2022 through two electronic databases (PubMed and Scopus) using lists of keywords referring to the Medical Subject Headings (MeSH) thesaurus. A total of 38 articles related to human melioidosis were included from 645 screened articles. These studies were carried out between 1986 and 2019 in six Southeast Asian countries: Thailand, Cambodia, Malaysia, Myanmar, Singapore, and Vietnam. Melioidosis has been reported with a high disease prevalence among high-risk populations. Studies in Thailand (48.0%) and Cambodia (74.4%) revealed disease prevalence in patients with septic arthritis and children with suppurative parotitis, respectively. Other studies in Thailand (63.5%) and Malaysia (54.4% and 65.7%) showed a high seroprevalence of melioidosis among Tsunami survivors and military personnel, respectively. Additionally, this review documented soil and water exposure, diabetes mellitus, chronic renal failure, thalassemia, and children under the age of 15 as the main risk factors for melioidosis. Human melioidosis is currently under-reported in Southeast Asia and its true prevalence is unknown.
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Affiliation(s)
- Kasturi Selvam
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Thanasree Ganapathy
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Mohamad Ahmad Najib
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Muhammad Fazli Khalid
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Nor Azlina Abdullah
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Azian Harun
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab 2, Kubang Kerian 16150, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Aziah
- Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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