Emma Birnie1, Harjeet S Virk2, Jelmer Savelkoel2, Rene Spijker3, Eric Bertherat4, David A B Dance5, Direk Limmathurotsakul6, Brecht Devleesschauwer7, Juanita A Haagsma8, W Joost Wiersinga9. 1. Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, Netherlands. Electronic address: e.birnie@amc.uva.nl. 2. Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, Netherlands. 3. Academic Medical Centre and Medical Library, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Netherlands. 4. Department of Infectious Hazard Management, Health Emergency Programme, World Health Organization, Geneva, Switzerland. 5. Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. 6. Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand. 7. Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium. 8. Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands. 9. Center for Experimental and Molecular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Amsterdam Infection & Immunity Institute, University of Amsterdam, Amsterdam, Netherlands.
Abstract
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 Skłodowska-Curie Innovative Training Network European Sepsis Academy.
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 Skłodowska-Curie Innovative Training Network European Sepsis Academy.
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