Emergence of Melioidosis in Indonesia and Today’s Challenges

Author : Patricia M. Tauran 1,2,* Sri Wahyunie 3 Farahanna Saad 4 Andaru Dahesihdewi 5 Mahrany Graciella 6 Munawir Muhammad 7 Delly Chipta Lestari 8 Aryati Aryati 9 Ida Parwati 10 Tonny Loho 11 Dewi Indah Noviana Pratiwi 12 Vivi Keumala Mutiawati 13 Ricke Loesnihari 14 Dewi Anggraini 15 Siwipeni Irmawanti Rahayu 16 Wahyu Nawang Wulan 2 Ungke Antonjaya 2 David A. B. Dance 17,18,19 Bart J. Currie 20 Direk Limmathuthurotsakul 18,21 Mansyur Arif 1,2 Abu Tholib Aman 2,22 Ni Nyoman Sri Budayanti 23 and Diah Iskandriati 24

  1. Department of Clinical Pathology, Faculty of Medicine, Universitas Hasanuddin/Dr. Wahidin Sudirohusodo Hospital, Makassar 90245, Indonesia
  2. Indonesia Research Partnership on Infectious Diseases (INA-RESPOND), Jakarta 10560, Indonesia
  3. Laboratory of Clinical Pathology, Abdul Wahab Sjahranie Hospital, Samarinda 75123, Indonesia4
  4. Laboratory of Clinical Pathology, Tarakan Hospital, Jakarta10150, Indonesia
  5. Department of Clinical Pathology, Faculty of Medicine, Universitas GadjahMada/Sardjito Hospital, Yogyakarta 55281, Indonesia
  6. Laboratory of Clinical Pathology, Prof. Dr. WZ Johannes Hospital, Kupang 85112, Indonesia
  7. Department of Microbiology, Faculty of Medicine, Universitas Hasanuddin/Hasanuddin University Hospital, Makassar 90245, Indonesia
  8. Department of Microbiology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
  9. Department of Clinical Pathology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo Hospital, Surabaya 60286, Indonesia
  10. Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung 40161, Indonesia
  11. Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia
  12. Department of Clinical Pathology, Faculty of Medicine, Universitas Lambung Mangkurat/Ulin Hospital, Banjarmasin 70233, Indonesia
  13. Laboratory of Clinical Pathology, Dr. Zainoel Abidin Hospital, Banda Aceh 24415, Indonesia
  14. Department of Clinical Pathology, Faculty of Medicine, Universitas Sumatera Utara/H. Adam Malik Hospital, North Sumatera 20136, Indonesia
  15. Laboratory of Microbiology, Eka Hospital, Pekanbaru 28293, Indonesia
  16. Department of Microbiology, Faculty of Medicine, Universitas Brawijaya/Saiful Anwar Hospital, Malang 65112, Indonesia
  17. Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Laos
  18. Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Old Road Campus, University of Oxford, Oxford OX3 7FZ, UK
  19. Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  20. Tropical and Emerging Infectious Diseases Division, Menzies School of Health Research, Casuarina, Northern Territory 0811, Australia
  21. Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
  22. Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada/Sardjito Hospital, Yogyakarta 55281, Indonesia
  23. Department of Microbiology, Faculty of Medicine, Universitas Udayana/Sanglah Hospital, Bali 80113, Indonesia
  24. Primate Research Center, Bogor Agricultural University, Bogor 16151, Indonesia

 

Abstract

A recent modeling study estimated that there could be as many as 20,000 human melioidosis cases per year in Indonesia, with around 10,000 potential deaths annually. Nonetheless, the true burden of melioidosis in Indonesia is still unknown. The Indonesia Melioidosis Network was formed during the first melioidosis workshop in 2017. Here, we reviewed 101 melioidosis cases (99 human and two animal cases) previously reported and described an additional 45 human melioidosis cases. All 146 culture-confirmed cases were found in Sumatra (n = 15), Java (n = 104), Kalimantan (n = 15), Sulawesi (n = 11) and Nusa Tenggara (n = 1). Misidentification of Burkholderia pseudomallei was not uncommon, and most cases were only recently identified. We also evaluated clinical manifestations and outcome of recent culture-confirmed cases between 2012 and 2017 (n = 42). Overall, 15 (36%) cases were children (age <15 years) and 27 (64%) were adults (age ≥15 years). The overall mortality was 43% (18/42). We conducted a survey and found that 57% (327/548) of healthcare workers had never heard of melioidosis. In conclusion, melioidosis is endemic throughout Indonesia and associated with high mortality. We propose that top priorities are increasing awareness of melioidosis amongst all healthcare workers, increasing the use of bacterial culture, and ensuring accurate identification of B. pseudomalleiand diagnosis of melioidosis.

 

Key word:  Burkholderia pseudomallei; melioidosis; Indonesia

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