Melioidosis: Clinical impact and public health threat in the tropics
Authors: Lina H K Lim
Ramar Perumal Samy
Bradley G Stiles
Gautam Sethi
Journal: PLoS Neglected Tropical Diseases (2017)
Discipline: IMMUNOLOGY
Keywords: melioidosis; Burkholderia pseudomallei; geographical distribution; clinical impact; antibiotic therapy
Affiliations: Department of Physiology, NUS Immunology Programme, Centre for Life Sciences, Yong Loo Lin School of Medicine, National University Health System (NUHS), National University of Singapore, Singapore., Integrated Toxicology Division, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America., Department of Pharmacology, Yong Loo Lin School of Medicine, NUHS, National University of Singapore, Singapore.

Abstract:  This review briefly summarizes the geographical distribution and clinical impact of melioidosis, especially in the tropics. Burkholderia pseudomallei (a gram-negative bacterium) is the major causative agent for melioidosis, which is prevalent in Singapore, Malaysia, Thailand, Vietnam, and Northern Australia. Melioidosis patients are increasingly being recognized in other parts of the world. The bacteria are intrinsically resistant to many antimicrobial agents, but prolonged treatment, especially with combinations of antibiotics, may be effective. Despite therapy, the overall case fatality rate of septicemia in melioidosis remains significantly high. Intracellular survival of the bacteria within macrophages may progress to chronic infections, and about 10% of patients suffer relapses. In the coming decades, melioidosis will increasingly afflict travelers throughout many global regions. Clinicians managing travelers returning from the subtropics or tropics with severe pneumonia or septicemia should consider acute melioidosis as a differential diagnosis. Patients with open skin wounds, diabetes, or chronic renal disease are at higher risk for melioidosis and should avoid direct contact with soil and standing water in endemic regions. Furthermore, there are fears that B. pseudomallei may be used as a biological weapon. Technological advancements in molecular diagnostics and antibiotic therapy are improving the disease outcomes in endemic areas throughout Asia. Research and development efforts on vaccine candidates against melioidosis are ongoing. 

Retracted: Yes

PubPeer comments:
 2020 retraction. https: journals.plos.org plosntds article?id=10.1371 journal.pntd.0008441 Following publication of this article [1], concerns were raised to the journal that some information reported in the article is inaccurate and or incomplete, and that recommendations discussed in the article are not supported by current guidelines for melioidosis. In addition, concerns about the review article were discussed in a Formal Comment published in 2019 [2]. The authors confirmed there were numerous errors in the article. The PLOS Neglected Tropical Diseases Editors-in-Chief and members of the PLOS Neglected Tropical Diseases Editorial Board evaluated the article and the issues raised, and determined that this review includes unreliable information; that statements regarding clinical diagnosis and treatment are not adequately supported by published findings; and that in light of these issues, the review could introduce potential risk to patient care. Specific issues confirmed in the editorial assessment include the following, which are discussed in more detail in [2]: In the section, u2018Antibiotic resistance and susceptibility treatment of melioidosis,u2019 the characterization of the resistance and susceptibility of Burkholderia pseudomallei to antibiotics is inaccurate. The section, u2018Laboratory diagnosisu2019 includes inaccurate and incomplete information that does not reflect current guidelines and knowledge in this area. Critical information regarding the interpretation of diagnostic results is missing. The discussion of treatments includes several statements that are not supported by randomized controlled trials, or in some cases, that do not align with clinical practice standards in place at the time of the publication of the review. Statements of concern include those discussing the standard oral treatment, the utility of third-generation antibiotics, and the efficacy of combination treatment (chloramphenicol, doxycycline, and trimethoprim-sulfamethoxazole), fluoroquinolones, and immunotherapy. The discussion of geographical distribution, disease incidence, and ecology, does not discuss some key articles that were published prior to the review. Table 1 (u201cGlobal distribution of melioidosis outbreak, incidence, and their reported cases (an overview)u201d) does not include all countries where melioidosis is present and does not accurately report the number of published cases per country in some cases. The section, u2018Development of antibodies and vaccines for prevention of melioidosis,u2019 lacks information about relevant advances. The PLOS Neglected Tropical Diseases Editors-in-Chief have determined that this review article is unreliable in light of the above issues, and we are therefore retracting this article. We regret that these issues were not addressed during the articleu2019s pre-publication peer review. RPS, GS, and LHKL disagreed with retraction. BGS either did not reply directly or could not be reached. LHKL apologized for the errors in the article. RPS commented that the issues in this case could have been addressed through revisions had they been raised prior to the articleu2019s publication. References 1.Perumal Samy R, Stiles BG, Sethi G, Lim LHK (2017) Melioidosis: Clinical impact and public health threat in the tropics. PLoS Negl Trop Dis 11(5): e0004738. https: doi.org 10.1371 journal.pntd.0004738 pmid:28493905 2.Limmathurotsakul D, Daily F, Bory S, Khim G, Wiersinga WJ, Torres AG, et al. (2019) Melioidosis: The hazards of incomplete peer-review. PLoS Negl Trop Dis 13(3): e0007123. https: doi.org 10.1371 journal.pntd.0007123 pmid:30870410 ,