Melioidosis in Malaysia: A renewed threat of an old disease |
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| Wednesday, 01 September 2010 22:06 | |
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BANGI, 24 Aug. 2010 – An old life-threatening disease first reported in Kuala Lumpur nearly 100 years ago with sporadic occurrences until 1932 is making a comeback. And Malaysians are perplexed with the appearance of the disease known as Melioidosis in the last month. Many today are desperately asking: what is melioidosis? What is its origin and why has it suddenly become so notorious and deadly? Is there a new breed of disease causing agent? The reasons for the recent outbreaks of melioidosis in Malaysia are still not fully understood. The fact is it has now become a national health challenge. It should, at best, trigger a political will to curb the spread of melioidosis in the future through improved diagnosis, treatment and management. Public awareness about the disease needs to be enhanced through educational activities and community programmes. Both technical and human resources to develop and support the public health systems are necessary to detect and stop the spread of this deadly disease. Without doubt, continued research funding to our own scientists must be increased and expanded into strategic and futuristic aspects of the diseases that can lead to its better management. Researchers at Universiti Kebangsaan Malaysia (UKM) and Universiti sains Malaysia (USM) are unraveling the disease at the genetic level through identification of virulence factors determined by its genomic constituents. At Universiti Malaya, another team has been looking at the clinical manifestation of melioidosis; significantly contributing to its diagnosis, treatment, prevention and reduction in mortality. It might be a surprise to many Malaysians that much is already known about melioidosis; a disease caused by the bacterium Pseudomonas pseudomallei, now known as Burkholderia pseudomallei. The disease was first reported in Rangoon, Burma1912 with 38 fatal cases of pneumonia. In Malaysia, melioidosis is a non-notifiable disease, leading to limited public and government awareness and even clinicians are sometimes unable to recognize the disease. The bacteria can be transmitted within the population via several established modes including inhalation, ingestion or inoculation through the skin lesions from the contaminated soil. Although, the disease was first reported in 1912 in 38 fatal cases of pneumonia amongst the destitutes and morphine addicts in Rangoon, Burma (now Yangon Myanmar), much of our subsequent knowledge of melioidosis was discovered in Malaysia or Malaya then. In 1913 Fletcher documented the occurrence of a similar disease described in Burmese drug addicts, in laboratory animals at the Institute for Medical Research in Kuala Lumpur. This was followed by another report of human infection in 1917 from Kuala Lumpur resulting in a short monograph on the disease and its sporadic occurrence in Malaya up to 1932. Research on this little known disease was again actively pursued in Malaysia in the 1960’s by scientists and students at research institutes and the then newly established Universiti Kebangsaan Malaysia (UKM). Person-to-person transmission of B. pseudomallei has also been reported. Over the years, our researchers have published voluminous information providing better understanding of melioidosis. Academics and students from our own universities have probed the disease at a multitude of scientific enquiries including the basic microbiology, pathogenesis, host defenses and epidemiology of the disease. The team at UKM started their investigation into the pathogenesis of melioidosis as early as 1977 at its temporary campus in Jalan Pantai, Kuala Lumpur. This led to our understanding of how the bacterium is capable of causing the disease at the molecular level. Melioidosis is an old disease that has become endemic in the tropical regions of the world. Today, it seems to have spread to non-endemic areas, a result of the ease in international travel. Research scientists in Malaysia have long realized that a better understanding of melioidosis is essential because it is life-threatening and if untreated, patients can succumb to it. Although the bacillus bacteria can cause disease in horses, sheep, goats, pigs, lambs, cows and other animals, its increasing importance in human infections has attracted much interest in recent years. It is mainly widespread in Southeast Asia with most human cases reported in Thailand, Malaysia, Vietnam, Cambodia, Laos, and Myanmar. In Thailand 2000 to 3000 new cases are diagnosed every year. In Malaysia, exposure to B. pseudomallei is high according to serological studies: 17-22% in farmers who are mainly rice farmers and 26% in blood donors. B. pseudomallei is a natural inhabitant of soil and water in the tropics. It is ever-present in wet or damp areas such as rice-farming areas, rubber plantations, cleared forest areas, cultivated and irrigated agricultural sites as well as drains and ditches. Deforestation and development of arable land perturbs the soil and encourages the surfacing of this bacteria. Emergence of new diseases is a real menace in the third world. Over the last 20 years, a number of old diseases have re-emerged, including tuberculosis, malaria, cholera, dysentery and pneumonia. However, we have also seen the surfacing of new diseases, for some of which there is no treatment, cure or vaccine yet. The most dramatic example of a new disease is AIDS which appeared about 35 years ago, but has since infected an estimated 24 million individuals worldwide. 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