Deadly Disease Goes Unrecognized, Study Finds

New research shows that Cam­bodian health professionals struggle to properly diagnose and treat melioidosis, a deadly condition caused by bacteria common in rural areas.

Though little studied in Cam­bodia, the scale of health effects from melioidosis is likely to be significant, a researcher said, as studies in nearby provinces in Thailand show that infection is widespread.

The study, published last month in the medical journal BMC In­fectious Diseases and conducted by researchers at the Pasteur In­stitute in Phnom Penh, followed 39 patients from the Takeo and Kom­­pong Cham provincial hospitals for up to 18 months after they were diagnosed with melioidosis-related respiratory infections.

Of these patients, 24 died and only one of the deceased had re­ceived the appropriate antibiotics, the study found. It noted that mel­ioidosis’ overall fatality rate of 62 percent in Cambodia was high, compared to about 40 percent in Thailand.

“These high rates likely were related to multiple factors, including inadequate antibiotic therapy, low awareness [among health workers] of the disease and limited access to health care services,” researchers wrote.

Effective medicine, in particular the antibiotic ceftazidime, could cut fatality rates in half, they said. But in Cambodia this is “costly and not available in the National Essential drugs list,” a list of government-approved and less expensive medicines often purchased through arrangements by health authorities.

Dr Vong Sirenda, a lead author of the study, said more research should be done to better understand the effects of melioidosis, and that training for health professionals, greater access to medicine and increased laboratory capacity to test for the disease were also needed

“We hope that the health authorities will be alerted by this disease and that we can come up soon with more data on the extent of infection,” Dr Sirenda said in an e-mail this week.

The bacterium that causes melioidosis is endemic in Southeast Asia and is transmitted from contact with water and mud. Rural populations reliant on rice farming and fishing are at significant risk of infection.

In Thailand, the health burden of melioidosis is known to be “huge,” Dr Sirenda said. But in Cambodia, he said, melioidosis is often not properly diagnosed and data on the disease is lacking as only “a handful of public hospitals” have a laboratory to conduct necessary tests.

Thailand’s northeastern provinces have the world’s highest recorded incidence of melioidosis, and Ubon Ratchathani province, which borders Cambodia’s Preah Vihear province, had 21.3 cases of melioidosis per 100,000 people in 2006, according to a study by Mahidol University in Bangkok.

Undiagnosed, melioidosis can cause an acute infection or remain in the body for many years only to surface when a different medical condition weakens the body. It then leads to often-fatal respiratory infections or septicemia.

“You can be infected at a young age and develop disease when you get older,” Dr Sirenda said, adding that due to the very high prevalence of diabetes in Cambodia, melioidosis often affects diabetics here. “Your risk for developing the disease would dramatically increased if you’re diabetic.”

About 352,000 Cambodians live with diabetes, according to the International Diabetes Federation’s 2009 Diabetes Atlas.

Thir Kruy, secretary of state at the Health Ministry, acknowledged that the disease was under-diagnosed and that data on its prevalence were lacking.

“The symptoms are not recognized and it is hard to tell if it is this disease. The government is trying to disseminate information about the disease and find out its root cause,” he said, adding that it is “a quiet disease” that did not have obvious, large-scale effects.

Denis Laurent, an assistant to Dr Beat Richner, director of the Kantha Bopha children’s hospitals in Phnom Penh and Siem Reap, said melioidosis was rarely a health concern in children and stressed that tuberculosis and typhoid were of much greater concern.

Dr Nima Asgari, a public health expert at WHO, said ongoing efforts to improve overall capacity of medical professionals and health facilities would help achieve better diagnosis and treatment of melioidosis.

He said however, that WHO and the government had held a workshop last year to train medical workers in recognizing melioidosis. “There have been steps that we have been taking, but there’s still a long way to go,” Dr Asgari said.


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