A new study published this week in Nature Microbiology has served as a wake-up call as to the possible prevalence of Burkholderia pseudomallei, a highly pathogenic bacterium that causes melioidosis.
Typically found in the soil, and thought to be endemic to Southeast Asia and Australia, the study suggests B. pseudomallei may be severely underreported and is likely present in nearly 80 countries across the globe.
The study estimates there are 165,000 human melioidosis cases per year worldwide, from which 89,000 people die. “The large numbers of estimated cases and fatalities emphasize that the disease warrants renewed attention from public health officials and policy makers.”
The researchers also predicted that several areas in the U.S., covering southern parts of Florida, Louisiana and Texas, are suitable for B. pseudomallei establishment. The few cases of Melioidosis reported in the U.S. each year are usually attributed to travel in endemic areas. But CDC noted in a report last year that several cases could not be linked to travel, “possibly indicating unrecognized sources of exposure in the United States.”
U.S. Investments in Diagnostics, Countermeasures
Part of the NIAID Category A, B, and C Priority Pathogen List, B. pseudomallei has been on the radar for years in the biodefense community as a potential bioterrorism weapon, and for the difficulty in treatment of those infected. The bacteria are highly resistant to antibiotic treatment regimens and mortality rates from Melioidosis are as high as 40 percent.
The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), includes the agent in Broad Agency Announcement (BAA) funding efforts for priority medical countermeasure development.
The Biomedical Advanced Research and Development Authority (BARDA), for example, in 2014 backed development of Carbavance as a medical countermeasure for Melioidosis, Glanders and other antibiotic-resistant infections. The initial commitment was $19.8 million, extendable to $90 million over the five years.
The Department of Defense has included the pathogen as a target for biodetection technology investments, and for medical countermeasure research. The concern is driven not only from potential terrorist usage of the bacteria; but also from natural exposures to military personnel while deployed to endemic areas.
In addition, B. pseudomallei and B. mallei are both on the hot list of targets under the new DoD CBRN Medical Countermeasure Consortium effort, which seeks to develop public-private partnerships to enable technologies that can be applied to development of FDA approved diagnostics and treatments.
The DHS Directorate of Science and Technology (S&T) in March 2015 issued a BAA for Clinical Assays for Ebola, Anthrax and Melioidosis, and have made investments in first responder detection technologies, including an Oct 2014 award to Tetracore for lateral flow assay development, and various other Public Health Actionable Assay (PHAA) investments.
While by no means a comprehensive list, the above examples provide some context as to the importance to the U.S. in improving countermeasures for this deadly bacteria.