Thailand: Melioidosis - The Unknown Killer

108 images Created 29 Jun 2016

Funding for scientific research in to cures and preventatives for tropical diseases is a competitive field with the limited resources often being used in only a handful of the world’s most serious and deadly. The World Health Organisation recognises 17 other diseases that they term Neglected Tropical Diseases or NTD’s. This diverse group includes diseases such as Rabies, Leprosy (Hansen’s Disease), Leishmaniasis and Chagas Disease.

Despite NTD’s existing in 149 tropical and sub-tropical countries and affecting upwards of a billion people annually they are generally ignored and remain diseases of poverty that could easily be prevented and cured yet due to social conditions of the victim are often deadly. Then there are the diseases that don’t even make it on to the NTD list, those that are literally too neglected to be considered neglected. Meet Melioidosis – the one disease that almost no-one has heard of but definitely should have because its deadly.

Discovered in Rangoon in Myanmar in 1911 further cases were reported across Asia during the first quarter of the 20th Century. Yet it wasn’t until the 1980’s that some serious focus on the disease. This isn’t because of the small numbers that the disease kills, but because it is extremely hard to diagnose and many of the deaths it causes are mistakably labelled as other things. Experts now estimate that Melioidosis, caused by a shape-shifting bacteria, has 165,000 new cases world-wide a year and that more than half result in death. That means melioidosis kills roughly the same number as measles or dengue annually across the globe. And even more shocking than that is that its mortality rate if no treatment is received is 90% and usually within 2 days.

In fact so deadly is this soil-dwelling bacteria (B. pseudomallei) that the U.S Center of Disease Control and Prevention classified it as a microorganism that could be used as bioweapons, placing it in the same group as anthrax. Whilst it has never been used for such purposes Dr. Direk Limmathurotsakul, Head of Microbiology at Bangkok’s Mahidol Oxford Tropical Medicine Research Unit (MORU), makes it extremely hard to study as it is highly restricted by the US Government and prior permission must be received for even the smallest amounts. The other problem Dr Limmathurotsakul has is that even many Thai doctors have never heard of it and even fewer are able to diagnose it despite being the third biggest killer in the country after TB and AIDS.

In Thailand it is highly endemic in the Northeast region. Every year this agriculturally intensive area sees thousands of cases of which 40% of victims die, a percentage relatively low due to the special unit that MORU has opened in the city of Ubon Ratchatani that is very quick to diagnose. Being Thailand’s rice-basket, the high numbers in this region are linked to the millions who toil in rice paddies every year allowing for easy infection.
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