Retrospective Analysis of Fever and Sepsis Patients from Cambodia Reveals Serological Evidence of Melioidosis

Vichaya Suttisunhakul Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;

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Phireak Hip U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Pidor Ouch U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Piseth Ly U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Chonthida Supaprom U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Agus Rachmat U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Michael Prouty U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Andrew Vaughn U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia;

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Ahreej Eltayeb Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland;
The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland;

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Sim Kheng Cambodian Communicable Disease Control, Ministry of Health, Phnom Penh, Cambodia;

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Danielle V. Clark Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland;
The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland;

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James V. Lawler Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland;
The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland;

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Narisara Chantratita Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand;

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Mary N. Burtnick Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada

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Paul J. Brett Department of Microbiology and Immunology, University of Nevada, Reno School of Medicine, Reno, Nevada

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Kevin L. Schully Naval Medical Research Center, Biological Defense Research Directorate, Ft. Detrick, Maryland;
The Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Bethesda, Maryland;

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Burkholderia pseudomallei, the etiologic agent of melioidosis, is predicted to be ubiquitous in tropical regions of the world with areas of highest endemicity throughout Southeast Asia (SEA). Nevertheless, the distribution of B. pseudomallei and the burden of melioidosis in many SEA countries remain unclear. In Cambodia, only two human endemic cases of melioidosis were reported through 2008 and since then only a few hundred cases have been described in the literature. This is in sharp contrast to the annual burden of thousands of cases in surrounding areas. To further investigate the prevalence of melioidosis in Cambodia, we used a recently developed O-polysaccharide–based rapid enzyme-linked immunosorbent assay to detect B. pseudomallei–specific antibodies in serum samples obtained from 1,316 febrile illness or sepsis patients from 10 different provinces. Based on a cutoff value derived through culture-confirmed melioidosis cases, the proportion of positive samples in our cohort was approximately 12%. Regression analysis indicated that the odds of obtaining a positive result were 2.2 times higher for males than females controlling for age and province (95% confidence interval: 1.6–3.2, P < 0.001). Consistent with this, 9.2% of females were positive versus 18.2% of males (P < 0.001). Notably, 22.5% of grain or rice farmers were positive versus 10.1% of subjects with occupations not involving regular contact with soil. Positive results varied significantly by province. Collectively, the results of this study suggest that the true burden of melioidosis in Cambodia is greater than has previously been reported.

Author Notes

Address correspondence to Kevin L. Schully, Austere Environments Consortium for Enhanced Sepsis Outcomes, NMRC-Frederick, Ft Detrick, MD 21702. E-mail: kevin.l.schully.ctr@mail.mil

Authors’ addresses: Vichaya Suttisunhakul and Narisara Chantratita, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, E-mails: patoandcat@hotmail.com and narisara@tropmedres.ac. Phireak Hip, Pidor Ouch, Piseth Ly, Chonthida Supaprom, Agus Rachmat, Michael Prouty, and Andrew Vaughn, U.S. Naval Medical Research Unit Two, Detachment Phnom Penh, Phnom Penh, Cambodia, E-mails: phireak@namru2.org.kh, pidor.ouch.ctr@namru2.org.kh, piseth.ly.ctr@namru2.org.kh, chonthida.supaprom.ctr@namru2.org.kh, agus.rachmat.ctr@namru2.org.kh, michael.g.prouty2.mil@mail.mil, and andrew.f.vaughn2.mil@mail.mil. Ahreej Eltayeb, Danielle V. Clark, James V. Lawler, and Kevin L. Schully, NMRC-Frederick, ACESO, Frederick, MD, and The Austere Environments Consortium for Enhanced Sepsis Outcomes, ACESO, Bethesda, MD, E-mails: aeltayeb@hivresearch.org, dclark@aceso-sepsis.org, jvlawler92@gmail.com, and kevin.l.schully.ctr@mail.mil. Sim Kheng, Ministry of Health, Cambodian Communicable Disease Control, Phnom Penh, Cambodia, E-mail: khengsim@gmail.com. Paul J. Brett and Mary N. Burtnick, University of Nevada, Reno School of Medicine, Department of Microbiology and Immunology, Reno, NV, E-mails: pbrett@med.unr.edu and mburtnick@med.unr.edu.

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