Adib, Siti Munirah Mohd
(2022)
Melioidosis in Kelantan : disease outcome, distribution and genotyping of burkholderia pseudomallei from patients and environments.
Masters thesis, Universiti Sains Malaysia.
Abstract
Melioidosis is an infectious disease caused by highly pathogenic soil-dwelling
bacteria known as Burkholderia pseudomallei. This infectious disease has a wide range
of non-pathognomonic clinical spectrum with high mortality rates worldwide.
Melioidosis is underdiagnosed and underreported which has become a global burden
due to the lack of awareness and knowledge among the population. Melioidosis is
endemic in Malaysia, however, there is paucity of data on the distribution pattern of
the disease and the causative agent. Therefore, this study is conducted to identify the
disease outcome, distribution and genotyping of B. pseudomallei isolates in Kelantan,
the north-eastern state of Malaysia. The demographic and clinical data of patients were
analysed by SPSS software while the genetic interrelationship between clinical and
environmental variants was analysed by MLST method. Study of a total of 70 positive
cases showed high prevalence of melioidosis among males (32.9%, n=23), middleaged
group (75.7%, n=53) and Malay ethnic group (98.6%, n=69). Diabetes mellitus
was the major comorbidity among the patients (65.7%, n=46). Mortality rate of 37.1%
(n=26) was reported, of which septicemic melioidosis carried high mortality rate.
Systemic melioidosis, formation of abscess and sepsis/septic shock were significantly
associated with the outcome of the patients. Kota Bharu district was identified as the
hotspot area of melioidosis in Kelantan. MLST analysis of 33 available clinical and
two environmental isolates of B. pseudomallei revealed 15 different sequence types
(STs) including seven new emerging novel STs. This study indicates the genetic diversity of B. pseudomallei in Kelantan with the highest ST diversity in Bachok
(67%). The most predominant genotype in the research population is ST371 (17.1%;
n=6). Even though the reported STs were not related to the districts in Kelantan, all
strains were shown to be closely related to the previously reported Southeast Asia
strains. The generated risk map with the variety of existing and novel genotypes
circulating in the population is important for the future preventive and management
plan of melioidosis in Kelantan.
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