Melioidosis as an emerging global problem

There is remarkably little known about the incidence of melioidosis outside a few countries (Thailand, Australia, Singapore and Malaysia). Presumably it is widespread in tropical south east Asia. Elsewhere there are tantalisi ng glimpses of the tip of what may be a large iceberg. Since a specific dia gnosis of melioidosis requires awareness on the part of clinicians, and the existence of a laboratory capable of isolating and identifying Burkholderi a pseudomallei, a luxury not available in most rural tropical areas, the si ze of this iceberg is likely to remain unknown for the foreseeable future. There is mounting evidence that the disease is endemic in the Indian sub-co ntinent and the Caribbean, and there have been unsubstantiated reports of r ecent cases in South Africa and the Middle East. It is unclear whether meli oidosis has really spread to such areas relatively recently, or has been th ere but unrecognised for a long time. Almost all cases diagnosed in tempera te climates have been imported from the tropics, with the exception of a un ique outbreak which occurred in France in the mid-1970s. With increasing wo rld wide travel of both humans and other animals, the potential exists for melioidosis to spread to new and fertile pastures. (C) 2000 Published by El sevier Science B.V. All rights reserved.