Melioidosis in global perspective and challenges for surveillance

Over the past 40 years, it has become apparent that melioidosis is not only highly endemic in Southeast Asia and northern Australia but is also widespread elsewhere in the tropics. Modelling suggests that there could be as many as 165,000 cases in 79 countries around the world each year, leading to some 89,000 deaths, with some 44% of these occurring in South Asia. In reality, far fewer cases than this are being diagnosed. There are numerous obstacles to accurate surveillance, especially since this is an infection that predominantly affects the rural poor, who are the last people to have access to good diagnostics. The potential for Burkholderia pseudomallei to be used as a bioweapon has had beneficial spin-offs, no matter how unlikely it is ever to be used in this way. Nonetheless, melioidosis deserves to be formally recognized as a neglected tropical disease (NTD) in the hope that this will help to raise awareness, improve management, and reduce the avoidable death toll from this silent killer.