Tropical fever in remote tropics: tuberculosis or melioidosis, it depends on the lab
Jeffrey Warner A B and Catherine Rush A CA College of Public Health, Medical and Veterinary Sciences and Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld, Australia
B Email: jeffrey.warner@jcu.edu.au
C Email: catherine.rush@jcu.edu.au
Microbiology Australia 42(4) 173-178 https://doi.org/10.1071/MA21049
Submitted: 16 August 2021 Accepted: 22 September 2021 Published: 12 November 2021
Journal Compilation © The Authors 2021 Open Access CC BY-NC-ND, published (by CSIRO Publishing) on behalf of the ASM
Abstract
Diagnostics tests used to identify the cause of infection using proteomics and genomics have revolutionised microbiology laboratories in recent times. However, approaches to build the capacity of clinical microbiology services in the rural tropics by simply transplanting these approaches have proven difficult to sustain. Tropical fever in the remote tropics is, by definition, a clinical diagnosis where the aetiology of fever is not known, treatment is empirical, guided by clinical suspicion with treatment failure often attributed to incorrect diagnosis or antimicrobial resistance. Tuberculosis (TB) in rural Papua New Guinea (PNG) is mostly diagnosed clinically, perhaps supported by microscopy. In fact, a ‘tuberculosis patient’ in rural PNG is included in the TB register upon commencement of TB treatment with or without any laboratory-based evidence of infection. The roll-out of GeneXpert is continuing to transform TB diagnostic certainty in TB endemic communities. Melioidosis is endemic in tropical regions and is increasingly reported to mimic TB. Isolation and identification of the causative agent Burkholderia pseudomallei remains the gold standard. Here, we discuss the increasing divide between rural and urban approaches to laboratory-based infection diagnosis using these two enigmatic tropical infectious diseases, in rural PNG, as examples.
References
[1] Australian Institute of Health and Welfare (AIHW) (2020) Rural and remote health. Australian Government Canberra. https://www.aihw.gov.au/reports/australias-health/rural-and-remote-health[2] Dancer, S.J. et al. (2015) Microbiology service centralization: a step too far. J. Hosp. Infect. 91, 292–298.
| Microbiology service centralization: a step too far.Crossref | GoogleScholarGoogle Scholar | 26520590PubMed |
[3] Robinson, A. et al. (1999) Controversies affecting the future practice of clinical microbiology. J. Clin. Microbiol. 37, 883–889.
| Controversies affecting the future practice of clinical microbiology.Crossref | GoogleScholarGoogle Scholar | 10074496PubMed |
[4] The Lancet (2015) Rural health inequities: data and decisions. Lancet 385, 1803.
| 25987137PubMed |
[5] Grundy, J. et al. (2019) Independent State of Papua New Guinea Health System Review. World Health Organization. Regional Office for South-East Asia. https://apps.who.int/iris/handle/10665/280088
[6] Currie, B.J. (2015) Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment. Semin. Respir. Crit. Care Med. 36, 111–125.
| Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment.Crossref | GoogleScholarGoogle Scholar | 25643275PubMed |
[7] Ferguson, J.K. et al. (2020) Quality microbiological diagnostics and antimicrobial susceptibility testing, an essential component of antimicrobial resistance surveillance and control efforts in Pacific island nations. Western Pac. Surveill. Response J. 11, 41–46.
| Quality microbiological diagnostics and antimicrobial susceptibility testing, an essential component of antimicrobial resistance surveillance and control efforts in Pacific island nations.Crossref | GoogleScholarGoogle Scholar | 32963890PubMed |
[8] O’Neill, J. (2016) Tackling drug-resistant infections globally: Final report and recommendations. HM Government, London, UK. https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf
[9] World Health Organization (2020) Global tuberculosis report 2020. World Health Organization, Geneva. https://www.who.int/publications/i/item/9789240013131
[10] Albert, H. et al. (2016) Development, roll-out and impact of Xpert MTB/RIF for tuberculosis: what lessons have we learnt and how can we do better? Eur. Respir. J. 48, 516.
| Development, roll-out and impact of Xpert MTB/RIF for tuberculosis: what lessons have we learnt and how can we do better?Crossref | GoogleScholarGoogle Scholar | 27418550PubMed |
[11] Lavu, E.K. et al. (2019) Drug-resistant tuberculosis diagnosis since Xpert® MTB/RIF introduction in Papua New Guinea, 2012-2017. Public Health Action 9, S12–S18.
| Drug-resistant tuberculosis diagnosis since Xpert® MTB/RIF introduction in Papua New Guinea, 2012-2017.Crossref | GoogleScholarGoogle Scholar | 31579644PubMed |
[12] Currie, B.J. et al. (2010) The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin Prospective Study. PLoS Negl. Trop. Dis. 4, e900.
| The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin Prospective Study.Crossref | GoogleScholarGoogle Scholar | 21152057PubMed |
[13] Warner, J.M. and Currie, B.J. (2018) Melioidosis in Papua New Guinea and Oceania. Trop. Med. Infect. Dis. 3, 34.
| Melioidosis in Papua New Guinea and Oceania.Crossref | GoogleScholarGoogle Scholar |
[14] Cheng, A.C. et al. (2006) Extreme weather events and environmental contamination are associated with case-clusters of melioidosis in the Northern Territory of Australia. Int. J. Epidemiol. 35, 323–329.
| Extreme weather events and environmental contamination are associated with case-clusters of melioidosis in the Northern Territory of Australia.Crossref | GoogleScholarGoogle Scholar | 16326823PubMed |
[15] Stewart, J.D. et al. (2017) Melioidosis in far north Queensland is not correlated with severe weather events. Med. J. Aust. 207, 394.
| Melioidosis in far north Queensland is not correlated with severe weather events.Crossref | GoogleScholarGoogle Scholar | 29092705PubMed |
[16] Yee, K.C. et al. (1988) Melioidosis, the great mimicker: a report of 10 cases from Malaysia. J. Trop. Med. Hyg. 91, 249–254.
| 3184245PubMed |
[17] Warner, J.M. et al. (2010) Melioidosis--an uncommon but also under-recognized cause of pneumonia in Papua New Guinea. P. N. G. Med. J. 53, 176–179.
| 23163189PubMed |
[18] Diefenbach-Elstob, T. et al. (2017) Fieldwork in isolated locations and under resourced settings: Practical insights from research in the remote Gogodala homelands of Papua New Guinea. SAGE Research Methods Cases.
[19] Diefenbach-Elstob, T. et al. (2018) The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea. Trop. Med. Int. Health 23, 1022–1032.
| The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea.Crossref | GoogleScholarGoogle Scholar | 29920858PubMed |
[20] Diefenbach-Elstob, T. et al. (2019) Molecular evidence of drug-resistant tuberculosis in the Balimo region of Papua New Guinea. Trop. Med. Infect. Dis. 4, 33.
| Molecular evidence of drug-resistant tuberculosis in the Balimo region of Papua New Guinea.Crossref | GoogleScholarGoogle Scholar |
[21] Stanton, A.T. and Fletcher, W. (1925) Melioidosis and its relation to glanders. J. Hyg. (Lond.) 23, 347–363.
| 20474845PubMed |
[22] Khaira, B.S. et al. (1959) Melioidosis. BMJ 1, 949–952.
| Melioidosis.Crossref | GoogleScholarGoogle Scholar | 13638596PubMed |
[23] Currie, B. (1993) Melioidosis in Papua New Guinea: is it less common than in tropical Australia? Trans. R. Soc. Trop. Med. Hyg. 87, 417.
| Melioidosis in Papua New Guinea: is it less common than in tropical Australia?Crossref | GoogleScholarGoogle Scholar | 8249067PubMed |
[24] Warner, J.M. et al. (2007) Melioidosis in a rural community of Western Province, Papua New Guinea. Trans. R. Soc. Trop. Med. Hyg. 101, 809–813.
| Melioidosis in a rural community of Western Province, Papua New Guinea.Crossref | GoogleScholarGoogle Scholar | 17499321PubMed |
[25] Warner, J.M. et al. (2008) The epidemiology of melioidosis in the Balimo region of Papua New Guinea. Epidemiol. Infect. 136, 965–971.
| The epidemiology of melioidosis in the Balimo region of Papua New Guinea.Crossref | GoogleScholarGoogle Scholar | 17714600PubMed |
[26] Jenjaroen, K. et al. (2015) T-cell responses ae associated with survival in acute melioidosis patients. PLoS Negl. Trop. Dis. 9, e0004152.
| T-cell responses ae associated with survival in acute melioidosis patients.Crossref | GoogleScholarGoogle Scholar | 26495852PubMed |
[27] Koh, G.C.K.W. et al. (2013) Host responses to melioidosis and tuberculosis are both dominated by interferon-mediated signaling. PLoS One 8, e54961.
| Host responses to melioidosis and tuberculosis are both dominated by interferon-mediated signaling.Crossref | GoogleScholarGoogle Scholar |
[28] Barnes, J.L. et al. (2004) Adaptive immunity in melioidosis: a possible role for T cells in determining outcome of infection with Burkholderia pseudomallei. Clin. Immunol. 113, 22–28.
| Adaptive immunity in melioidosis: a possible role for T cells in determining outcome of infection with Burkholderia pseudomallei.Crossref | GoogleScholarGoogle Scholar | 15380526PubMed |
