LAUSR

BACKGROUND Melioidosis, caused by Burkholderia pseudomallei, may be considered a neglected tropical disease which remains underdiagnosed in many geographical areas. Travelers can act as sentinels of disease activity and data from imported cases may help complete the global map of melioidosis. METHODS A literature search for imported melioidosis for the period 2016-2022 was performed in PubMed and Google Scholar. RESULTS In total, 137 reports of melioidosis associated with travel were identified. The majority were males (71%) and associated with exposure in Asia (77%) (mainly Thailand, 41%, and India, 9%). A minority acquired the infection in the Americas-Caribbean area (6%), Africa (5%) and Oceania (2%). The most frequent comorbidity was diabetes mellitus (25%) followed by underlying pulmonary, liver or renal disease (8%, 5% and 3%, respectively). Alcohol/tobacco use were noted for 7 and 6 patients, respectively (5%). Five patients (4%) had associated non-HIV related immunosuppression and 3 patients (2%) had HIV infection. One patient (0.8%) had concomitant COVID-19. A proportion (27%) had no underlying diseases. The most frequent clinical presentations included pneumonia (35%), sepsis (30%), and skin/soft tissue infections (14%). Most developed symptoms <1 week after return (55%) and 29% developed symptoms >12 weeks after. Ceftazidime and meropenem were the main treatments used during the intensive intravenous phase (52% and 41% of patients, respectively) and the majority (82%) received co-trimoxazole alone/combination, for the eradication phase. Most patients had a favorable outcome/survived (87%). The search also retrieved cases in imported animals or cases secondary to imported commercial products. CONCLUSIONS As post-pandemic travel soars, health professionals should be aware of the possibility of imported melioidosis with its diverse presentations. Currently no licensed vaccine is available so prevention in travelers should focus on protective measures (avoiding contact with soil/stagnant water in endemic areas). Biological samples from suspected cases require processing in biosafety level 3 facilities.