The global disease burden of melioidosis is severely underestimated and the disease is present in many more countries than previously thought, reports a paper published online in Nature Microbiology this week. The study suggests that, globally, the annual number of deaths from melioidosis-caused by the highly pathogenic bacterium Burkholderia pseudomallei-is similar to measles and far greater than dengue infection.

Intrinsically resistant to a wide range of antibiotics, B. pseudomallei is commonly found in soils in Southeast Asia and Northern Australia but can be spread to non-endemic areas through the importation of infected animals. As melioidosis is also difficult to diagnose, the global distribution of B. pseudomallei and global disease burden of melioidosis has proved difficult to assess.

Direk Limmathurotsakul and colleagues map recorded melioidosis cases (human and animal) and environmental reports of B. pseudomallei-published between 1910 and 2014-to estimate that melioidosis is severely under-reported in the 45 countries where it has already been reported, and that it is also present in an additional 34 countries that have never reported a case. The authors estimate that there are 165,000 human melioidosis cases per year worldwide, of which 89,000 will be fatal. They suggest these results highlight the need for this disease to be given a higher priority by international health organizations and policy makers.