Number of deaths by each country due to<unk>  in 2018<unk>  is an understudied disease that remains endemic in developing countries. In 2015, the International<unk>  Society was formed to raise awareness of the disease. In 2016, a statistical model was developed which showed that the number is 165,000 cases per year with 138,000 of those occurring in East and South Asia and the Pacific. In about half of those cases (54% or 89,000), people will die. Under-reporting is a common problem as only 1,300 cases were reported worldwide since 2010, which is less than 1% of the projected incidence based on the modeling. Lack of laboratory diagnostic capabilities and lack of disease awareness amongst health care providers also causes underdiagnosis. Even if bacterial cultures turn positive for B. pesudomallei, they can be discarded as contaminants especially in laboratories in non-endemic areas. As of 2018,<unk>  is not included in the WHO list of neglected tropical diseases. Geography<unk>  is endemic in parts of Southeast Asia, including Thailand, Laos, Singapore, Brunei, Malaysia, Myanmar and Vietnam), southern China, Taiwan and northern Australia. Heavy rainfall can increase its extent into central Australia. India, and sporadic cases in South America. A total of 51 cases of<unk>  were reported in Bangladesh from 1961–2017. Nonetheless, lack of awareness and resources gives rise to underdiagnosis of the disease in the country. As of 2018, the true burden of<unk>  in Africa and Middle East remained unknown due to low amount of data. There were 24 African countries and three Middle Eastern countries predicted to be endemic with<unk> , however not a single case was reported from them. In Europe, more than half of the<unk>  cases are imported from Thailand. In the United States, two historical cases (1950 and 1971) and three recent cases (2010, 2011, 2013) were reported amongst people that did not travel overseas. Despite extensive investigations, the source of<unk>  was never confirmed. One possible explanation was infection through importation of medicinal plant products or exotic reptiles. In 2021, four states each reported one case, of which two were fatal, among patients with no recent history of international travel; the US CDC found B. pseudomallei in a scented "room spray" in one patient's home. The cluster, which occurred over a few months, was eventually traced to lavender and chamomile scented aromatherapy spray from Better Homes and Gardens imported from India. One case died of septic shock, another one died from disseminated<unk>  complicated by Covid-19 infection, the other two cases had a prolonged ICU stay with neurologic complications, septic arthritis and osteomyelitis. Age, risk factors<unk>  is found in all age groups. For Australia and Thailand, the median age of infection is at 50 years; 5 to 10% of the patients are less than 15 years. The single most important risk factor for developing<unk>  is diabetes mellitus, followed by hazardous alcohol use, chronic kidney disease, and chronic lung disease. Greater than 50% of people with<unk>  have diabetes; diabetics have a 12-fold increased risk of contracting<unk> . Diabetes decreases the ability of macrophages to fight the bacteria and reduces T helper cell production. Excessive release of tumor necrosis factor alpha and interleukin 12 by mononuclear cells increases the risk of septic shock. The diabetes drug glibenclamide can also blunt monocyte's inflammatory responses. Other risk factors include thalassaemia, occupational exposure (e.g. rice paddy farmers), recreational exposure to soil, water, being male, age greater than 45 years, and prolonged steroid use/immunosuppression, but 8% of children and 20% of adults with<unk>  have no risk factors. HIV infection does not predispose to<unk> . Infant cases have been reported possibly due to mother-to-child transmission, community-acquired infection, or healthcare-associated infection. Those who are well may also be infected with B. pseudomallei. For example, 25% of children staying in endemic areas started producing antibodies against B. pseudomallei between 6 months and 4 years old, suggesting they were exposed to it over this time. This means that many people without symptoms will test positive in serology tests in endemic areas. In Thailand, the seropositivity rate exceeds 50%, while in Australia, the seropositivity rate is only 5%. The disease is clearly associated with increased rainfall, with the number of cases rising following increased precipitation. Severe rainfall increases the concentration of the bacteria in the topsoil, thus increasing the risk of transmitting the bacteria through the air.
Melioidosis
Sarcoidosis
Tuberculosis
Gamasoidosis
Amyloidosis
Miliary tuberculosis
Chronic pulmonary aspergillosis
Extrapulmonary tuberculosis