Seroprevalence of Burkholderia pseudomallei among Adults in Coastal Areas in Southwestern India

Citation: Vandana KE, Mukhopadhyay C, Tellapragada C, Kamath A, Tipre M, Bhat V, et al. (2016) Seroprevalence of Burkholderia pseudomallei among Adults in Coastal Areas in Southwestern India. PLoS Negl Trop Dis 10(4): e0004610. doi:10.1371/journal.pntd.0004610
Published: April 14, 2016

Abstract
Bps_closeBackground: Although melioidosis, is an important disease in many Southeast Asian countries and Australia, there is limited data on its prevalence and disease burden in India. However, an increase in case reports of melioidosis in recent years indicates its endemicity in India.
Aims and methods: A population-based cross-sectional seroprevalence study was undertaken to determine the seroprevalence of B. pseudomallei by indirect haemagglutination assay and to investigate the associated risk determinants. Subjects were 711 adults aged 18 to 65 years residing in Udupi district, located in south-western coast of India.
Key results: Overall, 29% of the study subjects were seropositive (titer ≥20). Females were twice as likely to be seropositive compared to males. Rates of seroprevalence were similar in farmers and non-farmers. Besides gardening, other factors including socio-demographic, occupational and environmental factors did not show any relationship with seropositive status.
Major conclusions: There is a serological evidence of exposure to B. pseudomallei among adults in India. While the bacterium inhabits soil, exposure to the agent is not limited to farmers. Non-occupational exposure might play an important role in eliciting antibody response to the bacterium and may also be an important factor in disease causation.

Author Summary: Melioidosis is an underdiagnosed and underreported disease in India with protean clinical manifestation and high fatality. Causative agent B. pseudomallei, after environmental exposure, may cause disease or survive unnoticed for a long time in human and animal hosts. Individuals with diabetes and renal disease develop melioidosis with greater intensity and fatality. Recent increase in case reports of melioidosis in India might only be a tip of iceberg and represent small portion of a larger public health problem in the background of large number of diabetic population in the country. The paucity of data on disease prevalence has prompted us to undertake this sero-epidemiological study in a site located along the west coast of south India with heavy rainfall and rice farming as predominant agricultural activity. This site serves as a catchment for Kasturba Medical College and Hospital, Manipal, where nearly 20 to 30 cases of melioidosis are diagnosed each year. This first ever population-based seroprevalence study in India demonstrated a 29% seropositivity that is comparable with other endemic regions in Southeast Asia and Australia. Non-farmers were as likely to be seropositive as farmers. We also found a uniform seropositive status across various age groups and skill level of jobs. Females demonstrated higher seropositivity. Activities exposing the individual to environment such as gardening emerged as risk determinants of seropositivity.

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