Suraj Bhattarai Poster 2024

Suraj Bhattarai

Dr Suraj Bhattarai

Global Health Research & Medical Interventions for Development (GLOHMED), Nepal

Urgent Need to Implement a Simple Laboratory Algorithm to Detect Burkholderia pseudomallei in Low-resource Endemic Areas Including Nepal

 

Poster Abstract

 

Background: Melioidosis is an emerging infectious disease caused by Burkholderia pseudomallei, a gram-negative bacillus.1,2 South and South-east Asian countries, such as India, Sri Lanka, Bangladesh, China, Thailand, has the highest burden.3,4,5,6 Although Nepal shares most of its border with India where melioidosis is endemic in many parts, and that most people in the hilly and mountainous regions are agriculture oriented, the country has not formally reported melioidosis cases.

 

 

Objectives: To introduce a simple and low-cost diagnostic laboratory algorithm for the identification of B. pseudomallei cultures in low-resource health facilities.

 

Methods: A prospective cross-sectional pilot study will be conducted in two health facilities, one of which lies in the Southern plains (tarai region) bordering India, and another lies in the hilly region. Adult patients (40 years and above) with fever of unknown origin or clinical suspicion of sepsis and having at least one risk factor for melioidosis (diabetes, alcoholism, chronic kidney and lung disease) will be enrolled. Laboratory analysis: A simple microbiological screening algorithm will be applied specifically to clinical samples collected from eligible patients. This simple three-antibiotic disk test on Gram-negative, oxidase- positive rod bacteria is highly specific when applied to bacterial cultures isolated from clinical samples.7 Bacterial identification will be confirmed by conventional PCR, and isolates will further undergo genomic typing.8,9 Ethics: Local ethics approval has been obtained.

 

Study Impact: The introduction of a culture-based simple and low-cost diagnostic laboratory algorithm for the identification of B. pseudomallei targeted at samples from at-risk patients is of utmost importance. It is reasonable to focus primary efforts on blood cultures because of the high rate of bacteremic melioidosis. Funding will be sought for the sustainability of research and capacity strengthening in Nepal, including technology transfer and training in collaboration with regional and global networks like VALIDATE.

 

 

References:

1. Dance D, Limmathurotsakul D. Global burden and challenges of melioidosis. Vol. 3, Tropical Medicine and Infectious Disease. MDPI AG; 2018.

2. Gassiep I, Armstrong M, Norton R. Human Melioidosis. 2020.

3. Mohapatra PR, Mishra B. Burden of melioidosis in India and South Asia: Challenges and ways forward. Lancet Reg Health Southeast Asia. 2022.

4. Pathirage MMK, Kularatne SAM, Weerakoon KG. Melioidosis after a long silence in Sri Lanka: an environmental hazard and dilemma in diagnosis, with recovery and longitudinal follow-up for 13 years: a case report. J Med Case Rep. 2020.

5. Mukhopadhyay C, Shaw T, Varghese GM, Dance DAB. Melioidosis in South Asia (India, Nepal, Pakistan, Bhutan and Afghanistan). Vol. 3, Tropical Medicine and Infectious Disease. MDPI AG; 2018.

6. Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, Rolim DB, Bertherat E, Day NP, Peacock SJ, Hay SI. Predicted global distribution of Burkholderia pseudomallei and burden of melioidosis. Nat Microbiol. 2016.

7. Trinh TT, Hoang TS, Tran DA, et al. A simple laboratory algorithm for diagnosis of melioidosis in resource-constrained areas: a study from north-central Vietnam. Clin Microbiol Infect. 2018.

 
Biography
Suraj is a clinician researcher based in Nepal, actively collaborating with global research groups. He leads the Global Health and Clinical Research Institute in Nepal (GLOHMED), which he co-founded with a vision to promote and implement global health and clinical research in the country. Currently, Suraj's research focuses on childhood respiratory infections, point-of-care diagnostics, climate-sensitive infectious diseases such as dengue, scrub typhus, and leishmaniasis, as well as the burden of melioidosis and epidemiology and treatment of cutaneous leishmaniasis. He also works on strengthening primary and urban health systems. Suraj has contributed significantly to national reports on the vulnerability and adaptation of climate-sensitive diseases. He received his medical training in Nepal before pursuing postgraduate medical and research training in the US and UK. He holds higher education credentials in Tropical Medicine from the London School of Hygiene & Tropical Medicine (LSHTM), UK, and is currently pursuing a joint PhD in Global Health from LSHTM, UK, and Nagasaki University School of Tropical Medicine and Global Health, Japan. His PhD research focuses on point-of-care diagnostics for respiratory infections.