Soil fever The forgotten disease of melioidosis

Soil fever or melioidosis is a (sub)tropical infectious disease caused by the environmental bacterium Burkholderia pseudomallei. The aim of this thesis is provide epidemiological, clinical, anthropological, and policy-relevant insights into melioidosis. First, the history of melioidosis and its global disease burden are reviewed. Although first recognized >100 years ago, melioidosis remains so neglected that it is not recognized by the World Health Organization (WHO) as a neglected tropical disease (NTD), despite an estimated disease burden exceeding that of other officially recognized NTDs. Therefore, arguments are presented for recognizing melioidosis under this status, along with a roadmap to reduce its burden. Secondly, uncovering the global epidemiology of B. pseudomallei requires geographical confirmation of its presence. To this end, this thesis describes the successful environmental isolation of the closely related B. thailandensis in Suriname and both B. pseudomallei and B. thailandensis in Nigeria. In line, a subsequent seroepidemiologic study in Nigeria showed a serologic response against B. pseudomallei in roughly a third of healthy individuals. Thirdly, the clinical diversity of traveler-associated melioidosis in the Netherlands is presented followed by a graphical overview of the histopathology of melioidosis. Lastly, the multifaceted impact of melioidosis on affected individuals is visualized through ethnographic fieldwork in Sri Lanka. In conclusion, we advocate that melioidosis should be recognized as an NTD by the WHO.