Observational study of adult respiratory infections in primary care clinics in Myanmar: understanding the burden of melioidosis, tuberculosis and other infections not covered by empirical treatment regimes. (3rd March 2021)

• Record Type: Journal Article
• Authors: Warrell, Clare E; Phyo, Aung Pyae; Win, Mo Mo; McLean, Alistair R D; Watthanaworawit, Wanitda; Swe, Myo Maung Maung; Soe, Kyaw; Lin, Htet Naing; Aung, Yee Yee; Ko, Chitmin Ko; Waing, Cho Zin; Linn, Kaung San; Aung, Yadanar Phoo Wai; Aung, Ne Myo; Tun, Ni Ni; Dance, David A B; Smithuis, Frank M; Ashley, Elizabeth A
• Is Part Of: Transactions of the Royal Society of Tropical Medicine and Hygiene. Volume 115:Number 8(2021)
• Page Start: 914
• Page End: 921
• Publication Date: 2021-03-03
• Subjects: Burkholderia pseudomallei -- influenza -- melioidosis -- Myanmar -- respiratory infection -- tuberculosis; Tropical medicine -- Periodicals; 616.9883
• DOI: 10.1093/trstmh/trab024
• Languages: English
• ISSNs: 0035-9203

Abstract

Abstract: Background: Lower respiratory infections constitute a major disease burden worldwide. Treatment is usually empiric and targeted towards typical bacterial pathogens. Understanding the prevalence of pathogens not covered by empirical treatment is important to improve diagnostic and treatment algorithms. Methods: A prospective observational study in peri-urban communities of Yangon, Myanmar was conducted between July 2018 and April 2019. Sputum specimens of 299 adults presenting with fever and productive cough were tested for Mycobacterium tuberculosis (microscopy and GeneXpert MTB/RIF [ Mycobacterium tuberculosis /resistance to rifampicin]) and Burkholderia pseudomallei (Active Melioidosis Detect Lateral Flow Assay and culture). Nasopharyngeal swabs underwent respiratory virus (influenza A, B, respiratory syncytial virus) polymerase chain reaction testing. Results: Among 299 patients, 32% (95% confidence interval [CI] 26 to 37) were diagnosed with tuberculosis (TB), including 9 rifampicin-resistant cases. TB patients presented with a longer duration of fever (median 14 d) and productive cough (median 30 d) than non-TB patients (median fever duration 6 d, cough 7 d). One case of melioidosis pneumonia was detected by rapid test and confirmed by culture. Respiratory viruses were detected in 16% (95% CI 12 to 21) of patients. Conclusions: TB was very common in this population, suggesting that microscopy and GeneXpert MTB/RIF on all sputum samples should be routinely included in diagnostic algorithms for fever and cough. Melioidosis was uncommon in this population.