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

Clare E. WarrellAung Pyae PhyoMo Mo WinAlistair R.D. McLeanWanitda WatthanaworawitMyo Maung Maung SweKyaw SoeHtet Naing LinYee Yee AungChitmin Ko KoCho Zin WaingKaung San LinnYadanar Phoo Wai AungNe Myo AungNi Ni TunDavid A.B. DanceFrank M. SmithuisElizabeth A. AshleyFaculty of Tropical Medicine, Mahidol UniversityLondon School of Hygiene & Tropical MedicineHospital for Tropical DiseasesMahosot Hospital, LaoNuffield Department of MedicineMyanmar Oxford Clinical Research UnitMedical Action MyanmarInsein General HospitalUniversity of Medicine 22022-08-042022-08-042021-08-01Transactions of the Royal Society of Tropical Medicine and Hygiene. Vol.115, No.8 (2021), 914-92118783503003592032-s2.0-85113278902https://repository.li.mahidol.ac.th/handle/20.500.14594/77245Background: 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.Mahidol UniversityImmunology and MicrobiologyMedicineObservational 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 regimesArticleSCOPUS10.1093/trstmh/trab024