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

• Main Authors: Clare E. Warrell, Aung Pyae Phyo, Mo Mo Win, Alistair R.D. McLean, Wanitda Watthanaworawit, Myo Maung Maung Swe, Kyaw Soe, Htet Naing Lin, Yee Yee Aung, Chitmin Ko Ko, Cho Zin Waing, Kaung San Linn, Yadanar Phoo Wai Aung, Ne Myo Aung, Ni Ni Tun, David A.B. Dance, Frank M. Smithuis, Elizabeth A. Ashley
• Other Authors: Faculty of Tropical Medicine, Mahidol University
• Format: Article
• Published: 2022
• Subjects: Immunology and Microbiology; Medicine
• Online Access: https://repository.li.mahidol.ac.th/handle/123456789/77245

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.