Clinical Scorecard: Prevalence of Burkholderia pseudomallei Antibodies in International Travelers
At a Glance
Category
Detail
Condition
Melioidosis and serological evidence of possible exposure to Burkholderia pseudomallei.
Key Mechanisms
B. pseudomallei can be acquired through contact with contaminated soil or water by cutaneous inoculation, inhalation, or ingestion. This study measured antibodies; it did not establish how individual participants were exposed.
Target Population
International travelers aged 18 years or older from nonendemic regions who had spent at least one month in Southeast Asia.
Care Setting
The Hospital for Tropical Diseases in Bangkok, Thailand, which operates specialized travel clinics.
Key Highlights
Among 370 travelers, 49 (13.2%) met a study threshold for seropositivity: 25 (6.8%) had antibody levels classified as probable melioidosis, and 24 (6.5%) were classified as having probable environmental exposure.
All seropositive participants were clinically healthy when tested. The antibody classifications did not confirm clinical melioidosis.
Female sex, North American origin, and an underlying medical condition were independently associated with seropositivity.
A separate survey cited by the authors found antibodies in 13 of 34 U.S. Marines (approximately 38%) after an exercise in Thailand. That figure was not the result of this traveler study.
The O-polysaccharide assay may cross-react with other environmental Burkholderia species, potentially inflating the estimated B. pseudomallei-specific seroprevalence.
Guideline-Based Recommendations
The supplied paper is a cross-sectional study, not a clinical guideline. The sections below distinguish its methods and the authors’ proposals from established recommendations.
Diagnosis
The authors support considering melioidosis in the differential diagnosis of febrile returning travelers. The study used antibody tests against Hcp1 and O-polysaccharide to assess seropositivity; a positive result alone did not confirm clinical disease.
Management
The paper discusses considering travel history and possible environmental exposure when evaluating a traveler with compatible symptoms. It did not test a treatment or provide a new management protocol.
Monitoring & Follow-up
Participants were tested at one point in time. The study did not evaluate a monitoring schedule, and the role of post-travel antibody screening remains undefined.
Risks
The paper identifies diabetes, chronic lung disease, immunosuppression, and occupational exposure as established melioidosis risk factors. In this study, having at least one underlying medical condition was associated with seropositivity; the study did not determine whether seropositive travelers would develop disease.
Patient & Prescribing Data
The study enrolled 370 adults from nonendemic regions who had traveled in Southeast Asia for at least one month. It assessed questionnaire responses and blood samples, but did not evaluate prescribing or treatment outcomes. Antibodies could reflect possible exposure during the current trip or an earlier one.
Clinical Best Practices
The authors propose including melioidosis in the assessment of febrile returning travelers and discussing ways to reduce contact with soil and floodwater before travel to endemic areas. The findings do not establish routine serological screening for travelers who feel well.
Related Resources & Content
Ali QM, Zschebek G, Cagape CMS, et al. “Seroprevalence of Burkholderia pseudomallei among international travelers.” International Journal of Infectious Diseases. 2026;172:109085.
Gassiep I, Armstrong M, Norton R. “Human melioidosis.” Clinical Microbiology Reviews. 2020;33:e00006-19.
Norman FF, Chen LH. “Travel-associated melioidosis: a narrative review.” Journal of Travel Medicine. 2023;30:taad039.
Kronmann KC, Truett AA, Hale BR, Crum-Cianflone NF. “Melioidosis after brief exposure: a serologic survey in US Marines.” American Journal of Tropical Medicine and Hygiene. 2009;80:182–184.
Pumpuang A, Dunachie SJ, Phokrai P, et al. “Comparison of O-polysaccharide and hemolysin co-regulated protein as target antigens for serodiagnosis of melioidosis.” PLOS Neglected Tropical Diseases. 2017;11:e0005499.
Chen C, Fang J, Li X, et al. “Diagnostic accuracy of non-culture methods for the diagnosis of melioidosis: a systematic review and meta-analysis.” BMC Infectious Diseases. 2025;25:851.
