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Melioidosis is endemic in at least 45 countries, but greatly under-reported. Up to 50% of cases seen in hospital die. Our Researchers at MORU have produced a rapid diagnostic test that aims to improve both diagnosis and public awareness. Better coordination between researchers and policy makers is needed to face upcoming emerging infectious diseases.

Direk Limmathurotsakul: Our Microbiology Department does research in the wide area of microbiology diseases including melioidosis, leptospirosis and scrub typhus. We do the research from the bench to the bed, up to the patients, population and policy makers. My personal area is melioidosis research. Melioidosis is a bacterial infectious disease. The bacteria is in the soil and water. People who are farmers in South East Asia are exposed to the soil all the time and they can get bacteria into their bodies, present with severe sepsis or pneumonia and they die.

Because the disease is very difficult to diagnose, patients normally come with severe sepsis or pneumonia which can be caused by many infectious diseases. You need good microbiology facilities to do the bacterial culture - to grow the bacteria. You cannot diagnose with clinical presentation, so the doctor cannot tell you upfront that you got melioidosis. You have to wait 2-7 days before the bacteria grow from your blood or from sputum or from urine. Most of the patients who die, they die quickly, within 1-2 days. When they die, patients are taken back home or to the temple, and when the culture results come back the doctors know but the patient doesn't know. So that makes people's awareness of this diseases very, very low. We see also in many developing countries we don't have microbiology facilities tied to hospitals. If you go to Africa, when you have a fever you might give one drop of blood to see if you have malaria or not; then if you don't have malaria, you get some antibiotics.

My work mainly tries to improve diagnosis and treatment. Then when you know what the disease burden is in your area, we improve public awareness, we try to connect with policy makers, and then we implement education programmes so that people can protect themselves more by wearing boots, drinking boiled water, so that we can see whether we can reduce incidence of melioidosis and save more lives.

Q: Are you or your group working on a rapid diagnostic test?

DL: Now we have a kit called a key reader that's like a mobile phone attached to a diagnostic kit. Once it's positive it will send an sms, so researchers can check how many cases you have in that area.

However, it's important not only to have this test available but also that people know that this disease is endemic in their country - and then recommend the test. For example, we saw patients in our hospital, in just one hospital: out of 400 cases per year, 200 died. But the national database report shows that only 6 cases die of melioidosis per year. That is because of the bad reporting system: doctors know that patients died but they don't write on the report. We recommended that 45 melioidosis endemic countries should not just enhance their diagnostic capacities but also enhance their national reporting systems as well.

Q: What important lines of research have emerged in the last few years?

DL: We can say for sure that we will have new emerging infectious diseases every 1-2 years. You can see, you can count: Ebola, Zika virus, maybe a new SARS, maybe a new flu soon. We should have our research ready to attack those new emerging infectious diseases, and also collaborate between the multiple researchers and organisation worldwide.

Q: Why does your line of work matter and why should we fund it?

DL: I think because microbiology is a part of infectious diseases: many infectious diseases are from bacteria, virus or parasite – not only just malaria. Also we know that it kills a lot of people worldwide and that it is preventable. These infectious diseases hit the lower and middle-income countries and a lot of poor people worldwide are dying from these diseases which we should be able to prevent. That's why we should improve our research and guide policy makers to save lives.

Q: How does your work fit into translational medicine within the department?

DL: In translational medicine, we mean that we use up-to-date advanced knowledge into the implementation so that it can save lives. So we try to bridge all of the bench work, the basic science about cells, about organelles in the cells. We try to make sure that this knowledge is not just in publications, but we take it down, we try to see whether we can improve diagnosis, we can improve treatment. And at the same time when we see a lot of patients we try to improve surveillance and give the information right to policy makers, so that at the end patients have a better life and we can improve outcome of their lives.

Q: What are the benefits of working at MORU for you as microbiologist?

DL: Would you like the beautiful answer or the real?

Q: The real.

DL: During the last 15 years that I have worked with MORU, it feels like a springboard for up-to-date advanced science into the global community. I have access to policy makers worldwide. I work with well-known professors from Oxford University and other universities from both the US and UK. That's why I think that working with an international organisation like MORU is the best experience of my life.

Direk Limmathurotsakul

Melioidosis

Dr Direk Limmathurotsakul's research focuses on the epidemiology of melioidosis, a bacterial infection caused by Burkholderia pseudomallei. Microbiological culture is required to confirm the diagnosis, and disease incidence is thus generally grossly underestimated. Dr Limmathurotsakul leads public engagement campaigns to make Thai people more aware of the disease and how to prevent it.

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