{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T16:16:58Z","timestamp":1758817018977,"version":"3.37.3"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T00:00:00Z","timestamp":1614729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000683","name":"Royal Society of Tropical Medicine and Hygiene","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000683","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Planet Wheeler fund"},{"name":"Medical Action Myanmar"},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["106698\/Z\/14\/Z"],"award-info":[{"award-number":["106698\/Z\/14\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>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\u00a0d) and productive cough (median 30\u00a0d) than non-TB patients (median fever duration 6\u00a0d, cough 7\u00a0d). 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/trstmh\/trab024","type":"journal-article","created":{"date-parts":[[2021,2,9]],"date-time":"2021-02-09T15:58:33Z","timestamp":1612886313000},"page":"914-921","source":"Crossref","is-referenced-by-count":5,"title":["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"],"prefix":"10.1093","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0633-0986","authenticated-orcid":false,"given":"Clare E","family":"Warrell","sequence":"first","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"},{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aung Pyae","family":"Phyo","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mo Mo","family":"Win","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alistair R D","family":"McLean","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"},{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanitda","family":"Watthanaworawit","sequence":"additional","affiliation":[{"name":"Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myo Maung Maung","family":"Swe","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyaw","family":"Soe","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Htet Naing","family":"Lin","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"},{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yee Yee","family":"Aung","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chitmin Ko","family":"Ko","sequence":"additional","affiliation":[{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cho Zin","family":"Waing","sequence":"additional","affiliation":[{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaung San","family":"Linn","sequence":"additional","affiliation":[{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yadanar Phoo Wai","family":"Aung","sequence":"additional","affiliation":[{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ne Myo","family":"Aung","sequence":"additional","affiliation":[{"name":"Department of Medicine, Insein General Hospital, Min Gyi Road, Insein Township, Yangon, Myanmar"},{"name":"Department of Medicine, University of Medicine 2, Khaymar Thi Road, North Okkalapa Township, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ni Ni","family":"Tun","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"},{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A B","family":"Dance","sequence":"additional","affiliation":[{"name":"Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK"},{"name":"Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic"},{"name":"Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank M","family":"Smithuis","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"},{"name":"Medical Action Myanmar, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A","family":"Ashley","sequence":"additional","affiliation":[{"name":"Myanmar Oxford Clinical Research Unit, Yangon, Myanmar"},{"name":"Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao People's Democratic Republic"},{"name":"Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,3]]},"reference":[{"key":"2021080207535135500_bib1","first-page":"1459","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: a systematic analysis for the Global Burden of Disease Study 2015","volume-title":"Lancet.","author":"GBD 2015 Mortality and Causes of Death Collaborators","year":"2016"},{"key":"2021080207535135500_bib2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S0022172400005234","article-title":"An account of a glanders-like disease occurring in Rangoon","volume":"13","author":"Whitmore","year":"1913","journal-title":"J Hyg (Lond)."},{"key":"2021080207535135500_bib3","first-page":"296","article-title":"Morphia injector's septicaemia","volume":"52","author":"Krishnaswamy","year":"1917","journal-title":"Indian Med Gaz"},{"issue":"8","key":"2021080207535135500_bib4","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1016\/S1473-3099(19)30157-4","article-title":"Global burden of melioidosis in 2015: a systematic review and data synthesis","volume":"19","author":"Birnie","year":"2019","journal-title":"Lancet Infect Dis."},{"issue":"11","key":"2021080207535135500_bib5","doi-asserted-by":"crossref","first-page":"e900","DOI":"10.1371\/journal.pntd.0000900","article-title":"The epidemiology and clinical spectrum of melioidosis: 540 cases from the 20 year Darwin prospective study","volume":"4","author":"Currie","year":"2010","journal-title":"PLoS Negl Trop Dis."},{"issue":"11","key":"2021080207535135500_bib6","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1056\/NEJMra1204699","article-title":"Melioidosi","volume":"367","author":"Wiersinga","year":"2012","journal-title":"N Engl J Med."},{"issue":"6","key":"2021080207535135500_bib7","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.4269\/ajtmh.2005.73.1165","article-title":"Short report: disease severity and outcome of melioidosis in HIV coinfected individuals","volume":"73","author":"Chierakul","year":"2005","journal-title":"Am J Trop Med Hyg."},{"issue":"5","key":"2021080207535135500_bib8","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.4269\/ajtmh.18-0678","article-title":"A study of Burkholderia pseudomallei in the environment of farms in Thanlyin and Hmawbi townships, Myanmar","volume":"100","author":"Win","year":"2019","journal-title":"Am J Trop Med Hyg."},{"issue":"1","key":"2021080207535135500_bib9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3390\/tropicalmed4010008","article-title":"Presence of Burkholderia pseudomallei in the \u2018Granary of Myanmar\u2019","volume":"4","author":"Win","year":"2019","journal-title":"Trop Med Infect Dis."},{"issue":"1","key":"2021080207535135500_bib10","doi-asserted-by":"crossref","first-page":"16260","DOI":"10.1038\/s41598-020-73545-8","article-title":"Myanmar Burkholderia pseudomallei strains are genetically diverse and originate from Asia with phylogenetic evidence of reintroductions from neighbouring countries","volume":"10","author":"Webb","year":"2020","journal-title":"Sci Rep."},{"issue":"1","key":"2021080207535135500_bib11","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3390\/tropicalmed3010028","article-title":"Melioidosis in Myanmar","volume":"3","author":"Win","year":"2018","journal-title":"Trop Med Infect Dis"},{"issue":"5","key":"2021080207535135500_bib12","doi-asserted-by":"crossref","first-page":"983","DOI":"10.4269\/ajtmh.13-0286","article-title":"Prevalence of melioidosis in patients with suspected pulmonary tuberculosis and sputum smear negative for acid-fast bacilli in northeast Thailand","volume":"89","author":"Suntornsut","year":"2013","journal-title":"Am J Trop Med Hyg."},{"first-page":"2020","volume-title":"Global tuberculosis report 2020","author":"World Health Organization","key":"2021080207535135500_bib13"},{"volume-title":"Clinical guidelines \u2013 diagnosis and treatment manual","year":"2016","author":"M\u00e9decins Sans Fronti\u00e8res","key":"2021080207535135500_bib14"},{"issue":"3","key":"2021080207535135500_bib15","doi-asserted-by":"crossref","first-page":"e020406","DOI":"10.1136\/bmjopen-2017-020406","article-title":"Urban-rural differences in the prevalence of diabetes mellitus among 25\u201374-year-old adults of the Yangon Region, Myanmar: two cross-sectional studies","volume":"8","author":"Aung","year":"2018","journal-title":"BMJ Open."},{"issue":"11","key":"2021080207535135500_bib16","doi-asserted-by":"crossref","first-page":"3192","DOI":"10.18203\/2320-6012.ijrms20151161","article-title":"Alcohol consumption among adult males in urban area of Thanlyin Township, Yangon Region, Myanmar","volume":"3","author":"Oo","year":"2015","journal-title":"Int J Res Med Sci."},{"issue":"10225","key":"2021080207535135500_bib17","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"395","author":"GBD Chronic Kidney Disease Collaboration","year":"2020","journal-title":"Lancet."},{"issue":"6","key":"2021080207535135500_bib18","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.4269\/ajtmh.14-0025","article-title":"Evaluation of a latex agglutination assay for the identification of Burkholderia pseudomallei and Burkholderia mallei","volume":"90","author":"Duval","year":"2014","journal-title":"Am J Trop Med Hyg."},{"volume-title":"Results of nationwide TB prevalence survey Myanmar (October 2017\u2013September 2018)","year":"2019","author":"Aung","key":"2021080207535135500_bib19"},{"key":"2021080207535135500_bib20","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1186\/s12889-016-3882-3","article-title":"Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25\u201374 years old citizens in Yangon Region, Myanmar: a cross-sectional study","volume":"16","author":"Htet","year":"2016","journal-title":"BMC Public Health."},{"issue":"4","key":"2021080207535135500_bib21","doi-asserted-by":"crossref","first-page":"181","DOI":"10.5588\/pha.18.0056","article-title":"Sputum smear-positive, Xpert\u00ae MTB\/RIF-negative results: magnitude and treatment outcomes of patients in Myanmar","volume":"8","author":"Phyu","year":"2018","journal-title":"Public Health Action."},{"key":"2021080207535135500_bib22","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1186\/s12879-016-1612-1","article-title":"Variation in C-reactive protein response according to host and mycobacterial characteristics in active tuberculosis","volume":"16","author":"Brown","year":"2016","journal-title":"BMC Infect Dis."},{"issue":"14","key":"2021080207535135500_bib23","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1056\/NEJMoa1902129","article-title":"Community-wide screening for tuberculosis in a high-prevalence setting","volume":"381","author":"Marks","year":"2019","journal-title":"N Engl J Med."},{"issue":"12","key":"2021080207535135500_bib24","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.5588\/ijtld.17.0294","article-title":"Melioidosis in patients with suspected tuberculosis in Cambodia: a single-center cross-sectional study","volume":"22","author":"Pho","year":"2018","journal-title":"Int J Tuberc Lung Dis."},{"issue":"3","key":"2021080207535135500_bib25","doi-asserted-by":"crossref","first-page":"e2727","DOI":"10.1371\/journal.pntd.0002727","article-title":"Development of a prototype lateral flow immunoassay (LFI) for the rapid diagnosis of melioidosis","volume":"8","author":"Houghton","year":"2014","journal-title":"PLoS Negl Trop Dis."},{"issue":"6","key":"2021080207535135500_bib26","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1007\/s10096-018-3237-3","article-title":"Diagnostic accuracy of the InBios AMD rapid diagnostic test for the detection of Burkholderia pseudomallei antigen in grown blood culture broth","volume":"37","author":"Peeters","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis."},{"issue":"8","key":"2021080207535135500_bib27","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1099\/jmm.0.000098","article-title":"Rapid diagnostics for melioidosis: a comparative study of a novel lateral flow antigen detection assay","volume":"64","author":"Robertson","year":"2015","journal-title":"J Med Microbiol."},{"issue":"12","key":"2021080207535135500_bib28","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1093\/trstmh\/trz092","article-title":"Evaluation of the Active Melioidosis Detect\u2122 test as a point-of-care tool for the early diagnosis of melioidosis: a comparison with culture in Laos","volume":"113","author":"Rizzi","year":"2019","journal-title":"Trans R Soc Trop Med Hyg."},{"issue":"7","key":"2021080207535135500_bib29","doi-asserted-by":"crossref","first-page":"e02002","DOI":"10.1128\/JCM.02002-17","article-title":"Evaluation of a rapid diagnostic test for detection of Burkholderia pseudomallei in the Lao People's Democratic Republic","volume":"56","author":"Woods","year":"2018","journal-title":"J Clin Microbiol."},{"issue":"12","key":"2021080207535135500_bib30","first-page":"568","article-title":"Sensitivity and specificity of a lateral flow immunoassay (LFI) in serum samples for diagnosis of melioidosis","volume":"112","author":"Wongsuvan","year":"2018","journal-title":"Trans R Soc Trop Med Hyg."},{"issue":"3","key":"2021080207535135500_bib31","doi-asserted-by":"crossref","first-page":"e0194595","DOI":"10.1371\/journal.pone.0194595","article-title":"Performance evaluation of Active Melioidosis Detect-Lateral Flow Assay (AMD-LFA) for diagnosis of melioidosis in endemic settings with limited resources","volume":"13","author":"Shaw","year":"2018","journal-title":"PLoS One."},{"issue":"5","key":"2021080207535135500_bib32","doi-asserted-by":"crossref","first-page":"812","DOI":"10.4269\/ajtmh.2007.77.812","article-title":"Quantitation of B. pseudomallei in clinical samples","volume":"77","author":"Wuthiekanun","year":"2007","journal-title":"Am J Trop Med Hyg."},{"key":"2021080207535135500_bib33","doi-asserted-by":"crossref","first-page":"291","DOI":"10.2147\/DMSO.S156270","article-title":"Measurement of diabetes, prediabetes and their associated risk factors in Myanmar 2014","volume":"12","author":"Latt","year":"2019","journal-title":"Diabetes Metab Syndr Obes."},{"issue":"4","key":"2021080207535135500_bib34","doi-asserted-by":"crossref","first-page":"e448","DOI":"10.1016\/S2214-109X(18)30487-X","article-title":"Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2.3 million patients with tuberculosis","volume":"7","author":"Noubiap","year":"2019","journal-title":"Lancet Glob Health."},{"issue":"2","key":"2021080207535135500_bib35","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1093\/trstmh\/try124","article-title":"The double burden of diabetes and global infection in low and middle-income countries","volume":"113","author":"Dunachie","year":"2019","journal-title":"Trans R Soc Trop Med Hyg."},{"issue":"5","key":"2021080207535135500_bib36","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/irv.12030","article-title":"Delayed emergence of oseltamivir-resistant seasonal influenza A (H1N1) and pandemic influenza A(H1N1)pdm09 viruses in Myanmar","volume":"7","author":"Dapat","year":"2013","journal-title":"Influenza Other Respir Viruses."}],"container-title":["Transactions of The Royal Society of Tropical Medicine and Hygiene"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/115\/8\/914\/39520676\/trab024.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/trstmh\/article-pdf\/115\/8\/914\/39520676\/trab024.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T07:55:53Z","timestamp":1627890953000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/trstmh\/article\/115\/8\/914\/6157741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,3]]},"references-count":36,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,3,3]]},"published-print":{"date-parts":[[2021,8,2]]}},"URL":"https:\/\/doi.org\/10.1093\/trstmh\/trab024","relation":{},"ISSN":["0035-9203","1878-3503"],"issn-type":[{"type":"print","value":"0035-9203"},{"type":"electronic","value":"1878-3503"}],"subject":[],"published-other":{"date-parts":[[2021,8]]},"published":{"date-parts":[[2021,3,3]]}}}