To Be Imported or to Be Endemic? That is the Question

Melioidosis is a potentially fatal infectious disease caused by the environmental anaerobic Gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic to areas of northern Australia and Southeast Asia, including Thailand, Malaysia, Cambodia, Laos, and Vietnam [1]. B. pseudomallei dwells in soil andwater, and is transmitted via percutaneous inoculation, inhalation, or the ingestion of infected food or water. Consequently, individuals in regular contact with soil and water are frequently affected [2]. Melioidosis shows a wide range of clinical manifestations with varying severity. Pneumonia is the most frequent presenting feature, followed by genitourinary infection, skin infection, septic arthritis, and osteomyelitis [3]. Disseminated abscess formation in the internal organs is the hallmark of melioidosis. With increasing international travel and migration, cases of melioidosis imported from endemic regions are being reported regularly, and it is important that physicians be more aware of melioidosis. In South Korea, there were 11 known cases of melioidosis from 2003 to 2014, and the first six of these cases have been reported previously [4e9]. Here, we summarize the epidemiological and clinical manifestations of imported melioidosis in South Korea. The authors summarize 11 cases of melioidosis reported in South Korea from 2003 to 2014. They traced epidemiological investigations on every patient reported to the national surveillance system since 2011. A systematic literature searchwas followed to identifymelioidosis cases that occurred before 2011. The overall fatality rate was 36.4%.All of the patients had visited Southeast Asiawhere melioidosis is endemic. They had stayed in the endemic region ranged from 4 days to 20 years. Of the seven patients who developed initial symptoms after returning to South Korea, the time interval from returning to symptom onset ranged from 1 day to 3 years. The remaining four patients developed symptoms during their stay in the endemic region and were diagnosed with melioidosis in South Korea. Seven (63.6%) patients possessed at least