Jelmer Savelkoel, PhD Candidate at the Center for Experimental and Molecular Medicine (CEMM), is one of the two UvA Thesis Prize winners of 2022. In his paper A call to action: time to recognize melioidosis as a neglected tropical disease, Jelmer argues for giving melioidosis the status of neglected tropical disease (NTD).

At the time of his medical studies, Jelmer attended a talk by Prof. Joost Wiersinga about the disease melioidosis. This immediately got Jelmer interested due to the combination of clinical, environmental and global health aspects that prove to be essential in understanding this disease. Melioidosis is a tropical infectious disease caused by the soil bacterium called Burkholderia pseudomallei. When this bacterium enters the body via inoculation, inhalation or ingestion the disease can become apparent in a number of ways. It often leads to pneumonia, blood poisoning, and abscess formation. The only way to accurately diagnose melioidosis is by culture in a microbiology laboratory.

The occurrence of the disease in a particular country can be established by the collection of environmental samples accompanied by serological and microbiological surveillance studies. It’s extremely important to establish endemicity so health professionals can be made aware of the existence of melioidosis as it presents oftentimes with non-specific symptoms. Every year, an estimated 165,000 people are infected with melioidosis, 89,000 die.

A call to action

Jelmer was awarded the UvA Thesis Prize because of the social relevance of his work. He sees the award as a recognition for the disease melioidosis. Currently, melioidosis is not on the WHO list, while the disease burden of melioidosis seems to be higher than many recognized neglected tropical diseases (NTDs). In his work, Jelmer took a look at WHO criteria for including a disease on the list of NTDs and whether melioidosis meets these criteria. Jelmer and his colleagues believe it does. Jelmer: "Awareness in endemic countries is the first step in reducing the global health burden of melioidosis.”

This is why Jelmer and his colleagues are making efforts to get melioidosis on the WHO list. Melioidosis mortality in endemic countries can be as high as 50%. "But we also know the story can be different. In northern Australia – a region where melioidosis is prevalent – they have been able to reduce mortality rates because of extensive experience in treating melioidosis patients and adequate resources for diagnosis and treatment. In most countries where melioidosis occurs, adequate resources are not available, or the disease is misdiagnosed", Jelmer states.

Melioidosis deserves to be officially recognized as a neglected tropical disease by WHO to end the continued under recognition.
Jelmer Savelkoel
PhD Candidate at the Center for Experimental and Molecular Medicine (CEMM)

Impact of melioidosis on the daily lives of patients

With the prize money he received from the UvA Thesis Prize, Jelmer wants to raise awareness of melioidosis. Together with his colleagues he wants to perform an ethnographic study. "Melioidosis is a serious infection that requires long-term treatment and we want to explore how this influences the day-to-day lives of the patient. We want to pay special attention to the societal point of view: what if the breadwinner of a family acquires melioidosis, how does this impact the family?”

The Grassroot Grant – recently awarded to Jelmer and his colleagues – is made available by the UvA to develop educational material and in this case links education and research. “This opportunity allows us to provide students with a patient perspective that is so important considering the social and societal aspect of tropical diseases. The outcomes of the ethnographic study will be used to develop educational material. We also would like to make a film that illustrates what melioidosis means for patients.”

Melioidosis research in Nigeria

In addition to the ethnographic study, Jelmer is working on environmental and clinical studies in Nigeria. Traditionally, melioidosis is a disease linked to southeast Asia and northern Australia where it can affect mainly farmers and people with underlying health conditions, such as people with diabetes and chronic liver, lung and kidney disease. In recent years there has been increasing evidence that the disease is also endemic in African and South American countries. In their study, Jelmer and colleagues aim to demonstrate the clinical importance of melioidosis in Nigeria. They use the approach as mentioned at the beginning of this article and combine environmental soil sampling, demonstrating antibodies in the blood of the population and hopefully detect the pathogen in the microbiology laboratory as part of a microbiological surveillance. "A similar study setup has never been performed in Nigeria."

The relationship between art and clinical reasoning

In addition to his fascination for the disease melioidosis, Jelmer enjoys art in his spare time. Jelmer: "Once I read an article explaining that appreciating art can enhance your clinical reasoning skills. You learn to look at details and try to interpret meaning which is also essential for patient care. In my opinion, small details in patient care can even be vital. Since then, I have been an avid museum visitor, my favorite museum is the Kröller-Muller Museum of modern and contemporary art, located in De Hoge Veluwe National Park in Otterlo, the Netherlands."

The results of Jelmer’s work were recently published in The Lancet Infectious Diseases.

Text: Esmée Vesseur

Image: Michael Niamut