Global dispersal of Burkholderia pseudomallei and the evolving endemicity of melioidosis in the United States of America.

Melioidosis is a clinical disease in humans and animals following infection with the soil and water bacterium Burkholderia pseudomallei. The global footprint of melioidosis has been rapidly expanding, but it remains unclear how much this represents unmasking of longstanding but previously unrecognised presence of B. pseudomallei and how much is from recent dispersal of B. pseudomallei. What is now clear is that the predicted establishment of B. pseudomallei in the southern United States has eventuated, with melioidosis endemic in Mississippi and likely to be endemic in Georgia and Texas. It is now time to move beyond concern of B. pseudomallei as a biothreat agent and to pivot towards addressing the gaps in public health responses to the enigmatic disease that it causes.