Published Date: 2003-03-14 23:50:00
Subject: PRO/EDR> Melioidosis - Brazil (Ceara)
Archive Number: 20030314.0632

MELIOIDOSIS - BRAZIL (CEARA)
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Date: Thu, 13 Mar 2003 16:22:16 -0300
From: Marilda <mmilagres@cve.saude.sp.gov.br>
Source: No Olhar 13 Mar 2003 [in Portuguese, English summary by Mod.JW]
[edited]
<http://www.noolhar.com/opovo/ceara/232922.html>

The Ceara, Brazil State Secretary for health reported that 3 brothers, aged
10, 14, and 15 years, who died in Tejucuoca in the interior of the state,
144 km from the state capital, Fortaleza, had contracted melioidosis. A
girl of 12 was also infected but is out of danger.

The disease is caused by the bacterium _Burkholderia pseudomallei_
[formerly known as _Pseudomonas pseudomallei_- Mod.LL], which is endemic to
Southeast Asia and Australia. It has never been previously recorded in
Ceara. A team of 25 researchers, including the American Douglas L. Hatch,
are carrying out epidemiological, environmental, clinical, and laboratory
investigations in the area.

_B. pseudomallei_ was isolated from 2 of the patients. The bacteria are
found in soil and water. Infection is via ingestion or contamination
through wounds in the skin or through the mucosae.

3 Mar 2003: first case died

4 Mar 2003: second case, a boy of 10 years, hospitalized; died 7 Mar 2003

5 Mar 2003: third case died.

7 Mar 2003: girl 12 years old hospitalized.

The 3 boys had symptoms of high fever, low blood pressure, enlarged liver
and spleen.

11 Mar 2003: insecticide spraying and rat poisoning carried out in houses
and apartments in Tejucuoca.

12 Mar 2003: Lab results provide diagnosis of melioidosis.

[Byline: Raquel Chaves]

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[_B. pseudomallei_ is an environmental Gram-negative rod found in the soil
of endemic areas. Although animals such as cows, horses, and pigs may be
infected, they are not clearly relevant in transmission to
man. Transmission through the person-to-person route has not been proven.

The organism is primarily found in Southeast Asia, including Vietnam,
Indonesia, Myanmar, Thailand, Malaysia, and the Philippines. Americans
acquired the infection during the Vietnam conflict, especially in
situations where soil or dust was aerosolized, such as helicopter
landings. It is also fairly endemic in northern Australia.

It has also been described in Africa, primarily in the western
part. Although rarely detected in the western hemisphere, melioidosis has
been found sporadically in South America, including Ecuador, Bolivia, and
Colombia, as well as in Brazil (1,2). In reference 2, related to a study
of burn patients in Belo Horizonte, Brazil in 1988, _P. pseudomallei_ was
found in 3 samples taken from the burn unit's showers (soap, shower head,
and floor), but not in the 21 burn patients themselves, from whom other
Pseudomonas species were isolated. Since _B. pseudomallei_ is not spread
by insects or rodents, the preventative maneuvers used above are not likely
to be productive.

The infection tends to affect humans in rural environments such as
soldiers, farmers, and others who come into contact with contaminated soil
or water such as in rice paddies, plantations, or gardens. It is primarily
an infection of humans with underlying diseases such as alcoholism,
malnutrition, cirrhosis, and immunosuppresion (3) but can also affect
healthy individuals.

Clinically, infection due to _B. pseudomallei_ is often subclinical, but
rapidly progressive disseminated disease involving the skin, liver, or
spleen can occur. Pneumonia may be the presenting form, either acute or
chronic. The latter may present years after exposure, when the individual
is no longer in an endemic area and may look very much like pulmonary
tuberculosis. The diagnosis can be confirmed microbiologically and/or
serologically. Ceftazidime, chloramphenicol, or
trimethoprim/sulfamethoxazole can be used therapeutically.

1. de Castro AF, Campedelli Filho O, Giorgi W, Rosa CA: Melioidosis and
its causative agent: _Pseudomonas pseudomallei_. Rev Inst Med Sao Paulo.
1973;15:43-49.

2. Silva SL, Macedo OG, Damasceno CA, et al: Bacteriological evaluation
of wounds in seriously burned hospitalized patients. Rev Soc Bras Med Trop
1991;24:163-68.

3. Ashdown LR, Duffy VA, Douglas RA: Melioidosis. Med J Aust 1980;5:314-6.
- Mods.LL/JW]
............................jw/ll/jw/pg/mpp

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