Published Date: 2005-01-27 23:50:00
Subject: PRO/EDR> Melioidosis, tsunami-related - Thailand
Archive Number: 20050127.0296
MELIOIDOSIS, TSUNAMI-RELATED - THAILAND
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Date: Thu 27 Jan 2005
From: Wirongrong Cheirakul <alwcr@diamond.mahidol.ac.th>
Melioidosis risk among survivors of tsunami, Phangnga, Southern Thailand
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Melioidosis is a serious infection caused by the Gram-negative
bacillus_Burkholderia pseudomallei_. Disease occurs most commonly in
Northeastern Thailand and Northern Australia. The causative organism is
present in soil and water in melioidosis-endemic areas where human exposure
is commonplace; infection is acquired via inhalation (including
near-drowning) or contamination of breaks in the skin.
Takuapa Hospital in Phangnga, Southern Thailand, was one of the major
referral centers for people injured during the tsunami, and saw
approximately 1000 patients on 26 Dec 2004. On 30 Dec 2004, a patient who
had suffered aspiration developed severe pneumonia, and 2 blood cultures
taken on that day were positive for _Burkholderia pseudomallei_. A further
4 patients have since been diagnosed with _B. pseudomallei_ pneumonia. All
had aspirated during the tsunami. Their age ranged from 24-65 years. 2
individuals had known risk factors for melioidosis (diabetes mellitus). All
patients are currently responding to antimicrobial treatment.
During the last 6 years, a total of 9 cases of melioidosis have been
diagnosed at Takuapa Hospital (none of which were during the preceding 12
months). This raises the possibility that individuals affected by the
tsunami are at increased risk of melioidosis. A melioidosis surveillance
team has been formed, and active clinical and serological surveillance is
now underway in the area. Previous soil sampling has demonstrated that a
small proportion of sites contain _B. pseudomallei_.
A longitudinal study of soil sampling is now underway to examine the
presence of _B. pseudomallei_ in tsunami-affected and -unaffected soil in
the Phangnga area. This work is being conducted through a collaboration
between Takuapa Hospital, The Faculty of Tropical Medicine, Mahidol
University, Bangkok, and The Wellcome Trust - Mahidol University - Oxford
Tropical Medicine Research Programme, based within the Faculty of Tropical
Medicine, Mahidol University.
All individuals affected by the tsunami may be at risk of developing
melioidosis. Given the normal mode of acquisition of the disease, people at
highest risk are likely to be those who sustained aspiration or
lacerations, particularly if the wound was contaminated with soil. The
variable and sometimes extended period of incubation prior to clinical
symptoms means that those affected by the tsunami in Thailand may have a
higher long-term risk of disease. Case reports of melioidosis in returning
travelers or indigenous peoples from Indonesia, Sri Lanka, and India
indicate that people affected by the tsunami in these areas should also be
considered at increased risk.
[Byline: Melioidosis surveillance team (Takuapa Hospital, Phangnga; Faculty
of Tropical Medicine, Mahidol University, Bangkok; Wellcome Trust - Mahidol
University - Oxford Tropical Medicine Research Programme, Faculty of
Tropical Medicine, Mahidol University, Bangkok)]
--
Wirongrong Cheirakul, MD
Department of Clinical Tropical Medicine
Mahidol University, Bangkok.
<alwcr@diamond.mahidol.ac.th>
Assoc. Prof. Pratap Singhasivanon
Mahidol University, Bangkok.
<tmpsh@.mahidol.ac.th>
[As mentioned in some of the earlier postings on the aftermath of the
tsunami, it is not at all surprising to note an upswing in cases, and more
may be reported.
Many cases of pneumonic melioidosis are related to a primary cutaneous
introduction of the bacterium, but aspiration of the organism directly into
the respiratory tract can also cause the disease. It is not stated whether
any of the affected individuals had extrapulmonary manifestations of
melioidosis. - Mod.LL]
See Also
Disease surveillance, tsunami-related - Indonesia 20050125.0266Cholera, tsunami-related - Indonesia (02): Not?, RFI 20050123.0251
Cholera, tsunami-related - Indonesia 20050118.0160
Tetanus, tsunami-related - Asia (Indonesia) (04) 20050116.0133
Melioidosis - Australia (NT) 20050116.0131
Tetanus, tsunami-related - Asia (Indonesia)(03) 20050114.0120
Wound infections, tsunami-related - Asia (02) 20050112.0109
Wound infections, tsunami-related - Asia 20050110.0079
Tetanus, tsunami-related - Asia (Indonesia)(02) 20050107.0039
Tetanus, tsunami-related - Asia (Indonesia): RFI 20050106.0030
Diarrhea, tsunami-related - Asia (India, Sri Lanka) 20050102.0005
2004
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Tsunami-related disease potential - Asia (04) 20041231.3453
Melioidosis - Mauritius 20041229.3435
Tsunami-related disease potential - Asia 20041227.3422
Melioidosis - Singapore (04) 20040917.2578
Undiagnosed illness - Taiwan (03): meliodosis 20040804.2133
Melioidosis - Singapore 20040409.0968
Melioidosis - Australia (NT) (02) 20040322.0797
Melioidosis - Australia (NT) 20040319.0770
Melioidosis - Australia (North Qld.) 20040308.0654
2003
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Melioidosis - Australia (Northern Territory) 20031217.3084
Melioidosis - Brazil (Ceara) 20030314.0632
2002
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Melioidosis - Australia (Queensland) 20020313.3732
1999
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Melioidosis, human - Singapore 1998 (02) 19990330.0512
Melioidosis, human - Singapore 1998 19990330.0507
1998
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Melioidosis - UK ex Indian subcontinent 19980905.1780
Melioidosis, fatal - Western Australia (02) 19980109.0061
Melioidosis, fatal - Western Australia 19980109.0060
.......................ll/pg/dk
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