Published Date: 2005-01-27 23:50:00
Subject: PRO/EDR> Melioidosis, tsunami-related - Thailand
Archive Number: 20050127.0296
MELIOIDOSIS, TSUNAMI-RELATED - THAILAND
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 27 Jan 2005
From: Wirongrong Cheirakul <email@example.com>
Melioidosis risk among survivors of tsunami, Phangnga, Southern Thailand
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.
Assoc. Prof. Pratap Singhasivanon
Mahidol University, Bangkok.
[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]