Melioidosis in 6 Tsunami Survivors in Southern Thailand

• Published in: Clinical infectious diseases 2005-10, Vol.41 (7), p.982-990
• Main Authors: Chierakul, Wirongrong, Winothai, Wut, Wattanawaitunechai, Charnkij, Wuthiekanun, Vanaporn, Rugtaengan, Thaweesak, Rattanalertnavee, Jurairat, Jitpratoom, Pornlert, Chaowagul, Wipada, Singhasivanon, Pratap, White, Nicholas J., Day, Nicholas P., Peacock, Sharon J.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bacterial diseases; Biological and medical sciences; Blood; Burkholderia pseudomallei; Disasters; Female; Health risk assessment; Hospital admissions; Human bacterial diseases; Humans; Infections; Infectious diseases; Lacerations; Major Articles; Male; Medical sciences; Melioidosis; Melioidosis - diagnosis; Melioidosis - drug therapy; Melioidosis - pathology; Middle Aged; Near drowning; Pneumonia; Soil samples; Southeast Asian culture; Survivalists; Thailand; Tidal waves; Treatment Outcome; Tropical bacterial diseases; Tsunamis; Water Movements
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/432942

Background. Six cases of melioidosis were identified in survivors of the 26 December 2004 tsunami who were admitted to Takuapa General Hospital in Phangnga, a region in southern Thailand where melioidosis is not endemic. All 6 cases were associated with aspiration, and 4 were also associated with laceration. Methods. We compared the clinical, laboratory, and radiographic findings and the outcomes for these 6 patients with those for 22 patients with aspiration-related melioidosis acquired during 1987–2003 in a melioidosis-endemic region in northeast Thailand. Results of tests for detection of Burkholderia pseudomallei in soil specimens from Phangnga and from northeast Thailand were compared. Results. The 6 patients (age range, 25–65 years) presented with signs and symptoms of pneumonia 3–38 days (median duration, 6.5 days) after the tsunami. Chest radiograph findings at the onset of pneumonia were abnormal in all cases; 1 patient developed a lung abscess. B. pseudomallei was grown in blood cultures in 3 cases and in cultures of respiratory secretions in 4 cases. Two patients required ventilation and inotropes; 1 patient died. Compared with tsunami survivors, patients with aspiration-related melioidosis in northeast Thailand had a shorter interval (median duration, 1 day) between aspiration and onset of pneumonia; were more likely to exhibit shock, respiratory failure, renal failure, and/or altered consciousness (P = .03); and had a higher in-hospital mortality (64% [14 of 22 patients]; P = .07). These differences may be related to the severity of the near-drowning episode, the inhalation of sea water versus fresh water, the size of bacterial inoculum, and the possible acquisition (among tsunami survivors) of B. pseudomallei via laceration. Only 3 (0.8%) of 360 soil samples from Phangnga were positive for B. pseudomallei, compared with 26 (20%) of 133 samples from northeast Thailand (P < .0001). Conclusions. Tsunami survivors are at increased risk of melioidosis if they are injured in an environment containing B. pseudomallei.