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Melioidosis in 6 tsunami survivors in southern Thailand.
Clin Infect Dis. 2005 Oct 01; 41(7):982-90.CI

Abstract

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.

Authors+Show Affiliations

Department of Clinical Tropical Medicine, Wellcome TrustMahidol UniversityOxford Tropical Medicine Research Programme, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16142663

Citation

Chierakul, Wirongrong, et al. "Melioidosis in 6 Tsunami Survivors in Southern Thailand." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 41, no. 7, 2005, pp. 982-90.
Chierakul W, Winothai W, Wattanawaitunechai C, et al. Melioidosis in 6 tsunami survivors in southern Thailand. Clin Infect Dis. 2005;41(7):982-90.
Chierakul, W., Winothai, W., Wattanawaitunechai, C., Wuthiekanun, V., Rugtaengan, T., Rattanalertnavee, J., Jitpratoom, P., Chaowagul, W., Singhasivanon, P., White, N. J., Day, N. P., & Peacock, S. J. (2005). Melioidosis in 6 tsunami survivors in southern Thailand. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 41(7), 982-90.
Chierakul W, et al. Melioidosis in 6 Tsunami Survivors in Southern Thailand. Clin Infect Dis. 2005 Oct 1;41(7):982-90. PubMed PMID: 16142663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Melioidosis in 6 tsunami survivors in southern Thailand. AU - Chierakul,Wirongrong, AU - Winothai,Wut, AU - Wattanawaitunechai,Charnkij, AU - Wuthiekanun,Vanaporn, AU - Rugtaengan,Thaweesak, AU - Rattanalertnavee,Jurairat, AU - Jitpratoom,Pornlert, AU - Chaowagul,Wipada, AU - Singhasivanon,Pratap, AU - White,Nicholas J, AU - Day,Nicholas P, AU - Peacock,Sharon J, Y1 - 2005/09/01/ PY - 2005/04/06/received PY - 2005/05/24/accepted PY - 2005/9/6/pubmed PY - 2006/8/5/medline PY - 2005/9/6/entrez SP - 982 EP - 90 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 41 IS - 7 N2 - 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. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/16142663/Melioidosis_in_6_tsunami_survivors_in_southern_Thailand_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/432942 DB - PRIME DP - Unbound Medicine ER -