An investigation of confirmed melioidosis case, Kura Sub District, Kuraburi District, Phang Nga Province, Thailand, April–May 2015

Abstract

Background: On 22 April 2015 epidemiology section of Kuraburi chaipat Hospital received a notification of hemoculture-confirmed melioidosis in a septic patient at in-patient department. Surveillance and rapid response team started outbreak investigation during April 23 to May 22, 2015 with aimed to confirmed outbreak, describe to disease burden, identify source of infection and implement prevention and control measure.
Methods: We conducted descriptive epidemiology study by reviewed medical records and interviewed the case and his relatives. We did active case finding in the family and co-workers by standard case definition. Laboratory testing of melioidosis IgM by IFA was done in all family members and co-workers. Environmental investigation was also carried out. Soil and water samples in case’s habitat and working place were sent to a university for Burkholderia pseudomallei culture.
Results: A hemoculture-confirmed melioidosis case was a 62 years old fisherman without underlying disease. He was diagnosed with disseminated septicemic melioidosis. The affected organs involvement was urinary tract infection, pneumonia and hepatitis. The drug sensitivity test revealed Ceftazidime susceptible. The case was survived. His behavior prone to infection included not wearing boot when expose to the mud. There was no case met definition but another fisherman was subclinical infection (positive IFA IgM without symptom). Two soil samples revealed culture-positive B. pseudomallei (22%). The positive samples were soil where collected from in front of index’s home and at entrance of the village. All water samples were negative.
Discussion: The potential exposure area was at home or working place due to the case did not travel outside the habitat for a year and the soil at case’ home showed evidence of bacterial contamination. We educated the family members how to prevent themselves from the bacteria and also noticed to the clinician about the environment contamination with aim to early treatment for prevent fatal outcome. We didn’t find the additional case after implement surveillance.