An investigation of probable co-infection leptospirosis and melioidosis in pregnancy, Kho Mai Pai, Punyee sub district, Muang district, Phangnga Province, September-November 2015

Abstract

Background: On 16 September 2015, an epidemiology section of Phang-nga Hospital was notified by Female Medicine ward about a 19 year-old postpartum female with jaundice for 7 days before delivery. A preterm baby boy was weighting 1,270 grams and sent to NICU immediately. Case investigation was conducted immediately with objectives aimed to confirmed diagnosis and implement control and prevention measure.
Methods: Descriptive study was conducted by review medical records and interview the attending obstetrician and pediatricians. We conducted active case finding in the community and passive search in Phang-nga Hospital. We collected serum from the patient and her baby with family close contact for testing lishmaniasis, leptospirosis, melioidosis, scrub typhus and brucellosis by MAT, IFA and ELISA at Thai National Institute of Health (NIH) and King Chulalongkorn Memorial Hospital. Environmental survey at the case’s home, village and community was done. Soil and water specimens were collected from around the case’s home and community for Burkolderia pseudomallei culture. Animal reservoir study was done. The animal serum specimens were collected from goats in community including testing antibody for leptospirosis, melioidosis and brucellosis at Thai NIH and National Institute of Animal Health (NIAH).
Results: The mother was met probable case definition of leptospirosis and melioidosis in pregnancy. Leptospirosis was positive by IgM and 4-fold rising of IgG accompanied with melioidosis was positive IgM. Her baby was negative both leptospirosis and melioidosis IgM. Serology from family contacts were negative both leptospirosis and melioidosis by MAT and IFA. There was 75% (3/4) of Burkolderia pseudomallei identified from soil sample at the case’s home. And 45.45% (5/11) of goats was seropositive for leptospirosis by MAT. The most common serovar of Leptospira spp. including Shermani (100%), Mini (20%) and Hebdomadis (20%). The animal blood revealed seronegative for melioidosis and brucellosis.
Conclusions: The cause of co-infection in the pregnancy was Burkolderia pseudomallei and Leptospira interogans. There was also evident of environmental contamination in soil around home and animal reservoir of the domestic animals. Pregnancy in endemic area of leptospirosis and melioidosis must avoid contact the domestic animals, if failed to do so, wearing protective equipment is recommend. Surveillance was conducted for 30 days after implement control there was no additional case.