An investigation of confirmed melioidosis death, first case in Chingko Sub District, Singhanakorn District, Songkhla Province, September 2020

Abstract

Background: On August 28, 2020 at 3:41 PM, the Situation Awareness Team for Disease and Health Hazards (SAT) of the Disease Control Office in 12 provinces received a Line notification from the Public Health Office in Songkhla Province regarding a death due to melioidosis on August 26, 2020. Hemoculture testing at Songkhla Hospital confirmed the presence of Burkholderia pseudomallei bacteria. On September 1, 2020, the Joint Investigation Team (JIT) collaborated with the Provincial Public Health Office and Songkhla Nakharin University, Hat Yai Campus, to investigate the death. The objectives were to review the situation of melioidosis in Singha Nakhon District, Songkhla, during 2016 to 2020, to confirm the diagnosis of death, to find source of infection and mode of transmission among this death, and to provide recommendations of prevention and control. Methods: An epidemiological study was conducted by reviewing the melioidosis situation from R506 Office of Disease Prevention and Control Office 12 Songkhla. Medical record of index case during admitting at Songkhla Hospital was reviewed. Interviewing among close relatives of index case and active case finding were done. Environmental study was performed by  collecting soil and water samples from index case’s place.Results: The death case was Thai female 57 years old with uncontrolled diabetes. She worked as a laborer in a factory and as a farmer. Her blood found Burkholderia pseudomallei from culture with presenting as indicating disseminated septicemic melioidosis (urinary tract infection and pneumonia).  Risk of infection among this case wererisk occupation to contact with contaminated soil and chronic foot wound with uncontrolled diabetes. No additional cases. Soil samples collected from rice fields yielded two Burkholderia pseudomallei isolates out of 23 samples (8.7%). No pathogen detected from holy water that the case used before death.Conclusions: The infection likely occurred due to soil contact through foot wounds during rice farming and chronic foot wound with uncontrolled diabetes. Public awareness of disease and self-prevention should be raised and emphasized on wearing shoes and cleaning after soil contact. Risk communication among risk population (i.e., diabetes) should be integrated with the non-communicable disease clinic services. Melioidosis situation should be provided to healthcare workers to increase the disease awareness in the province.