T he gram-negative soil-dwelling saprophytic bacterium Burkholderia pseudomallei causes melioidosis, a fatal disease highly endemic to Southeast Asia and northern Australia (1). Humans can be infected with B. pseudomallei via inoculation, inhalation, and ingestion. Rice farmers are at high risk for infection because of their frequent exposure to soil and water, but newborns, children, and older persons also are at risk (2,3). We report 3 melioidosis deaths among children in northern Vietnam.
The StudyIn November 2019, the Preventive Health Center of Soc Son district in Vietnam reported the deaths of 3 children from 1 family. The first child, a 7-year-old girl, had a high fever and abdominal pain on April 6, 2019. Two days later, she was admitted to a local hospital; after 1 day, she was transferred to St. Paul Hospital in Hanoi, where septic shock was diagnosed. She died on April 9, shortly after admission, before any diagnostic tests were performed.On October 27, 2019, the second child, a 5-yearold boy, had a high fever and abdominal pain around the umbilicus. He was admitted to Vietnam National Children's Hospital in Hanoi on October 28 with diagnosed septic shock. Abdominal and chest radiographs and abdominal ultrasound results were unremarkable. His blood culture grew B. pseudomallei, and he died on October 31.The third child, a 13-month-old boy, had a high fever and poor appetite on November 10, 2019. According to his grandparents, he had black stool, like his sister and brother. He was admitted to Vietnam National Children's Hospital; chest radiography results were unremarkable, but B. pseudomallei was cultured from his blood sample. He died on November 16.We retrieved laboratory findings from all hospitals to which these children were admitted. Results showed leukopenia, neutropenia, thrombocytopenia, and high procalcitonin and C-reactive protein in all children's blood. Liver dysfunction was diagnosed in all 3 children, but kidney dysfunction was recognized only in the 2 older children. We detected no identifiable risk factors (Table 1).To trace the source of infection, on November 17, 2019, we visited the family home in the midland region of northern Vietnam (Figure 1). During our active surveillance for melioidosis cases admitted to provincial and tertiary hospitals surrounding Hanoi (4), no previous cases had been reported from this area.We interviewed the parents and grandparents using epidemiologic questions about all the children's daily activities inside and outside the house. The family used water supplied from 3 boreholes: 1 for bathing (borehole A), 1 for livestock (borehole B), and 1 for human consumption (borehole C). During our first environmental investigation, we collected samples of front garden soil (n = 7), borehole water (n = 9), and boiled drinking water (n = 1). We performed qualitative culture for B. pseudomallei, and all 3 water samples collected from borehole A tested positive (Appendix, https://wwwnc.cdc.gov/EID/ article/28/8/22-0113-App1.pdf).