Melioidosis in a Traveller from Thailand: Case Report

Maccanti, O; Pardelli, R; Tonziello, A; Gracci, G; I, Vivaldi; Bolognesi, L; Pantini, C; Sani, Sepehr

doi:10.1179/joc.2004.16.4.404

Cited by 12 publications

(2 citation statements)

References 10 publications

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“…Although atypical mycobacteria and anaerobic bacteria may also be encountered in wounds with fresh water or soil exposure [ 35 ], the most common pathogens associated with fresh water exposure remain staphylococci and streptococci [ 35 ]. Burkholderia species have only been anecdotally reported to induce necrotising pneumonia [ 36 , 37 ], cutaneous and septicaemic melioidosis [ 38 - 41 ].…”

Section: Discussionmentioning

confidence: 99%

One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia

et al. 2006

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IntroductionFollowing the 2004 tsunami disaster in southeast Asia severely injured tourists were repatriated via airlift to Germany. One cohort was triaged to the Cologne-Merheim Medical Center (Germany) for further medical care. We report on the tertiary medical care provided to this cohort of patients.MethodsThis study is an observational report on complex wound management, infection and psychoemotional control associated with the 2004 Tsunami disaster. The setting was an adult intensive care unit (ICU) of a level I trauma center and subjects included severely injured tsunami victims repatriated from the disaster area (19 to 68 years old; 10 females and 7 males with unknown co-morbidities).ResultsMultiple large flap lacerations (2 × 3 to 60 × 60 cm) at various body sites were characteristic. Lower extremities were mostly affected (88%), followed by upper extremities (29%), and head (18%). Two-thirds of patients presented with combined injuries to the thorax or fractures. Near-drowning involved the aspiration of immersion fluids, marine and soil debris into the respiratory tract and all patients displayed signs of pneumonitis and pneumonia upon arrival. Three patients presented with severe sinusitis. Microbiology identified a variety of common but also uncommon isolates that were often multi-resistant. Wound management included aggressive debridement together with vacuum-assisted closure in the interim between initial wound surgery and secondary closure. All patients received empiric anti-infective therapy using quinolones and clindamycin, later adapted to incoming results from microbiology and resistance patterns. This approach was effective in all but one patient who died due to severe fungal sepsis. All patients displayed severe signs of post-traumatic stress response.ConclusionIndividuals evacuated to our facility sustained traumatic injuries to head, chest, and limbs that were often contaminated with highly resistant bacteria. Transferred patients from disaster areas should be isolated until their microbial flora is identified as they may introduce new pathogens into an ICU. Successful wound management, including aggressive debridement combined with vacuum-assisted closure was effective. Initial anti-infective therapy using quinolones combined with clindamycin was a good first-line choice. Psychoemotional intervention alleviated severe post-traumatic stress response. For optimum treatment and care a multidisciplinary approach is mandatory.

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Section: Discussionmentioning

confidence: 99%

One year ago not business as usual: Wound management, infection and psychoemotional control during tertiary medical care following the 2004 Tsunami disaster in southeast Asia

et al. 2006

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“…In the Caribbean, few cases of melioidosis have been reported: in Puerto Rico during flood waters, in Guadeloupe and a single case 15 years ago from an inhabitant of Martinique [1][2][3]. Melioidosis is occasionally reported in travellers returning from Asia, including in three Finnish tourists after the tsunami of 2004 [4][5][6][7][8][9][10]. Melioidosis in travellers from other regions is rarely reported: a tourist who presented with acute fatal septicaemic pneumonia due to melioidosis after a visit to Brazil was diagnosed in the Netherlands [11].…”

Section: Introductionmentioning

confidence: 99%

Fatal acute melioidosis in a tourist returning from Martinique Island, November 2010

et al. 2011

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We report the fatal case of acute melioidosis in a patient returning from Martinique with fever in November 2010. Gram-negative rods were isolated from a blood culture and Burkholderia pseudomallei identified within 24 hours after first medical contact. The patient died two days after admission to hospital despite intravenous therapy with high doses of imipenem/cilastatin and intensive care. Clinicians seeing travellers returning from the subtropics or tropics with severe pneumonia or septicaemia should consider the possibility of acute melioidosis.

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