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Biological Health Hazard – Melioidosis (Fatal): Sonoran Territory, Mexico

2018/09/11

MELIOIDOSIS – MEXICO: (SONORA) SUSPECTED, FATAL
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Published Date: 2018-09-10 20:13:43
Subject: PRO/EDR> Melioidosis – Mexico: (SO) suspected, fatal
Archive Number: 20180910.6019879

Administrative divisions of the United Mexican States (Estados Unidos Mexicanos)showing state names and borders

Administrative Map of Mexico: Map based on a UN map. Source: UN Cartographic Section. Source: Nations Online Project.

Date: Sun 9 Sep 2018
Source: El Imparcial, Mexico [in Spanish, machine trans., edited]

The bacterium _Burkholderia pseudomallei_ was isolated in various tissues at autopsy from 2 siblings of Huasabas who died. The organism causes melioidosis, a disease that causes serious and fatal complications. A 16-year-old girl and her 12-year-old brother, residents of Huasabas, died [Thu 6 Sep 2018], in the HIES hospital in this city, where they had been transferred due to the worsening of their symptoms.

The general director of Health Promotion and Prevention of Diseases of the Ministry of Health in Sonora, Gerardo Alvarez Hernandez, announced through a bulletin, that the bacterial agent [_Burkholderia pseudomallei_] was found preliminarily in the necropsy of both children. He also explained that it tends to cause isolated cases, that it has not been documented that it has an epidemic behavior and that although various forms of transmission are recognized, it is not possible to spread from person to person through occasional contact.

Except for the deceased siblings, none of the 7 or 8 young people who bathed in the Bavispe river have presented signs or symptoms of the disease, nor have any similar cases been recorded. “The clinical and epidemiological study of both deaths is ongoing and what is reported is what we have up to now; the results of the bacteriological and toxicological analyses are expected, together with the histopathological study of the lung, liver and brain, as well as serum and blood,” the director said in the statement.

The State Commission for Protection against Sanitary Risks (Coesprisson) took environmental samples of water and food for the search of various agents.

Although it is very rare to find the bacterium _Burkholderia pseudomallei_, it is possible to find it in the Sonoran territory; and the deceased siblings from Huasabas could have acquired it when they were swimming in the river, explained the infectologist Jesus Sanchez Colin. The specialist pointed out that it is more likely to find the species _B. cepacia_ than the _B. pseudomallei_, in nosocomial infections; and that causes pneumonias or abscesses in different parts of the body.

“They are rare cases this type of _Burkholderia_, it is a rare bacterium, but we do see it, the cases of melioidosis are extremely rare and these situations are fatal,” he said.

Communicated by:
ProMED-mail
<promed@promedmail.org>
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[As noted below, melioidosis is quite rate in the Western Hemisphere as compared to Southeast Asia and northern Australia but one would think that the announcement would not have been made without reasonable microbiologic confirmation.

Although a classical infection in eastern Asia and Northern Australia, cases have been acquired in Africa, Central and South America and the Caribbean basin. This 2016 paper (Limmathurotsakul D, Goldring N, Dance DAB, et al: Predicted global distribution of _Burkholderia pseudomallei_ and burden of melioidosis. Nature Microbiol 2016; doi: 10.1038/nmicrobiol.2015.8, http://www.nature.com/articles/nmicrobiol20158.pdf) estimates — for 2015 — the burden of melioidosis for the areas of major and some risk as follows:

Area / Population at risk in millions / Melioidosis cases in thousands / Melioidosis deaths in thousands
South Asia / 1525 / 73 / 42
East Asia and Pacific / 858 / 65 / 31
Sub-Saharan Africa / 602 / 24 / 15
Latin America and Caribbean / 246 / 2 / 1
Middle East and North Africa / 49 / less than 1 / less than 1

Melioidosis is a disease of the rainy season in its endemic areas. It mainly affects people who have direct contact with soil and water. Many have an underlying predisposing condition such as diabetes (commonest risk factor), renal disease, cirrhosis, thalassemia, alcohol dependence, immunosuppressive therapy, chronic obstructive lung disease, cystic fibrosis, and excess kava consumption. Kava is a herbal member of the pepper family that can be associated with chronic liver disease.

Melioidosis may present at any age, but peaks in the 4th and 5th decades of life, affecting men more than women. In addition, although severe fulminating infection can and does occur in healthy individuals, severe disease and fatalities are much less common in those without risk factors.

The most commonly recognized presentation of melioidosis is pneumonia, associated with high fever, significant muscle aches, chest pain, and — although the cough can be nonproductive — respiratory secretions can be purulent, significant in quantity, and associated with on-and-off bright, red blood. The lung infection can be rapidly fatal — with bacteremia and shock — or somewhat more indolent.

Acute melioidosis septicemia is the most severe complication of the infection. It presents as a typical sepsis syndrome with hypotension, high cardiac output, and low systemic vascular resistance. In many cases, a primary focus in the soft tissues or lung can be found. The syndrome, usually in patients with risk factor comorbidities, is characteristically associated with multiple abscesses involving the cutaneous tissues, the lung, the liver, and spleen, and a very high mortality rate of 80 to 95 percent. With prompt optimal therapy, the case fatality rate can be decreased to 40 to 50 percent.

The melioidosis bacillus is intrinsically insensitive to many antimicrobials. It should be noted that bioterrorism strains may be engineered to be even more resistant. _Burkholderia pseudomallei_ is usually inhibited by tetracyclines, chloramphenicol, trimethoprim-sulfamethoxazole (SXT), antipseudomonal penicillins, carbapenems, ceftazidime, and amoxicillin/clavulanate or ampicillin/sulbactam. Ceftriaxone and cefotaxime have good in vitro activity but poor efficacy; and cefepime did not appear, as well, to be equivalent to ceftazidime in a mouse model. The unusual antimicrobial profile of resistance to colistin and polymyxin B and the aminoglycosides but sensitivity to amoxicillin/clavulanate is a useful tool to consider in treatment of infection with the organism.

The randomized and quasi-randomized trials comparing melioidosis treatment have been reviewed, and it was found that the formerly standard therapy of chloramphenicol, doxycycline, and SXT combination had a higher mortality rate than therapy with ceftazidime, imipenem/cilastatin, or amoxicillin/clavulanate (or ampicillin/sulbactam). The betalactam-betalactamase inhibitor therapy, however, seemed to have a higher failure rate.

Source: Tolaney P, Lutwick LI: Melioidosis. In: Lutwick LI, Lutwick SM (eds). Bioterror: the weaponization of infectious diseases. Totowa NJ: Humana Press, 2008 pp 145-58.

For the microbiologists among our readers, a new (and 5th) member of the _B. pseudomallei_ complex has been described, _B. humptydooensis_, from the Northern Territory of Australia and named after the small town of Humpty Doo near to where the isolate was found (Tuanyok A, Mayo M, Scholz H, et al. _Burkholderia humptydooensis_ sp nov, a new species related to _Burkholderia thailandensis_ and the 5th member of the _Burkholderia pseudomallei_ complex. App Environ Microbiol 2017; 83(5): e02802-16); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311406/. – Mod.LL

HealthMap/ProMED map available at:
Sonora, Mexico: http://healthmap.org/promed/p/31682]

See Also

Melioidosis – Australia (02): (NT) 20180210.5620284
Melioidosis – Australia: (NT) 20180202.5601113

2017
—-
Melioidosis – Malaysia: fatal 20171210.5494132
Melioidosis – USA: (PA) ex Thailand, 2016 20170921.5332525
Melioidosis – Thailand 20170828.5279735
Melioidosis – Germany: ex Cambodia 20170808.5236533
Melioidosis – Belgium: ex Southeast Asia 20170628.5137064
Melioidosis – Australia (04): (NT) 20170412.4965903
Melioidosis – Australia (03): (NT) fatality 20170210.4830367
Melioidosis – Australia (02): (NT) 20170113.4760582
Melioidosis – Australia: (NT) 20170107.4749013

2016
—-
Melioidosis – Peru 20161114.4624371
Melioidosis – Viet Nam: (TH) 20161019.4570856
Melioidosis – Malaysia: (SK) 20160213.4018880
Melioidosis: worldwide burden 20160112.3930300

2015
—-
Melioidosis – Malaysia: (PH) 20150310.3218685
Leptospirosis, melioidosis – Malaysia: (Eastern states) flooding 20150123.3114267
………………………………………….jt/ll/ao/jh

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


Melioidosis

Melioidosis, also called Whitmore’s disease, is an infectious disease that can infect humans or animals. The disease is caused by the bacterium Burkholderia pseudomallei.

It is predominately a disease of tropical climates, especially in Southeast Asia and northern Australia where it is widespread. The bacteria causing melioidosis are found in contaminated water and soil. It is spread to humans and animals through direct contact with the contaminated source.

HHS funds drug for bioterrorism, antimicrobial-resistant infections

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