Fatal Disseminated Melioidosis Following Flood Exposure in a Patient without Overt Diabetes Mellitus or Chronic Kidney Disease: A Case Report from Southern Thailand

Nattapat Sangkakul; Tawin Khaimook; Siripen Kanchanasuwan

doi:10.31584/jhsmr.20261433

Fatal Disseminated Melioidosis Following Flood Exposure in a Patient without Overt Diabetes Mellitus or Chronic Kidney Disease: A Case Report from Southern Thailand

Nattapat Sangkakul, Tawin Khaimook, Siripen Kanchanasuwan

Abstract

We describe the case of a 51-year-old man with a history of gout and no overt diabetes mellitus or chronic kidney disease who presented with rapidly progressive severe pneumonia and septic shock after substantial exposure to stagnant floodwater in Southern Thailand. He developed severe pneumonia, septic shock, and multiorgan failure requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) and continuous renal replacement therapy (CRRT). Blood cultures grew Burkholderia pseudomallei, with persistent bacteremia and evidence of disseminated infection, including necrotizing pneumonia with extensive cavitation and multiple visceral abscesses. Despite appropriate intensive antimicrobial therapy, source control, and advanced organ support, the clinical course was complicated by multidrug-resistant ventilator-associated pneumonia and refractory septic shock. The patient died on day 27 of hospitalization. This case highlights that severe disseminated melioidosis may occur in close temporal association with substantial floodwater exposure even in patients without overt diabetes mellitus or chronic kidney disease; however, the route of acquisition, environmental bacterial burden, and exposure inoculum were not established.

Keywords

Burkholderia pseudomallei; flooding; melioidosis

Full Text:

PDF

References

Wiersinga WJ, Currie BJ, Peacock SJ. Melioidosis. N Engl J Med 2018;367:1035–44. doi: 10.1056/NEJMra1204699.

Hantrakun V, Kongyu S, Klaytong P, Rongsumlee S, Day NPJ, Peacock SJ, et al. Clinical epidemiology of 7126 melioidosis patients in thailand and the implications for a national notifiable diseases surveillance system. Open Forum Infect Dis 2019;6:ofz498. doi: 10.1093/ofid/o fz498.

Kaewrakmuk J, Chusri S, Hortiwakul T, Kawila S, Patungkaro W, Jariyapradub B, et al. A. Under-reporting cases and deaths from melioidosis: a retrospective finding in Songkhla and Phatthalung province of Southern Thailand, 2014–2020. Trop Med Infect Dis 2023;8:286. doi: 10.3390/tropicalmed8050286.

Selvam K, Ganapathy T, Najib MA, Khalid MF, Abdullah NA, Harun A, et al. Burden and risk factors of melioidosis in Southeast Asia: a scoping review. Int J Environ Res Public Health 2022;19. doi: 10.3390/ijerph192315475.

Limmathurotsakul D, Golding N, Dance DA, Messina JP, Pigott DM, Moyes CL, et al. Predicted global distribution of burkholderia pseudomallei and burden of melioidosis. Nat Microbiol 2016;1:15008. doi: 10.1038/nmicrobiol.2015.8.

Liu X, Pang L, Sim SH, Goh KT, Ravikumar S, Win MS, et al. Association of melioidosis incidence with rainfall and humidity, Singapore, 2003–2012. Emerg Infect Dis 2015; 21:159–62. doi: 10.3201/eid2101.140042.

Clinical and Laboratory Standards Institute. Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. 3rd ed. CLSI guideline M45. Wayne (PA): Clinical and Laboratory Standards Institute; 2016.

Wiersinga WJ, Virk HS, Torres AG, Currie BJ, Peacock SJ, Dance DAB, et al. Melioidosis. Nat Rev Dis Primer 2018;4:17107. doi: 10.1038/nrdp.2017.107.

Cheng AC, Currie BJ. Melioidosis: epidemiology, pathophysiology, and management. Clin Microbiol Rev 2005; 18:383–416. doi: 10.1128/CMR.18.2.383-416.2005.

Currie BJ. Melioidosis: evolving concepts in epidemiology, pathogenesis, and treatment. Semin Respir Crit Care Med 2015;36:111–25. doi: 10.1055/s-0034-1398389.

Limmathurotsakul D, Wongratanacheewin S, Teerawattanasook N, Wongsuvan G, Chaisuksant S, Chetchotisakd P, et al. Increasing incidence of human melioidosis in Northeast Thailand. Am J Trop Med Hyg 2010;82:1113–7. doi: 10.4269/ajtmh.2010.10-0038.

Churuangsuk C, Chusri S, Hortiwakul T, Charernmak B, Silpapojakul K. Characteristics, clinical outcomes and factors influencing mortality of patients with melioidosis in Southern Thailand: a 10-year retrospective study. Asian Pac J Trop Med 2016;9:256–60. doi: 10.1016/j.apjtm.2016.01.034.

Morris J, Williams N, Rush C, Govan B, Sangla K, Norton R, et al. Burkholderia pseudomallei triggers altered inflammatory profiles in a whole-blood model of type 2 Diabetes-melioidosis comorbidity. Infect Immun 2012;80:2089–99. doi: 10.1128/IAI.00212-12.

Birnie E, Biemond JJ, Wiersinga WJ. Drivers of melioidosis endemicity: epidemiological transition, zoonosis, and climate change. Curr Opin Infect Dis 2022;35:196–204. doi: 10.1097/QCO.0000000000000827.

Currie BJ, Jacups SP. Intensity of Rainfall and Severity of Melioidosis, Australia. Emerg Infect Dis 2003;9:1538–42. doi: 10.3201/eid0912.020750.

Wiersinga WJ, van der Poll T, White NJ, Day NP, Peacock SJ. Melioidosis: insights into the pathogenicity of Burkholderia Pseudomallei. Nat Rev Microbiol 2006;4:272–82. doi: 10.1038/nrmicro1385.

DOI: http://dx.doi.org/10.31584/jhsmr.20261433

Refbacks

There are currently no refbacks.

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.