Case report: Fatal co-infection-melioidosis and leptospirosis

Co-infection of melioidosis and leptospirosis is uncommon. We report here four such cases, confirmed by blood culture for melioidosis and blood polymerase-chain reaction for leptospirosis, which occurred among rescuers involved in a search and rescue operation for a young man who was suspected to have drowned in Lubuk Yu, a recreational forest in Pahang, Malaysia. Despite treatment, three of the patients died from the co-infection

Fatal pneumonia following search and rescue operation

Introduction On 26th June 2010, a young man was suspected to have drowned at Lubuk Yu, a natural recreational forest with river and waterfall in Pahang. A rescue team was formed, comprising of 150 members from police offi cers, army offi cers, divers, fi remen and volunteers from a nearby village. His body was recovered fi ve days later. Following this rescue operation, at least 22 people presented with an acute febrile illness. Objective To describe ten patients with melioidotic pneumonia. Results Six were culture-confi rmed for melioidosis only while four were positive for leptospirosis (based on polymerase chain reaction) and melioidosis. All except one had diabetes mellitus. Among these 10 patients, all had fever and cough, 8 had shortness of breath. Surprisingly, symptoms of myalgia, diarrhoea and vomiting were the presenting complaints in some of these patients. Chest radiograph showed bilateral consolidation in 6 and 7 patients died. Conclusions Melioidotic pneumonia in this series was associated with high mortality

Outbreak of melioidosis and leptospirosis co-infection following a rescue operation

We analyzed the epidemiological data of all people who were involved in the search and rescue operation in Lubuk Yu, a natural recreational forest with waterfall and stream. The hospital admission records of the cases who fulfilled the case definition and the environmental samples result taken at Lubuk Yu recreational area were studied. 153 people were exposed to this outbreak, 85 (55.5%) were professional rescuers from various government agencies and 68 (44.5%) were villagers. 21 fulfilled the case definition. Ten cases were confirmed melioidosis, six melioidosis alone and four coinfected with leptospirosis. There were eight deaths in this outbreak, seven were villagers and one professional rescuer. Overall case fatality was 70%. All confirmed melioidosis cases and seven who died had diabetes mellitus. The morbidity rate were higher among the villagers, 23.5% compared to professional rescuers, 5.9%. The case fatality rate were also higher in this group which was 100% compared to 33.3% in professional rescuers. The soil and water samples in Lubuk Yu recreational area were positive for leptospira and Burkholderia pseudomallei. The presence of co-infection and co-morbidities especially diabetes mellitus among the exposed led to the high mortality in this outbreak hence a high index of suspicion is important among the healthcare professionals in the management of melioidosis cases. To avoid similar incident in future, search and rescue operation should be only conducted by professional rescuers with appropriate personal protective equipment. A register of rescuers should be maintained for surveillance and follow up if necessary