Korean J healthc assoc Infect Control Prev.  2022 Jun;27(1):85-89. 10.14192/kjicp.2022.27.1.85.

Melioidosis from Thailand and Risk Classification and Precautionary Measures for Laboratory Staff who were Exposed

• Kim MH
• Kim DK
• Kim JH
• Ahn JY
• Jeong SJ
• Ku NS
• Yeom JS
• Choi JY

• KMID: 2530832
• DOI: http://doi.org/10.14192/kjicp.2022.27.1.85

Abstract

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a Gram-negative bacillus, with a fatality rate of 14-49%. They are mainly exposed to contaminated soil or water through wounds, mucosa, inhalation, and ingestion. In addition, the exposure of healthcare workers (HCWs) participating in sample handling in the laboratory may occur. Herein, we report a case of melioidosis and introduce infection control guidelines for laboratory exposure. A 45-year-old male patient, a travel agent who resided in Chiang Mai, Thailand, and had uncontrolled diabetes, visited the hospital with a fever for 1 month. Initial laboratory study suggested systemic infection (C-reactive protein 259.8 mg/L, white blood cell 16,500/mm 3 ), and liver abscess was identified in abdominal computed tomography (CT). Blood cultures identified Gram-negative bacilli, and B. pseudomallei was confirmed using 16s rRNA sequencing. Ceftazidime and doxycycline were administered, and the symptoms improved. The patient was discharged with trimethoprim-sulfamethoxazole treatment for 3 months. Ten laboratory staff handled the contaminated samples without proper protective personal equipment. Through risk classification, they were classified into the low-risk group and were monitored without postexposure prophylaxis for 21 days, and none of the patients developed any symptoms. Therefore, it is recommended to classify laboratory exposures to B. pseudomallei according to risk classification, monitor symptoms, and provide appropriate post-exposure prophylaxis.

Keyword

Melioidosis; Burkholderia pseudomallei; Laboratory staff; Risk classification

Figure

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  Fig. 1 Abdominal CT scan (A) showing liver abscess, knee MRI (B) showing quadriceps tendon rupture with joint effusion, Gram staining (C) showing pin appearance Gram negative rods (×1,000), and dry, wrinkled colonies on blood agar (D) after 10 days inoculation.

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