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Melioidosis And Glanders Found In Siquijor Fatalities, DOH Confirms
NEGROS OCCIDENTAL, Philippines – It began with a report on glanders, but nearly a week after two Siquijor men died in a Dumaguete City, Negros Oriental hospital on Wednesday, May 28, health officials revealed another deadly detail.
The two men were inflicted with glanders and melioidosis, and both had comorbidities, Health Undersecretary Mary Ann Palermo-Maestral told Rappler on Monday, June 2, citing laboratory tests.
At least four others from Siquijor were also confirmed earlier to have contracted glanders.
The health department placed a second rare deadly disease at the center of the case: melioidosis. Known as Whitmore's disease, melioidosis is caused by the environmental bacterium Burkholderia pseudomallei, which thrives in soil and water. Glanders, on the other hand, is caused by Burkholderia mallei, a pathogen typically found in sick horses and other animals.
The two diseases share a number of symptoms including high fever, pneumonia, abscesses, and septic shock. Both can infect humans, and are rare.
While the Department of Health (DOH) has moved to contain the infections, questions remain about how two uncommon bacterial diseases managed to surface in the same area, affecting the same patients, with fatal consequences.
Glanders and melioidosis are present in Siquijor right now, said Albert Barrogo, acting regional director of the Department of Agriculture (DA) for the Negros Island Region.
He said the bacterium that causes melioidosis thrives in wallows or mud holes used by carabaos or cattle.
Barrogo said the DA is working closely with the DOH to contain the diseases and prevent their spread.
He flew to Manila to follow up on laboratory results of blood samples taken from nearly 100 goats, carabaos, and cattle in the towns of Larena, Siquijor, and San Juan between May 20 and 25.
He said they have been waiting for the results so the Bureau of Animal Industry (BAI) could make recommendations. He said the decision on whether or not to start culling animals would depend on BAI's assessment.
The samples were taken from animals suspected to be infected in the towns of Larena, Siquijor, and San Juan from May 20 to 25.
Barrogo said a surveillance team is monitoring the situation to prevent the spread of the diseases to other towns in Siquijor such as Lazi, Maria, and Enrique Villanueva.
The DOH, meanwhile, said it remained on top of the situation to prevent the spread of the bacterial diseases to NIR.
Melioidosis is a potentially fatal disease that can infect humans and animals through contact with contaminated soil, water, or air, according to the US Centers for Disease Control and Prevention (CDC). It said infection typically occurs through skin abrasions, inhalation, or ingestion, particularly following extreme weather events that disturb soil.
On its website, the CDC said symptoms may mimic other infections and could include fever, chest pain, cough, muscle aches, and confusion. Severe cases may lead to bloodstream infection and multi-organ failure.
It said people with diabetes, chronic illnesses, or weakened immune systems are at higher risk of severe illness.
The CDC said human-to-human transmission of melioidosis is rare, but a wide range of animals can be infected, including sheep, goats, pigs, boars, horses, cats, dogs, and cattle.
It has recommended avoiding exposure to soil and standing water in affected areas and using protective gear during high-risk activities. Treatment requires a prolonged course of antibiotics – initially intravenous, followed by oral antibiotics for several months – to prevent relapse. – Rappler.Com
Rare But Deadly Melioidosis Is A New Infectious Disease Threat
An analysis of soil and water samples in the southern United States has revealed the presence of a rare bacteria called Burkholderia thailandensis that is capable of causing potentially serious infections.
Investigators detected the microbe in water in Texas and Puerto Rico and soil in Mississippi, making it a public health risk, according to a recent report in Emerging Infectious Diseases, a publication from the Centers for Disease Control and Prevention (CDC).
This bacterium is closely related to Burkholderia pseudomallei, which can cause melioidosis, a disease with a fatality rate of 10 to 50 percent, according to the CDC. Although considered less virulent, B. Thailandensis can make people severely ill.
When Was Melioidosis First Discovered in the U.S.?In 2022, the CDC put out a melioidosis health advisory after the first discovery of B. Pseudomallei in the environment in the continental United States. It was identified through sampling of soil and water in the Gulf Coast region of southern Mississippi during an investigation of two human melioidosis cases. A third case in Mississippi was identified in January of this year.
While the federal health agency is still investigating how widespread the bacteria are within the continental United States, the latest version of the CDC Yellow Book, which provides guidance for travel medicine, now warns that melioidosis is locally endemic in areas of the Mississippi Gulf Coast. Also, a May 2023 CDC report alerted laboratory staff that they may face an increased risk for B. Pseudomallei exposure.
Why Happens if You Get Melioidosis?While rare, melioidosis is garnering attention because it is so dangerous. The discovery in the United States of the microorganisms that cause this disease was an unpleasant surprise.
"This is an environmental bacteria that is associated usually with freshwater and swampy areas, typically in Southeast Asia and northern Australia," says William Schaffner, MD, an infectious disease specialist and professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee. "To have melioidosis show up here in the United States along the Gulf Coast is pretty unusual."
Dr. Schaffner stresses that the disease can be very serious. According to the Cleveland Clinic, the illness can cause fever, weight loss, vomiting, stomach or chest pain, muscle or joint pain, headache, seizures, and rash on the trunk, abdomen, or face. It can infect the lungs, skin, and blood and affect many organs at once, including the heart, brain, liver, kidneys, joints, and eyes.
In severe cases, the disease may lead to pneumonia, multiple abscesses (collections of pus accompanied by swelling and inflammation), and life-threatening septicemia (blood infection).
How Is Melioidosis Treated?Doctors generally prescribe a long course of antibiotics for melioidosis. Treatment generally starts with intravenous (within a vein) antimicrobial therapy for a minimum of two weeks (but up to eight weeks depending on extent of infection), followed by three to six months of oral antimicrobial therapy.
Prompt diagnosis can improve the chances of recovery. Schaffner suggests that a person who shows symptoms and lives in the Gulf Coast may want to request a lab test to confirm whether the illness is melioidosis.
"The microbiology laboratory is your friend," he says. "Once we have the appropriate diagnosis, then we can treat you."
How Do People Get Melioidosis?Humans may develop melioidosis by inhaling contaminated dust or water droplets, swallowing contaminated water, ingesting soil-contaminated food, or exposing skin abrasions or open wounds to contaminated soil.
The CDC emphasizes that the disease rarely spreads person-to-person.
Specific health conditions such as diabetes, chronic kidney disease, chronic lung disease, or excessive alcohol use may put some individuals at higher risk, the CDC notes. Schaffner points out that drinking to excess can cause chronic liver impairment, which leaves a person susceptible to serious sickness.
How Can You Reduce the Risk of Getting Melioidosis?Environmental conditions of the Gulf Coast states appear to be conducive to the growth of the bacteria that cause melioidosis. For those who live in that area, the CDC recommends these precautions:
In addition, CDC health authorities note that a cluster of four melioidosis cases in four U.S. States in 2021 were linked to an imported contaminated aromatherapy spray.
Because injuries can open the door to severe infection, Schaffner advises thoroughly washing any injury (such as a cut or abrasion) with soap and water and seeking medical attention.
"If you start to see an infection develop at your local site of injury, definitely have it looked at," he says.
DA, DOH Closely Monitor Melioidosis Cases In Siquijor
CEBU, Philippines — The Department of Agriculture (DA) and the Department of Health (DOH) are closely monitoring confirmed cases of melioidosis in humans in Siquijor province to prevent further spread of the disease.
The rare but serious infection, caused by the bacterium Burkholderia pseudomallei, was confirmed by the DOH after initial suspicion of glanders in the affected patients. Melioidosis is known to be contracted through exposure to contaminated soil or water and poses significant health risks, especially in tropical areas like the Philippines.
The agency stated that as of now, there is no available vaccine for melioidosis.
To address the situation, the DA, through its Bureau of Animal Industry (BAI) and the DA-Regional Field Office of the Negros Island Region (DARFO-NIR), has deployed surveillance teams to affected communities and initiated protocols to control disease transmission in livestock and the environment.
"The BAI is in the process of sending samples to a reference laboratory for confirmatory testing and continues to monitor the situation on the ground," the agency said in a statement.
Authorities reminded farmers and animal handlers to maintain strict biosecurity and sanitary protocols, including wearing protective gear when working in potentially contaminated areas.
The transport and sale of live animals and animal products must comply with regulatory standards to ensure they are disease-free.
"The public is strongly advised to purchase meat with valid inspection certificates and to observe proper food handling and cooking practices. The consumption of raw or unpasteurized milk is also discouraged," -Philippine STAR News Service
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