Volume 30, Number 4—April 2024
Dispatch
Melioidosis in Patients with COVID-19 Exposed to Contaminated Tap Water, Thailand, 2021
Panupong Tantirat, Yotsathon Chantarawichian, Pantila Taweewigyakarn, Somkid Kripattanapong, Charuttaporn Jitpeera, Pawinee Doungngern, Chadaporn Phiancharoen, Ratanaporn Tangwangvivat, Soawapak Hinjoy, Anupong Sujariyakul, Premjit Amornchai, Gumphol Wongsuvan, Viriya Hantakun, Vanaporn Wuthiekanun, Janjira Thaipadungpanit, Nicholas R. Thomson, David A.B. Dance, Claire Chewapreecha, Elizabeth M. Batty, and Direk Limmathurotsakul
Table
Clinical characteristics of 25 patients with COVID-19 who developed acute melioidosis, Saraburi Province, Thailand, 2021*
| Case no. | Age, y/sex | Underlying diseases | Dates of COVID-19–positive PCR/field hospital admission/first melioidosis symptoms | Clinical manifestations of melioidosis | Cultures positive for B. pseudomallei (collection date) | Parenteral treatment for acute melioidosis (start date–stop date) | Oral treatment for melioidosis (start date) | Outcome (discharge or death date) |
|---|---|---|---|---|---|---|---|---|
| 1† |
56/F |
DM, chronic hepatitis B |
Aug 16/Aug 27/Sep 1 |
Fever, dyspnea, pneumonia‡ |
Blood (Sep 1) |
MEM (Sep 5–7), CAZ (Sep 7–10), MEM (Sep 10–24) |
TMP/SMX (Sep 24) |
Survived (Sep 29) |
| 2 |
66/M |
IHD, VHD, CHF |
Aug 22/Aug 26/Sep 1 |
Cough, fever, dyspnea, pneumonia‡ |
Blood (Sep 1) |
None |
NA |
Died (Sep 1) |
| 3† |
52/F |
DM |
Aug 24/Aug 26/Sep 2 |
Fever, dyspnea, pneumonia‡ |
Blood (Sep 2) |
MEM (Sep 5–6), CAZ (Sep 6–Oct 9), TMP/SMX (Sep 20–30) |
TMP/SMX (Sep 30), changed to AMC (Oct 9) |
Survived (Oct 9) |
| 4 |
62/M |
DM |
Aug 20/Aug 29/Sep 2 |
Fever, diarrhea, pneumonia‡ |
Blood (Sep 2) |
None |
NA |
Died (Sep 3) |
| 5 |
44/F |
DM, allergic rhinitis |
Aug 20/Aug 26/Sep 2 |
Fever, hypotension, pneumonia‡ |
Blood (Sep 2) |
CAZ (Sep 4–5) |
NA |
Died (Sep 5) |
| 6 |
34/M |
DM, obesity |
Aug 17/Aug 26/Sep 1 |
Hypotension, pneumonia‡ |
Blood (Sep 2) |
CAZ (Sep 4–19) |
TMP/SMX (Sep 19) |
Survived (Sep 20) |
| 7 |
58/F |
DM, HT, DLP |
Aug 17/Aug 22/Sep 2 |
Cough, dyspnea, pneumonia‡ |
Blood (Sep 2) |
CAZ (Sep 5–20) |
TMP/SMX (Sep 20) |
Survived (Sep 23) |
| 8 |
56/M |
HT, CKD, gout |
Aug 16/Aug 26/Sep 1 |
Fever, diarrhea |
Blood (Sep 2) |
None |
NA |
Died (Sep 2) |
| 9† |
60/F |
DM, HT, DLP |
Aug 23/Aug 27/Sep 1 |
Dyspnea, pneumonia‡ |
Blood (Sep 3) |
MEM (Sep 3–4) |
NA |
Died (Sep 4) |
| 10 |
63/F |
DM |
Aug 22/Aug 28/Sep 2 |
Fever, pneumonia‡ |
Blood (Sep 2) |
CAZ (Sep 4–18) |
AMC (Sep 18) |
Survived (Sep 22) |
| 11 |
60/M |
Gout |
Aug 24/Aug 31/Sep 5 |
Fever |
Blood (Sep 5) |
CAZ (Sep 4–19) |
TMP/SMX (Sep 19) |
Survived (Sep 21) |
| 12† |
56/F |
Rheumatoid arthritis |
Aug 22/Aug 31/Sep 4 |
Fever, pneumonia‡ |
Blood (Sep 4) |
MEM (Sep 5–8), CAZ (Sep 8–19) |
TMP/SMX (Sep 19) |
Survived (Sep 20) |
| 13† |
36/F |
DM, obesity |
Aug 18/Aug 29/Sept 10 |
Dyspnea, pneumonia‡ |
Blood (Sep 6) |
CAZ (Sep 8–23) |
TMP/SMX (Sep 22) |
Survived (Sep 24) |
| 14 |
56/M |
None |
Aug 17/Aug 24/Sep 4 |
Fever, pneumonia‡ |
Blood (Sep 4) |
MEM (Sep 5–8) |
NA |
Died (Sep 8) |
| 15 |
59/F |
HT |
Aug 21/Sept 2/Sep 6 |
Dyspnea, pneumonia‡ |
Blood (Sep 6) |
CAZ (Sep 6–20) |
TMP/SMX (Sep 21) |
Survived (Sep 23) |
| 16 |
61/F |
DM, HT |
Aug 19/Aug 24/Sep 2 |
Dyspnea, pneumonia‡ |
Sputum (Sep 3) |
CAZ (Sep 5–19) |
TMP/SMX (Sep 19) |
Survived (Sep 20) |
| 17 |
73/M |
COPD |
Aug 23/Aug 25/Sep 3 |
Dyspnea, pneumonia‡ |
Blood (Sep 3) |
CAZ (Sep 4–18) |
AMC (Sep 18) |
Survived (Sep 20) |
| 18 |
66/M |
DM, CKD, HT, DLP |
Aug 23/Aug 30/Sep 3 |
Diarrhea, pneumonia‡ |
Blood (Sep 3) |
CAZ (Sep 4–19) |
TMP/SMX (Sep 19) |
Survived (Sep 20) |
| 19 |
62/M |
DM, HT, DLP |
Aug 24/Aug 27/Sep 2 |
Fever, dyspnea, pneumonia‡ |
Blood (Sep 3) |
CAZ (Sep 4) |
NA |
Died (Sep 4) |
| 20 |
60/F |
DM, HT, DLP |
Aug 20/Aug 27/Sep 3 |
Dyspnea, pneumonia‡ |
Blood (Sep 3) |
Meropenems (Sep 3) |
NA |
Died (Sep 4) |
| 21 |
36/M |
DM, obesity |
Aug 24/Aug 28/Sep 5 |
Fever, pneumonia‡ |
Blood (Sep 5) |
CAZ (Sep 5–18) |
TMP/SMX (Sep 19) |
Survived (Sep 23) |
| 22† |
60/F |
None |
Aug 20/Aug 27/Sep 5 |
Dyspnea, pneumonia‡ |
Blood (Sep 10) |
CAZ (Sep 5–19), MEM (Sep 19–Oct 13), TMP/SMX (Sep 22–Oct 12) |
TMP/SMX (Oct 13) |
Survived (Oct 19) |
| 23 |
70/M |
None |
Aug 29/Aug 31/Sep 11 |
Fever Dizziness |
Blood (Sep 11) |
CAZ (Sep 11–25) |
TMP/SMX (Sep 25) |
Survived (Sep 26) |
| 24† |
52 |
None |
Aug 18/Aug 22/Sep 11 |
Fever, dyspnea, pneumonia‡ |
Blood (Sep 13) |
MEM (Sep 13–20), CAZ (Sep 20–Oct 9), TMP/SMX (Sep 20–Oct 9) |
TMP/SMX (Oct 9) |
Survived (Oct 9) |
| 25 | 58 | DM | Aug 29/Sep 2/Sept 10 | Fever, pneumonia‡ | Blood (Sep 14) | CAZ (14–28 Sep) | TMP-SMX (from Sep 28) | Survived (Sep 29) |
*The discharge date was the date of discharge from hospital after completion of intensive phase treatment for melioidosis. For patients who died of acute melioidosis, the date of death is given. CKD, chronic kidney disease; DLP, dyslipidemia; DM, diabetes mellitus; HT, hypertension; CAZ, ceftazidime; IMP, imipenem; MEM, meropenem; AMC, amoxicillin/clavulanic acid; TMP/SMX, trimethoprim/sulfamethoxazole; NA, not applicable. †Transferred to Saraburi Hospital, Thailand. ‡Pneumonia was defined as the presence of a new or progressive radiographic infiltrate and >1 of 3 clinical features (fever >38°C, leukocytosis or leukopenia, and purulent secretions) suspected to be caused by acute melioidosis.
Page created: March 07, 2024
Page updated: March 20, 2024
Page reviewed: March 20, 2024
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