Contact investigation of neonatal melioidosis case in the heart of Sabah, Malaysia

Abstract

Background Paediatric melioidosis is not unheard of in the Malaysian state of Sabah . This neonatal melioidosis however is the youngest case recorded since Sabah State health Department took the initiative to implement administrative notification of the disease in 2011. C ontact investigation , which was not done for melioidosis cases prior to 2011, was conducted in order to determine the mode of transmission. Methods: Tracing epidemiological investigations were performed on 8 contacts. Blood sample s were collected a nd tested for Burkholderia pseudomallei seropositivity. Environmental investigat ions were also performed around and nearby the case house. Two soil samples were collected for culture and isolation of B. pseudomallei Results: The case was a 22 day old male baby born at full term at the nearest government health clinic in the central District of Tongod . Birth weight was 3.1 Kg and fe tal abnormality was not detected Baby was exclusively breastfeeding. At 14 days old , patient had fever, cough and fast breathing and tr eat ed as outpatient at the nearest government health clinic . He was given nebulizer and syrup paracetamol. Th e symptoms became worst and patient was brought to the nearest district hospital , where h e was diagnosed with bronchopneumonia . Treatments given included intravenous drip at 13.3 cc/hour, nebulizer V:N 0.5:3.5 at 4 hourly, intravenous C. Penicillin 50,000mg/kg QID, i ntravenous Gentamicin 5mg/kg OD and chest physio therapy . The conditions of the patient however did not improve. Subsequently, patient was referred to the nearest tertiary hospital and managed at the Intensive Care Unit on ventilator. Two days later, t he pa tient succumbed to his ailment. L aboratory investigation showed that blood and cerebrospinal flui d were culture positive for B. pseudomallei . The cause of death was due to B. pseudomallei infection. Contacts invest igation revealed that an 8 year old cousin was seropositive for B. pseudomallei but asymptomatic for the disease Soil samples however were culture negative for B. pseudomallei Conclusions: Direct t ransmission of B. pseudomallei to the case from the co usin is compelling but not conclusive. It is also likely that the case was exposed to contaminated dust and soil that were brought into the house by visitors that include the seropositive cousin. Prevention and control measures taken include h ealth educati on on melioidosis for resid ents nearby the case house