Melioidosis in Tsunami Survivors

Melioidosis in Tsunami SurvivorsTo the Editor: A tsunami devastated coastal areas of the Indian Ocean rim in December 2004.Of the affected countries, more than half of the ≈300,000 deaths occurred in the Aceh Province of Indonesia, close to the epicenter of the earthquake near northern Sumatra.Infrastructure, including medical and laboratory facilities, in this region was severely damaged.Of >1,000,000 survivors, >500,000 likely were injured.Most injuries were from trauma, but a substantial number were caused by aspiration of, or immersion in, saltwater that may have been contaminated by soil, sewage, or other environmental sources.Melioidosis, caused by the saprophytic gram-negative bacillus Burkholderia pseudomallei, is endemic in Southeast Asia and northern Australia.Most cases have been found in northeastern Thailand, Singapore, and northern Australia.Melioidosis has been reported only sporadically from Indonesia and mainly in returning travelers (1-3).In the context of acute medical relief efforts to the town of Banda Aceh, we report on 10 patients with pneumonia, including 4 patients with culture-confirmed melioidosis, after their immersion in contaminated saltwater during the tsunami.Clinical and laboratory services were reestablished on January 3, 2005, at Fakinah Hospital and on January 13, 2005, at Zainoel Abidin Hospital by the relief teams.Patients were identified opportunistically; details of treatment and outcome were reviewed retrospectively.Cultures were taken when clinically indicated and when specimens were available.Sputum cultures were plated onto horse blood agar, cystine lactose electrolyte-deficient agar, Haemophilus agar, and colistin/ nalidixic acid blood agar incubated in a candle jar at 35°C for <3 days.Colonies suspicious for B. pseudoma-