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Taiwan CDC urges vigilance as melioidosis death occurred in Kaohsiung-Pingtung area

As of September 15, 2011, a total of 15 melioidosis cases have been confirmed in Taiwan this year according to the data collected by the Infectious Disease Reporting System set up by the Taiwan Centers for Disease Control (Taiwan CDC). Although the case number is lower than that during the same period in previous years (32 confirmed melioidosis cases in 2008, 38 confirmed melioidosis cases in 2009, and 20 confirmed melioidosis cases in 2010), the majority of confirmed melioidosis cases reside in the Kaohsiung-Pingtung area. Since Typhoon Namadol struck Taiwan on August 27, 2011, a total of 11 suspected melioidosis cases have been reported in the Kaohsiung-Pingutng area. 8 cases, including one death, have been reported in Nanzih District, Kaohsiung City; one case each has been reported in Dashe District, Kaoshiung City and Mituo District, Kaohsiung City; and one case has been reported in Hengchun Township, Pingtung County. Taiwan CDC stated that the heavy rain brought by the typhoon exposed the pathogen in the soil is likely to have caused the recent occurrence of human infection. Melioidosis is caused by a bacterium called Burkholderia pseudomallei. The bacteria are found in contaminated water and soil and can cause disease in sheep, goats, pigs, horses, and other animals, as well as in humans. The bacteria spread to humans and animals through direct contact with the contaminated source. The organism enters the body through skin abrasions, burns, or wounds infected by contaminated soil or water; inhalation of contaminated dust or vapor; or by consuming contaminated food or water. Clinically, less than 20% of melioidosis cases have skin wounds. The primary route of transmission is through inhalation or ingestion of pathogen. Person-to-person transmission is unusual. The incubation period varies from two days to months or years. The clinical presentation of melioidosis varies from person to person. Some may be symptom-free. Some may develop pneumonia, chronic pus-filled abscesses in the skin, lungs, or other organs. More severe cases may develop septic shock, which may lead to death. The acute form of melioidosis can produce sepsis and pneumonia. To prevent infection, avoid exposing to contaminated water or damp soil and walking barefoot across suspicious ponds or still water and wear waterproof gloves, rubber boots and masks when in contact with soil or contaminated water and when cleaning the environment. According to the relevant literature, at-risk groups include elderly and patients with chronic diseases or poor immunity. Past outbreaks of melioidosis occurred mostly in southern Taiwan after Typhoon Haitang and Typhoon Talim passed through Taiwan in 2005, after Typhoon Morakot passed through Taiwan in 2009, and after Typhoon Fanapi passed through Taiwan in 2010. Over 80% of the cases are elderly with chronic diseases such as diabetes, high blood pressure, p, malignant tumor and heart disease. Taiwan CDC urges physicians and the public to stay vigilant against melioidosis. Melioidosis can be deadly without prompt treatment. If suspected symptoms develop, please seek immediate medical attention. Physicians are urged to consider the possibility of melioidosis when diagnosing residents from the aforementioned at-risk areas with fever of unknown origin, especially elderly people or patients with history of chronic diseases in order to prescribe the appropriate treatment. Residents from at-risk areas who develop fever are advised to seek medical treatment as soon as possible and inform the physician the area of residence and history of contact with contaminated water to facilitate diagnosis. For any questions or further information on communicable diseases, please call the toll-free Communicable Disease Reporting and Consultation Hotline 1922, or visit the Taiwan CDC’s website at http://www.cdc.gov.tw/english/index.aspx. Source:Centers for Disease Control, R.O.C.(Taiwan)