Outbreak of melioidosis and leptospirosis co-infection following a rescue operation.

We analyzed the epidemiological data of all people who were involved in the search and rescue operation in Lubuk Yu, a natural recreational forest with waterfall and stream. The hospital admission records of the cases who fulfilled the case definition and the environmental samples result taken at Lubuk Yu recreational area were studied. 153 people were exposed to this outbreak, 85 (55.5%) were professional rescuers from various government agencies and 68 (44.5%) were villagers. 21 fulfilled the case definition. Ten cases were confirmed melioidosis, six melioidosis alone and four coinfected with leptospirosis. There were eight deaths in this outbreak, seven were villagers and one professional rescuer. Overall case fatality was 70%. All confirmed melioidosis cases and seven who died had diabetes mellitus. The morbidity rate were higher among the villagers, 23.5% compared to professional rescuers, 5.9%. The case fatality rate were also higher in this group which was 100% compared to 33.3% in professional rescuers. The soil and water samples in Lubuk Yu recreational area were positive for leptospira and Burkholderia pseudomallei. The presence of co-infection and co-morbidities especially diabetes mellitus among the exposed led to the high mortality in this outbreak hence a high index of suspicion is important among the healthcare professionals in the management of melioidosis cases. To avoid similar incident in future, search and rescue operation should be only conducted by professional rescuers with appropriate personal protective equipment. A register of rescuers should be maintained for surveillance and follow up if necessary.

Surveillance For Sarcocystosis In Tioman Island, Malaysia

In October 2011, the National International Health Regulations (IHR) 2005 Focal Point for Malaysia received notification from the United States’ Centers for Disease Control and Prevention (CDC) of a probable Sarcocystis outbreak amongst 23 travellers from six countries who had vacationed on Tioman Island between June and August 2011. The Ministry of Health, Malaysia (MOH) in collaboration with the Department of Veterinary Services, Malaysia (DVS) conducted a cross sectional study in November 2011 to determine the presence of Sarcocystosis among humans, animals and in the environment in Tioman Island. Epidemiological investigations conducted involved a community health survey of 44 residents in Kampung Salang, Tioman and review of outpatient attendance cards for suspected or confirmed cases of Sarcocystosis. Twenty-eight fresh stool samples were collected and sent to the National Public Health Laboratory (NPHL) for detection of Sarcocystis oocysts using fluorescence microscopy. Water samples taken from 27 water sampling points around the island were processed and analysed under the fluorescence microscope using ultraviolet (UV) light at the Institute for Medical Research (IMR) to detect the presence of Sarcocystis sporocyst. DVS collected 84 faecal samples from four types of domesticated animals and then analysed them at the Veterinary Services Centre in Tioman Island for Sarcocystis oocysts and other parasitic ova and cysts using qualitative Floatation Technique. The results showed that Sarcocystis was not present in humans, animals and in the environment in Tioman Island during the study period. Further surveillance among humans, wildlife and the environment is needed to determine Sarcocystis endemicity in Tioman Island.