Correspondence

Treatment of Survivors after the Tsunami

N Engl J Med 2005; 352:2654-2655June 23, 2005

Article

To the Editor:

The tsunami that struck the Asian subcontinent and Africa on December 26, 2004, caused the deaths of more than 200,000 people. In Thailand more than 10,000 people were treated in ambulatory health centers. After a tsunami, the effects on people occur in three phases. The injuries that are incompatible with life (e.g., severe cardiovascular events, head injury, and blunt injury) happen in the first minutes; then, over the following hours, complications such as massive hemorrhage, hemopneumothorax, and pulmonary embolism are seen. These are followed, in turn, by the late complications, including infectious diseases that develop over days to weeks.1

A tsunami directly injures the victims by the mechanism of blunt trauma and penetrating injury to any part of the body.1 Soil, small pieces of wood, and glass in the contaminated saltwater penetrate the soft tissue of victims at high velocity. Most of those who survived the disaster also had saltwater aspiration. In most of those admitted to health care facilities with cellulitis, progressive fasciitis developed unless there was prompt treatment with appropriate antibiotics and aggressive débridement.2 Other common complications included bony fractures, soft-tissue contusions, hypoxic encephalopathy, and acute stress disorder.

The volunteer medical team at Rajavithi Hospital in Bangkok, Thailand, treated 37 patients with serious medical complications. All 37 had aspirated saltwater contaminated with soil and had soft-tissue infections. Aspiration pneumonia (in 17 patients), pneumothorax (in 7), and pneumomediastinum (in 3) were the major respiratory problems. In eight patients the acute respiratory distress syndrome developed, with a progressive course in three, rapid resolution followed by severe pneumonia in three, and rapid resolution followed by mild-to-moderate pneumonia in two.

Burkholderia pseudomallei is endemic in this region.3 We encountered one human immunodeficiency virus (HIV)–positive patient with a B. pseudomallei lung abscess and one patient with diabetes mellitus in whom acute B. pseudomallei lobar pneumonia developed (Figure 1Figure 1 B. pseudomallei Lung Abscess in a Patient after the Tsunami.). Table 1Table 1Clinical Findings in Two Patients with B. pseudomallei Infection and Melioidosis after the Tsunami. summarizes the clinical findings in these two patients, who had melioidosis after the disaster. Both were febrile, with cough, dyspnea, and sputum production, and required respiratory support.

Among all the patients, cultures of blood, sputum, or pus contained the following organisms: Pseudomonas aeruginosa (in four patients), B. pseudomallei (in two), Stenotrophomonas maltophilia (in one), Acinetobacter baumanii (in five), Escherichia coli (in three), klebsiella (in three), enterobacter (in two), neisseria (in one), citrobacter (in one), corynebacteria (in two), and viridans streptococcus (in two). All the patients were treated with combination antibiotic therapy (imipenem plus cotrimoxazole [trimethoprim–sulfamethoxazole]) that is active against pseudomonas and B. pseudomallei.

In summary, the tsunami hit in an area where B. pseudomallei is endemic,3-5 and the patients needed treatment for B. pseudomallei and also treatment with antibiotics that are active against anaerobic bacteria, débridement, and respiratory care.

Subsai Kongsaengdao, M.D.
Sakarn Bunnag, M.D.
Napa Siriwiwattnakul, M.D.
Rajavithi Hospital, Bangkok 10400, Thailand
skhongsa@gmail.com

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Citing Articles (7)

Citing Articles

1. 1

   BRUCE ROBINSON, MOHAMMAD FAHMI ALATAS, ANDREW ROBERTSON, HENRY STEER. (2011) Natural disasters and the lung. Respirology 16:3, 386-395
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2. 2

   Bart J. Currie, David A.B. Dance, Allen C. Cheng. (2008) The global distribution of Burkholderia pseudomallei and melioidosis: an update. Transactions of the Royal Society of Tropical Medicine and Hygiene 102, S1-S4
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3. 3

   Thavat Prasartritha, Rachata Tungsiripat, Pairoj Warachit. (2008) The revisit of 2004 tsunami in Thailand: characteristics of wounds. International Wound Journal 5:1, 8-19
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4. 4

   Joseph B. Legutki, Michelle Nelson, Richard Titball, Darrell R. Galloway, Alfred Mateczun, Leslie W. Baillie. (2007) Analysis of peptide mimotopes of Burkholderia pseudomallei exopolysaccharide. Vaccine 25:45, 7796-7805
   CrossRef

5. 5

   Jorge M Arzola, Joshua S Hawley, Crystal Oakman, Rafael V Mora. (2007) A case of prostatitis due to Burkholderia pseudomallei. Nature Clinical Practice Urology 4:2, 111-114
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   Owe Källman, Christina Lundberg, Bengt Wretlind, Åke Örtqvist. (2006) Gram-negative bacteria from patients seeking medical advice in Stockholm after the tsunami catastrophe. Scandinavian Journal of Infectious Diseases 38:6-7, 448-450
   CrossRef

7. 7

   Christian Garzoni, Stéphane Emonet, Laurence Legout, Rilliet Benedict, Pierre Hoffmeyer, Louis Bernard, Jorge Garbino. (2005) Atypical Infections in Tsunami Survivors. Emerging Infectious Diseases 11:10, 1591-1593
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