The disease that kills after 48 hours

With a high fever and painful swelling in his right leg, Cao Van Them was diagnosed with Whitmore's disease - a dangerous infectious disease that can kill people quickly.

The 25-year-old patient had a history of glomerulonephritis and was admitted to Thanh Hoa General Hospital with symptoms of fever and swollen right leg. After 11 days of treatment at the provincial hospital but the fever did not subside, Mr. Them was transferred to the Department of Musculoskeletal, Bach Mai Hospital. After consultation, Mr. Them was transferred to the Department of Infectious Diseases for treatment.

Doctor Ngo Thi Phuong Nhung, Department of Infectious Diseases, Bach Mai Hospital, said that on August 11, the patient was admitted to the department in critical condition, with high fever, chills, signs of liver failure, extensive lung damage, and abscesses. Doctors performed blood and joint fluid cultures of the right knee to diagnose the disease. After three blood cultures, the patient tested positive for the bacteria Burkholderia pseudomallei that causes whitmore disease.

During treatment at the department, the patient continued to show signs of septic shock with severe liver failure, kidney failure, and respiratory failure. The doctor had to intubate, treat septic shock, and use specific antibiotics. Currently, kidney and liver function have improved, but the patient still needs a ventilator and intensive care, with a poor prognosis.

Dr. Do Duy Cuong examines patient Cao Van Them. Photo: Le Nga

Dr. Do Duy Cuong, Head of the Department of Infectious Diseases at Bach Mai Hospital, said that since the beginning of this year, the department has received several cases of whitmore disease. The disease has very diverse clinical manifestations, complex developments, and can cause rapid death if not properly diagnosed and treated with appropriate antibiotics. Of the whitmore disease cases, 90% of patients have symptoms of sepsis and pneumonia, half of which are at risk of complications of septic shock and death.

According to Mr. Cuong, in addition to patient Them, the department is also treating Ms. Nguyen Thi Luong (52 years old) in Nghe An. Fortunately, the patient was diagnosed early at the provincial general hospital and transferred to Bach Mai for timely treatment, so her condition is no longer critical.

According to Ms. Luong, after coming back from cutting grass at the pond, she had a continuous high fever, cough, and pain in the neck and chest. Doctors at the provincial general hospital discovered that the patient had Whitmore's disease and treated her with antibiotics. After 10 days in the hospital, Ms. Luong's fever had not subsided. She was transferred to the Infectious Diseases Department, Bach Mai Hospital in a state of high fever, lung damage, lung abscess, and many necrotic foci in the lungs. Here, she continued to be treated with antibiotics by doctors. Currently, the patient's health condition has improved positively.

Thanks to early detection, patient Luong has overcome the danger. Photo: Le Nga.

Whitmore disease (also known as melioidosis) is a dangerous acute infectious disease caused by the bacteria Burkholderia pseudomallei. The bacteria live in soil or surface water, entering the body through skin scratches when in contact or by inhaling dust particles containing bacteria, inhaling contaminated water when swimming/drowning in ponds, lakes, rivers and streams.

Whitmore disease is being "forgotten" in Vietnam because very few people pay attention to the disease or test to detect the bacteria. Due to the diverse clinical picture, doctors often misdiagnose whitmore with other diseases such as pneumonia, tuberculosis, muscle abscess, sepsis caused by other bacteria such as staphylococcus, streptococcus... However, even when diagnosed correctly, treatment is extremely difficult because it requires high-dose antibiotics (usually ceftazidime) continuously for at least 2 to 4 weeks, then maintenance antibiotics for about 3 to 6 months. The danger is that the disease is easy to relapse, the patient's health is easily exhausted due to the disease recurring or if the treatment regimen is not correct. To date, there is still no vaccine to prevent whitmore disease.

Dr. Trinh Thanh Trung, Head of the Bacteria Research Group, Institute of Microbiology and Biotechnology, Hanoi National University, said that whitmore has a very diverse clinical picture, progresses rapidly and can take the patient's life after only 48 hours of hospitalization. The mortality rate when infected is very high, from 40 to 100% depending on the region. The mortality rate will be significantly reduced if the patient is correctly diagnosed and treated with antibiotics according to the instructions. "The number of whitmore cases increases proportionally to the monthly rainfall, especially increasing dramatically between September and November. Therefore, whitmore season is coming, people and doctors need to be vigilant," Mr. Trung warned.

Mr. Trung said that whitmore is not a rare disease as many people think, but a common disease in some areas of Vietnam. However, many medical facilities cannot test for this disease due to the following 3 main reasons:

- The disease does not have any typical clinical signs and symptoms, making it difficult to diagnose. Many doctors do not suspect the case, so they do not send samples for microbiological testing, leading to missed cases.

- Diagnosis of the disease must be based on microbiological testing. However, many microbiological testing staff still do not have experience in testing for Whitmore bacteria or have not been trained in testing methods, leading to missed cases. Accurate diagnosis of the disease must be based on isolation and identification of bacteria in blood, pus, sputum, urine and other fluid samples.

- Bacteria identification devices in hospitals such as API kits, Vitek machines and Phoenix machines often mistakenly identify Whitmore bacteria as other bacteria, leading to incorrect test results, thereby not being able to guide the correct treatment.

According to VNE