1 Sline Bottle Claims 8 Lives In Tamil Nadu's Tirupattur District: Study
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The symptoms of Neuromelioidosis include fever and headache followed by slurred speech, visual distortion and in some cases facial palsy.
In a tragic incident, eight people died of neuromelioidosis — a bacterial infection of the brain — that they got from a dental clinic in Vaniyambadi town of Tamil Nadu's Tirupattur district in 2023, a study published in The Lancet has revealed.
According to an investigation by a team of doctors from multiple organisations, including CMC Vellore, ICMR-NIE and Tamil Nadu Directorate of Public Health, the outbreak, which hasn't been reported by any government agency, has been linked to unsterile dental practices.
The first author of the study, Dr Angel Miraclin Thirugnanakumar of the neurological sciences department at CMC, said that an unsterile surgical instrument called a periosteal elevator was used to open a saline bottle, which was then loosely resealed. The reuse of its contents by the clinic led to at least 10 people contracting the infection and eight of them dying, pegging the fatality rate at 80%.
'The rapid and high fatality may be because the bacteria in the saline travelled directly along nerve pathways when used to clean the patients' mouth during procedures, rather than through the bloodstream, a common route for such infections," the researcher concluded. Whole genome sequencing showed that the bacteria have a gene that aggressively attacks the brain.
Neuromelioidosis is a severe central nervous system infection, affecting the brain and spinal cord, caused by the bacterium Burkholderia pseudomallei, commonly found in contaminated soil and water in tropical and subtropical areas.
The symptoms of Neuromelioidosis include fever and headache followed by slurred speech, visual distortion and in some cases facial palsy.
Researchers found 21 neuromelioidosis cases between July 2022 and April 2023, including 10 linked to a dental clinic, resulting in 9 deaths. The fatality rate was 9% among the 11 patients not linked to the clinic.
State public health officials praised the study for aiding case identification and informing containment measures. 'We've halted the spread with corrective actions, and this serves as a reminder for healthcare providers to prioritise infection control," said Dr. TS Selvavinayagam, Director of Public Health.
On May 9, 2023, CMC reported a surge in neuromelioidosis cases linked to a dental clinic. Four days later, health officials convened a meeting with local healthcare facilities. Co-author Prabu Rajkumar from the ICMR-NIE said that a team of doctors investigated the cluster to describe the clinical and epidemiological characteristics and identify the source of infection.
'But before doctors could visit the dental clinic to pick samples, the clinic was disinfected, the water supply was cut off, and the clinic was closed following public outcry," the authors wrote.
However, scientists detected B. pseudomallei in a saline bottle sample, while unopened bottles tested negative. Further verification involved testing additional samples and conducting whole-genome sequencing.
Analysis showed head and neck involvement, such as inflammation of a salivary gland (parotid gland), inner lining of cheeks (buccal mucosa), along with enlargement or swelling of one or more lymph nodes (lymphadenopathy), was common in cases not linked to the dental clinic. But patients exposed to the dental clinic's contaminated saline progressed rapidly, developing facial cellulitis and soft tissue abscesses, likely due to ingestion of the contaminated solution.
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