About 3 weeks before being hospitalized, Mr. LSH (36 years old, in Thanh Hoa) had symptoms of prolonged fever, accompanied by body aches and bought and used fever-reducing medicine at home for 10 days but no improvement.
Afterward, this man went to a local medical facility and was given outpatient medication. However, the condition did not improve, the fever continued and breathing difficulty became more and more severe. On November 3, Mr. H. was transferred to the provincial hospital, where doctors diagnosed infectious fever.
Here, the patient was intubated, mechanically ventilated, and had continuous dialysis. Blood culture results identified the bacteria Burkholderia pseudomallei, the causative agent of Whitmore’s disease.
After 6 days of intensive treatment but with little improvement, the male patient was transferred to the Central Tropical Disease Hospital. Mr. H. was diagnosed with septic shock, multiple organ failure, sepsis due to B.pseudomallei, and diabetes.
At the Emergency Department, Central Hospital for Tropical Diseases, Mr. H. was treated with concomitant antibiotics, antifungals and continuous dialysis. However, after a few days, the man developed a subcutaneous air leak in the neck and chest area. X-ray and CT results showed pleural and mediastinal pneumothorax, causing acute cardiac tamponade.
The patient underwent surgery to open the mediastinal cavity for decompression, but the respiratory and circulatory failure did not improve yet supporting the patient VV ECMO (extracorporeal blood membrane oxygenation). After that, the patient was transferred to the Intensive Care Department in a state of septic shock, multiple organ failure (including liver failure, renal failure and respiratory failure), vasopressor maintenance, and continuous dialysis.
Currently, the patient still has to use VV ECMO and continuous dialysis. Photo: BVCC.
Bronchoscopy detected a lot of pus and pseudomembrane covering the bronchial mucosa, serious consequences of Whitmore bacteria causing lung damage.
Dr. Le Thi Huyen, Intensive Care Department, said that the patient’s circulatory function has improved where he no longer needs vasopressors, but his lung function is very poor, and he needs active monitoring and support. The patient’s kidney condition has shown signs of improvement.
“Patients work in environments with direct contact with contaminated soil and water, together with uncontrolled diabetes, creating conditions for disease-causing bacteria. Whitmore is a dangerous disease with a negative progression, often in a subacute form with atypical symptoms such as prolonged fever, making it difficult for patients to recognize and access early treatment,” said Dr. Huyen.
There is currently no vaccine to prevent Whitmore’s disease. Therefore, the main preventive measure is to avoid direct contact with sources of contaminated soil and water. Do not bathe, swim, or dive in ponds, lakes and rivers in polluted areas. Ensure personal hygiene, wash hands regularly with soap and clean water, especially before and after preparing food, before eating, after going to the toilet, and after working in the fields.
In particular, people with underlying diseases such as diabetes should limit direct contact with contaminated soil,” said Dr. Huyen.
What are the initial symptoms of Whitmore’s disease and how can they be mistaken for other conditions?
Interview between Time.news Editor and Dr. Le Thi Huyen, Intensive Care Specialist
Time.news Editor: Welcome, Dr. Le Thi Huyen. Thank you for joining us today to discuss the recent case of Mr. LSH, who has been battling a severe infection that led to multiple organ failures. It’s a tragic but enlightening situation. Could you start by summarizing Mr. HSH’s symptoms and how they progressed before he was hospitalized?
Dr. Le Thi Huyen: Thank you for having me. Mr. LSH started with prolonged fever and body aches. Initially, he attempted to manage his symptoms at home with fever-reducing medication for ten days. However, when he didn’t experience any improvement, he sought outpatient care at a local facility. His condition escalated to breathing difficulties, ultimately leading to his transfer to a provincial hospital where he was diagnosed with infectious fever.
Time.news Editor: It’s concerning how quickly these symptoms can escalate. How did the diagnosis evolve from infectious fever to the identification of Burkholderia pseudomallei, the bacteria responsible for Whitmore’s disease?
Dr. Le Thi Huyen: Once Mr. LSH was admitted to the hospital, the medical team conducted blood cultures which confirmed the presence of Burkholderia pseudomallei. It’s important to note that Whitmore’s disease can be quite insidious—initial symptoms may seem common but can swiftly lead to severe complications.
Time.news Editor: After the diagnosis, Mr. LSH’s condition continued to deteriorate. He developed septic shock and multiple organ failure. Can you elaborate on what happens during septic shock and why it’s so critical?
Dr. Le Thi Huyen: Septic shock occurs when the body’s response to an infection leads to dangerously low blood pressure and insufficient blood flow to organs. It is a life-threatening condition requiring immediate and aggressive treatment. In Mr. LSH’s case, his diabetes further complicated the situation, putting him at greater risk for organ failure.
Time.news Editor: Given the complexity of Mr. LSH’s condition, what were the treatment protocols you implemented?
Dr. Le Thi Huyen: His treatment included a combination of antibiotics, antifungals, and continuous dialysis. Unfortunately, despite these interventions, he developed complications like a subcutaneous air leak and pneumothorax, indicating the severity of his condition. We also had to provide decompression surgery and support his respiratory and circulatory function using VV ECMO, which is a form of life support.
Time.news Editor: That sounds incredibly challenging. Could you share what this ongoing treatment entails and how it supports patients like Mr. LSH?
Dr. Le Thi Huyen: VV ECMO supports patients by taking over the role of the heart and lungs in oxygenating blood when they cannot do so adequately themselves. It allows us to manage critical complications while ensuring adequate blood flow to vital organs. Continuous dialysis is essential to cope with renal failure, and we closely monitor for any further complications.
Time.news Editor: With the advancements in intensive care, how hopeful are you for Mr. LSH’s recovery, given his current health status?
Dr. Le Thi Huyen: Recovery from such severe conditions is complex and varies from patient to patient. While Mr. LSH is still on support systems and exhibiting multiple organ failure, we remain hopeful. Each day introduces potential for small improvements, particularly with critical care backing him.
Time.news Editor: what measures can be taken to prevent such infections in the community, especially given the potency of Burkholderia pseudomallei?
Dr. Le Thi Huyen: Awareness is crucial. Communities need to be educated about the symptoms of Whitmore’s disease and the environments where the bacteria thrive, typically wet soil. Taking preventive measures, such as avoiding exposure to contaminated water or soil and seeking prompt medical attention for persistent symptoms, can save lives.
Time.news Editor: Thank you, Dr. Huyen. Your insights into this case of Mr. LSH bring to light the critical nature of early detection and intervention in infectious diseases. It’s reassuring to know that dedicated healthcare professionals like yourself are on the front lines, working tirelessly for patient recovery.
Dr. Le Thi Huyen: Thank you for shedding light on this important issue. It’s vital that we continue to raise awareness and improve how we address infectious diseases within our communities.