A bacterial brain infection caused by contaminated bottles of saline led to the death of eight patients following dental treatment in India, according to an article published on May 21 in The Lancet Regional Health – Southeast Asia.
An unsterile surgical instrument was used to open a saline bottle, which was resealed loosely and reused on patients, leading 10 patients to contract the severe nervous system infection neuromelioidosis at a dental clinic. Of those patients, eight died within 16 days from the time of infection, which is caused by a germ found in contaminated soil and water in tropical and subtropical regions, the authors wrote.
“We confirmed a large cluster of neuromelioidosis from South India, likely representing sporadic cases from environmental sources and cases linked to an iatrogenic source at a dental clinic,” wrote the authors, led by Dr. Angel Miraclin Thirugnanakumar of the neurological sciences department at Christian Medical College in India.
In May 2023, the Christian Medical College and Hospital, Vellore notified state public health authorities and related officials about an increase in the cases of neuromelioidosis, which is caused by the bacterium Burkholderia pseudomallei that prospers in contaminated soil and water. The infection causes symptoms like fever, headache, slurred speech, and facial paralysis.
An investigation linked the cases to a dental clinic in the small town of Tamil Nadu. It was discovered that a nonsterile periosteal elevator, an instrument used to lift tissue covering bone, was used to open bottles of saline and loosely reseal them. The saline bottles were used on multiple patients over subsequent days until they were empty, they wrote.
Imaging and laboratory samples confirmed the bacteria. The authors surmise that the bacteria likely reached dental patients’ brains through nerve pathways via the mouth. Typically, bacteria spread through the bloodstream.
Furthermore, genetic testing revealed that the bacteria involved in these cases had a very aggressive gene that targets the brain, which allowed the infection to progress quickly, the authors wrote.
Also, it was determined that the clinic, which was staffed with a dentist, nursing staff, and receptionist, lacked formal training in hospital infection control.
“These findings emphasize the importance of strict infection control and prevention practices in healthcare settings, including dental facilities, especially in melioidosis-endemic areas,” Thirugnanakumar and colleagues wrote.
