Bacterial brain infections caused by contaminated saline bottles killed eight patients undergoing dental treatment in India, according to an article published May 21 in The Lancet Regional Health – Southeast Asia.
Unsterilized surgical instruments were used to open a saline bottle that was improperly sealed and reused on patients, resulting in 10 patients contracting neuromelioidosis, a severe neurological infection, at a dental clinic.
Eight of the patients died within 16 days of infection, the authors wrote. The pathogen is caused by a bacterium found in contaminated soil and water in tropical and subtropical regions.
“We identified a large number of neuromelioidosis cases in southern India that may have arisen from sporadic cases from environmental sources and iatrogenic cases associated with dental clinics,” wrote the study authors, led by Dr. Angel Miraclin Thirugnanakumar of the Department of Neuroscience at the Christian Medical College in Vellore.
In May 2023, the Christian Medical College and Hospital in Vellore notified the state public health department and relevant officials of an increase in neuromelioidosis cases.
The disease is caused by the bacterium Burkholderia pseudomallei, which thrives in contaminated soil and water. Infection can cause symptoms such as fever, headache, slurred speech and facial paralysis.
The investigation linked the cases to a dental clinic in a small town in Tamil Nadu. The investigation found that the clinic used an unsterilized periosteal elevator (a tool used to remove bone tissue) to open the saline bottles and then loosely reseal them.
The saline bottles were then used on multiple patients over the next few days until they ran out, police wrote.
Imaging tests and lab samples confirmed the presence of the bacteria. The authors speculated that the bacteria likely entered the dental patients’ brains through oral neural pathways. Typically, bacteria spread through the bloodstream.
In addition, genetic testing showed that the bacteria involved in these cases had a very aggressive gene that targets the brain, which allowed the infection to develop rapidly, the authors wrote.
In addition, it was found that the clinic was staffed with dentists, nursing staff and receptionists, but lacked formal training in hospital infection control.
“These findings highlight the importance of strict infection control and prevention in health care settings, including dental facilities, especially in areas where melioidosis is endemic,” Thirugnanakumar and colleagues wrote.