Aeromonas spp. Bacteremia in Pregnant Women, Thailand–Myanmar Border, 2011

To the Editor: Aeromonas spp. bacteria cause a broad spectrum of human infections (1). Invasive infections can be associated with exposure to contaminated water and occur frequently in patients with underlying immunosuppression or trauma but only infrequently in pregnant women (2). During January– May 2011, Aeromonas spp. bacteremia was identifi ed in 3 pregnant Myanmar women of Karen ethnicity, who sought care at migrant/refugee clinics on the Thailand–Myanmar border. In January 2011, a 31-year-old woman in week 12 of pregnancy sought care at the Wang Pha migrant clinic. She reported a brief history of fever, headache, abdominal pain, and vaginal bleeding. She was tachycardic and tachypneic. A complete blood count indicated mild thrombocytopenia (104 × 10 3 /μL). Ampicillin, gentamicin, and metronidazole were empirically prescribed. Ultrasonography con-fi rmed a nonviable fetus, and products of conception were surgically evacuated. Four days later, treatment was changed to oral amoxicillin and ciprofl oxacin because of clinical improvement and isolation of A. hydrophila from blood collected at admission. The patient recovered and was discharged after 6 days. In March 2011, a 25-year-old primigravid woman in week 12 of pregnancy sought care at the Maela refugee camp; she had a 24-hour history of fever, chills, vomiting, diarrhea, and vaginal bleeding. She had recently sought treatment from a traditional birth attendant, who reportedly had inserted 3 sticks into the cervix and performed uterine massage. At admission, the patient was febrile and in shock. Bimanual examination revealed an open cervix with malodorous discharge. Ultrasonography revealed only products of conception. The patient received intravenous fl uids and was empirically treated with ampicillin, gentamicin, and metronidazole. After surgical evacuation of the products of conception, the patient's condition continued to deteriorate. Despite referral to the local hospital, the woman died the next day with clinical features suggestive of septic shock and disseminated intravascular coagulopathy. Complete blood count results were unavailable. A. veronii biovar sobria was isolated from blood collected at admission. In May 2011, a 50-year-old woman in week 12 of pregnancy was admitted to the Wang Pha Clinic with a history of vaginal bleeding. She was febrile and in shock. Vaginal examination detected an open cervix with malodorous discharge. Complete blood count indicated reference level leukocytes and mild thrombocytopenia (116 × 10 3 cells/μL). Blood was collected for culture. The patient received intravenous fl uids and was empirically treated with ampicillin, gentamicin, and metronidazole. Products of conception were removed …