I am sure you have heard media reports about the harrowing rescue of the 12 boys and their coach trapped in cave for 2 weeks by flood waters – – trapped 4 km from the entrance to the cave, separated by narrow flooded passages.

Link to NY Times article

 

 

Thanks to international efforts and skilled divers the boys were rescued by helping them swim out through the tight dark passages with scuba gear on.  (Sadly, and a testament of the extreme difficulty of the rescue, one of the rescue divers ran out of oxygen and died during the rescue efforts.)

 

 

After they emerged from the cave, the boys were whisked away to a hospital where they were put under quarantine.  The photo below shows the boys in a separate room in the hospital with masks over their mouths.

 

 

The media reports are not clear, but the reason for isolation post rescue seems to have been several-fold:

1. To screen for infections they may have gotten while trapped in this moist humid dark cave for 2 weeks.
2. To minimize the psychological trauma of the event and the risk of subsequent development of PTSD.
3. (I don’t think they were truly seen as a public health risk; with risk of transmission of communicable diseases to others, but am not sure.)

Trapped in the cave for 2 weeks what kinds of infections would they be at risk for?

Some possibilities:

• Leptospirosis
  • Endemic to north-eastern Thailand, and transmitted through exposure to water contaminated by animal urine (especially rodents, the reservoir hosts of Leptospira bacteria).
  • The presenting features of leptospirosis are very nonspecific, diagnosis can be challenging, and empiric treatment is often offered.
• Histoplasmosis
  • Hearing the word “cave” – one has to consider histoplasmosis, an invasive fungal infection that lives in the soil contaminated by bird or bat droppings.
• Melioidosis
  • This may be a leading risk.  North-eastern Thailand is a hot-spot for the Burkholderia pseudomallei bacteria that live in muddy soil.  If the bacteria were in the cave, the prolonged exposure may increase the children’s risk of infection, which can be initially latent and later reactivate similar to TB.
  • Fatal cases of melioidosis had been reported among rescue workers in Malaysia.

The list of possible infections is much longer.  Trapped in the cave for 2 weeks, combined with the humid air, their weakened condition deprived of food and water, forced to drink the water condensed on the walls of the cave to survive, they were at increased risk of exposure and infection with environmental pathogens.   I can’t even begin to imagine what it must have been like for them….