The giant tsunami of December 2004 engulfed everything in its path: cars, houses, vegetation, animals, soil, chemicals, and a host of pathogens. Some people caught in the wave inhaled contaminated seawater as they fought their way to safety. Seemingly unscathed in the immediate aftermath of the disaster, they subsequently fell ill with a type of aspiration pneumonia that was accompanied by brain abscesses. Health workers dubbed the condition "tsunami lung."

Tsunami lung, also known as melioidosis, had two main causes. The first was bacterial: scientists have cultured Burkholderia pseudomallei (a bacterium found in tropical areas) and Nocardia species from victims' lungs. 1, 2 The second cause was health system failure of the sort that Garfield and Hamid describe. Health care workers in hard-hit areas had no antibiotics for patients in the early stages of pneumonia. As a result, otherwise treatable infections festered and, in some cases, traveled through the bloodstream to the brain, where they produced abscesses and caused neurologic problems, including paralysis.

A diagnosis of tsunami lung is based on chest X-ray plus computed tomographic scanning of the brain to document abscesses. A case report published last June described successful antibiotic treatment of a 17-year-old girl who'd lost speech and was partially paralyzed because of brain abscesses. 3 The antibiotics, which were administered intravenously, included imipenem, vancomycin, ceftazidime, and metronidazole.

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