Abstract
BackgroundMelioidiosis, infection by Burkholderia pseudomallei, is an important but frequently under-recognised cause of morbidity and mortality in Southeast Asia and elsewhere in the tropics. Data on the epidemiology of paediatric melioidosis in Cambodia are extremely limited.MethodsCulture-positive melioidosis cases presenting to Angkor Hospital for Children, a non-governmental paediatric hospital located in Siem Reap, Northern Cambodia, between 1st January 2009 and 31st December 2013 were identified by searches of hospital and laboratory databases and logbooks.ResultsOne hundred seventy-three evaluable cases were identified, presenting from eight provinces. For Siem Reap province, the median commune level incidence was estimated to be 28-35 cases per 100,000 children <15 years per year. Most cases presented during the wet season, May to October. The median age at presentation was 5.7 years (range 8 days–15.9 years). Apart from undernutrition, co-morbidities were rare. Three quarters (131/173) of the children had localised infection, most commonly skin/soft tissue infection (60 cases) or suppurative parotitis (51 cases). There were 39 children with B. pseudomallei bacteraemia: 29 (74.4%) of these had clinical and/or radiological evidence of pneumonia. Overall mortality was 16.8% (29/173) with mortality in bacteraemic cases of 71.8% (28/39). At least seven children did not receive an antimicrobial with activity against B. pseudomallei prior to death.ConclusionsThis retrospective study demonstrated a considerable burden of melioidosis in Cambodian children. Given the high mortality associated with bacteraemic infection, there is an urgent need for greater awareness amongst healthcare professionals in Cambodia and other countries where melioidosis is known or suspected to be endemic. Empiric treatment guidelines should ensure suspected cases are treated early with appropriate antimicrobials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2034-9) contains supplementary material, which is available to authorized users.
Highlights
Melioidiosis, infection by Burkholderia pseudomallei, is an important but frequently under-recognised cause of morbidity and mortality in Southeast Asia and elsewhere in the tropics
These figures are lower than the numbers of cases seen annually in neighbouring Thailand [12], more recently, B. pseudomallei has been reported to account for 74% of suppurative parotitis [6], and 7.9% of culture-positive bacteraemia [13] seen in Angkor Hospital for Children (AHC), further evidence that melioidosis is likely to have been grossly underdiagnosed in Cambodia
Data were obtained from a single hospital and so extrapolation of findings to the wider population of Cambodia must be done cautiously. This retrospective study demonstrates a considerable burden of melioidosis in Cambodian children
Summary
Melioidiosis, infection by Burkholderia pseudomallei, is an important but frequently under-recognised cause of morbidity and mortality in Southeast Asia and elsewhere in the tropics. Angkor Hospital for Children (AHC), a non-governmental hospital located in Siem Reap province, identified a total of 39 paediatric melioidosis cases over an overlapping time period (October 2005 to December 2008), following the opening of a diagnostic microbiology laboratory within the hospital [11]. These figures are lower than the numbers of cases seen annually in neighbouring Thailand [12], more recently, B. pseudomallei has been reported to account for 74% of suppurative parotitis [6], and 7.9% of culture-positive bacteraemia [13] seen in AHC, further evidence that melioidosis is likely to have been grossly underdiagnosed in Cambodia. Assuming that between 5 and 15% of melioidosis occurs in children [4], 100–300 paediatric cases per year would be expected across the whole country
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
