Abstract
We describe the first cases of pediatric melioidosis in Cambodia. Thirty-nine cases were diagnosed at the Angkor Hospital for Children, Siem Reap, between October 2005 and December 2008 after the introduction of microbiology capabilities. Median age was 7.8 years (range = 1.6–16.2 years), 15 cases were male (38%), and 4 cases had pre-existing conditions that may have pre-disposed the patient to melioidosis. Infection was localized in 27 cases (69%) and disseminated in 12 cases (31%). Eleven cases (28%) were treated as outpatients, and 28 (72%) cases were admitted. Eight children (21%) died a median of 2 days after admission; seven deaths were attributable to melioidosis, all of which occurred in children receiving suboptimal antimicrobial therapy and before bacteriological culture results were available. Our findings indicate the need for heightened awareness of melioidosis in Cambodia, and they have led us to review microbiology procedures and antimicrobial prescribing of suspected and confirmed cases.
Highlights
Melioidosis is a serious infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei.[1,2] This organism is present in the environment in a defined geographic distribution including much of south and east Asia, northern Australia, and areas of South America, where infection is thought to be acquired after bacterial inoculation, ingestion, or inhalation.[1,2,3] The clinical presentation is highly variable and ranges from a mild localized infection to acute fulminant sepsis with widespread bacterial dissemination.[1,2] The clinical diagnosis of melioidosis is notoriously inaccurate, and diagnostic confirmation relies on culture of B. pseudomallei.[4]
Melioidosis was first reported from Laos in 2001 after the development of a diagnostic microbiology laboratory at Mahosot Hospital, Vientiane,[10] and B. pseudomallei was subsequently isolated from the surrounding environment.[11]
B. pseudomallei has been isolated from rice paddies in Siem Reap province in northwest Cambodia,[12] and a recent report of two cases of melioidosis in adults from southern Cambodia has confirmed the presence of melioidosis in the indigenous population.[13]
Summary
Melioidosis is a serious infectious disease caused by the Gram-negative bacterium Burkholderia pseudomallei.[1,2] This organism is present in the environment in a defined geographic distribution including much of south and east Asia, northern Australia, and areas of South America, where infection is thought to be acquired after bacterial inoculation, ingestion, or inhalation.[1,2,3] The clinical presentation is highly variable and ranges from a mild localized infection to acute fulminant sepsis with widespread bacterial dissemination.[1,2] The clinical diagnosis of melioidosis is notoriously inaccurate, and diagnostic confirmation relies on culture of B. pseudomallei.[4]. Melioidosis is a leading cause of bacterial sepsis in northeast Thailand.[5,6,7,8] Childhood infection accounts for around 10% of cases overall in this setting, and acute suppurative parotitis accounts for one-third of pediatric cases.[9] Adjacent to northeast Thailand is Laos to the east and southeast and Cambodia to the south. We report the identification of 39 cases of melioidosis at the Angkor Hospital for Children in Siem Reap, the first reported
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