Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics.

Anand Mohan,Nickson Tai,Hie-Ung Ngian,Barbara Machunter,Vanessa Rigas,Bart J Currie,King-Ching Hii,Wen-Yi Chua,Reginal Bantin,Alexander Mijen,Su-Lin Chien,Lee-See Tan,Mark Mayo,Yuwana Podin,Jamilah Hashim,Charles Goh,Chae‐Hee Chieng ,See Chang Wong ,Jin Shyan Wong ,Danilo Lo Fo Wong ,Mong How Ooi

doi:10.1371/journal.pntd.0005650

Abstract

BackgroundMelioidosis is a serious, and potentially fatal community-acquired infection endemic to northern Australia and Southeast Asia, including Sarawak, Malaysia. The disease, caused by the usually intrinsically aminoglycoside-resistant Burkholderia pseudomallei, most commonly affects adults with predisposing risk factors. There are limited data on pediatric melioidosis in Sarawak.MethodsA part prospective, part retrospective study of children aged <15 years with culture-confirmed melioidosis was conducted in the 3 major public hospitals in Central Sarawak between 2009 and 2014. We examined epidemiological, clinical and microbiological characteristics.FindingsForty-two patients were recruited during the 6-year study period. The overall annual incidence was estimated to be 4.1 per 100,000 children <15 years, with marked variation between districts. No children had pre-existing medical conditions. Twenty-three (55%) had disseminated disease, 10 (43%) of whom died. The commonest site of infection was the lungs, which occurred in 21 (50%) children. Other important sites of infection included lymph nodes, spleen, joints and lacrimal glands. Seven (17%) children had bacteremia with no overt focus of infection. Delays in diagnosis and in melioidosis-appropriate antibiotic treatment were observed in nearly 90% of children. Of the clinical isolates tested, 35/36 (97%) were susceptible to gentamicin. Of these, all 11 isolates that were genotyped were of a single multi-locus sequence type, ST881, and possessed the putative B. pseudomallei virulence determinants bimABp, fhaB3, and the YLF gene cluster.ConclusionsCentral Sarawak has a very high incidence of pediatric melioidosis, caused predominantly by gentamicin-susceptible B. pseudomallei strains. Children frequently presented with disseminated disease and had an alarmingly high death rate, despite the absence of any apparent predisposing risk factor.

Highlights

Melioidosis is a serious tropical infectious disease endemic to Southeast Asia and northern Australia, caused by the gram-negative bacillus Burkholderia pseudomallei [1]
Children frequently presented with disseminated disease and had an alarmingly high death rate, despite the absence of any apparent predisposing risk factor
We found that this region has a very high incidence of pediatric melioidosis, and that children frequently presented with disseminated disease and had high fatality rates, despite the absence of any predisposing risk factor

Summary

Introduction

Melioidosis is a serious tropical infectious disease endemic to Southeast Asia and northern Australia, caused by the gram-negative bacillus Burkholderia pseudomallei [1]. Melioidosis is a major cause of fatal community-acquired bacteremia and pneumonia in adults [4, 5], and case fatality rates of 50% continue to be reported [6]. Pediatric melioidosis is reported to be less common than adult disease, constituting between 5–15% of all melioidosis cases [7]. The majority of pediatric melioidosis data to date have originated from small, retrospective studies, marked differences in disease manifestations have been noted between the various melioidosis endemic regions. Melioidosis is a serious, and potentially fatal community-acquired infection endemic to northern Australia and Southeast Asia, including Sarawak, Malaysia.

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Results

Conclusion