Melioidosis In Children Research Articles

Melioidosis in Children, Brazil, 1989–2019

Melioidosis in Children, Brazil, 1989–2019

Clinical and Imaging Manifestations of Pediatric Melioidosis in Hainan, China

OBJECTIVE: The objective of this study was to investigate the clinical and imaging manifestations of melioidosis in children in Hainan Province, China, to improve its understanding. MATERIALS AND METHODS: We retrospectively analyzed 10 children with melioidosis in Hainan Province, China, from January 2002 to November 2021. We collected clinical and imaging data. These data were analyzed retrospectively by two radiologists with more than 10 years' radiology imaging experience. RESULTS: The patients' average age was 8.4 years (range: 17 days to 15 years), the male-to-female ratio was 6:4, and the average length of hospital stay was 31.5 days (5–96 days). Only two patients had underlying diseases, which were acute lymphocytic leukocyte hepatitis and hepatitis B. One patient had no onset of fever, and the other nine patients had a fever, with an average temperature of 39.5°C (38.4–40.3°C). Two patients had a low white blood cell count (0.27 × 109/L, 3.6 × 109/L), four had a normal white blood cell count, and two had a slightly high white blood cell count (13.6 × 109/L, 14.2 × 109/L). Two patients aged <1 year had a high white blood cell count >34 × 109/L and died. One patient was automatically discharged from the hospital and stopped treatment because of economic factors, and the rest improved after treatment. The neutrophil count was normal in two patients, but it was increased in the other patients. There were no data of C-reactive protein (CRP) measurements in three patients, and four of the other seven patients showed greatly elevated CRP concentrations. Among these four patients, two died and two were cured. One patient had sepsis, three had septicopyemia, and two had multiple organ dysfunction syndrome; among these six patients, one died and others improved. Four patients with pneumonia showed scattered exudation, consolidation, and nodules in both lungs, which developed into lung abscesses, as well as melioidosis and mumps. Three patients showed parotid swelling and abscess formation multilocular. One patient had liver and splenic abscesses. One patient had neck abscesses and one had perineal skin abscesses. One patient had purulent meningitis (clinical diagnosis) and disseminated intravascular coagulation (DIC), and this patient died. CONCLUSIONS: For patients in endemic areas, and those who have clinical manifestations of sepsis, pneumonia, mumps, and liver and splenic abscesses on imaging manifestations, the possibility of melioidosis should be considered. Microbial culture should be carried out as soon as possible, and these results of culture should be considered. Antibiotic treatment should be performed before a diagnosis. Mortality is more likely in patients who are aged <1 year and have considerably elevated CRP concentrations, multiple organ dysfunction syndrome, and central nervous system infection/DIC.

Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009-2018.

We report trends in manifestations, treatment, and outcomes of 355 children with culture-confirmed melioidosis over 10 years at a pediatric hospital in northern Cambodia. Bacteremia and presentation with pneumonia were risk factors for death. A total of 39 children recovered after being given only oral antimicrobial drug treatment.

Melioidosis in Children, Brazil, 1989-2019.

We studied 20 confirmed or suspected cases of melioidosis in children in Ceará, Brazil, during 1989–2019. We observed a high death rate, severe signs and symptoms, and substantial environmental exposure. These data suggest that childhood melioidosis might be more severe in Brazil than in other regions.

A systematic review of screening and diagnostic tests outcome for melioidosis in children and adolescents

Melioidosis is a disease caused by infection of the Gram-negative environmental bacterium Burkholderia pseudomallei. Despite of the high fatality rate from this infection, melioidosis is often a neglected disease. It has been estimated that this disease was regularly under-reported in many countries in Southeast Asia and elsewhere in the tropics. Infection occurs following percutaneous inoculation, inhalation, or ingestion of the organism. The spectrum of the infection is broad, ranging from minor skin or soft tissue infection to pneumonia and bacteraemia with a high mortality rate. The objective of this study is to review the available literatures on the different methods of screening and diagnostic developed for melioidosis among children. Methods. Article search was conducted using two electronic databases including Science Direct and PubMed. Articles published within the year from 2013 until 2018 that fulfills the inclusion and exclusion criteria were selected and included in the list for further review. Keywords such as melioidosis, children, screening and diagnosis were used during the article search process. Children and adolescent aged less than 19 years were chosen as the target group for this review. Results. Six full text article were selected and included in the final data extraction and analysis process. Overall, six different screening methods that were used in melioidosis detection were discussed in this review. Among these methods, blood culture technique was consistently reported in all the six selected literatures and have reported a 100% detection rate for melioidosis. Conclusion. The blood culture method showed the most promising result in detecting melioidosis compared to the other available methods of screening. This method has been consistently reported throughout the various studies with a reasonably high detection rate. Keywords: melioidosis, children, screening and diagnosis

Distribution and antimicrobial susceptibility pattern of paediatric melioidosis in Malaysia

Background: Melioidosis, caused by ubiquitous Burkholderia pseudomallei is endemic to Malaysia, northern Australia and Southeast Asia. This disease is associated with more than 50% mortality. Often, melioidosis in children is misdiagnosed as leptospirosis, dengue or other tropical infections. This study explores the burden of melioidosis on Malaysian children. Methods and materials: Retrospective data from 2018 Malaysian National Surveillance of Antimicrobial Resistance (NSAR) was retrieved. Pediatric patients of <15 years with culture-confirmed B. pseudomallei were included for further analysis. Next, the epidemiology and antimicrobial susceptibility results were examined. Results: Based on the 2018 NSAR database, 47 B. pseudomallei were isolated from 27 pediatric patients. Of these, 36 isolates were from blood (76.6%), followed by pus/wound (n = 5, 10.6%), tissue (n = 2, 4.3%) and other sites (n = 4, 8.5%). Upon antimicrobial susceptibility testing, all isolates were found to be sensitive to amoxicillin/clavulanic acid, ceftazidime, imipenem and trimethoprim/sulphamethoxazole. In contrast, none of the isolates was sensitive to gentamicin and amikacin. Conclusion: Melioidosis in children often caused a septicaemic form of infection. Albeit its potentially fatal consequences, the aetiologic bacteria remains sensitive to the standard regime of antimicrobial treatment.

Detection of spleen abscesses facilitates diagnosis of melioidosis in Malaysian children

ObjectivesMelioidosis is associated with extremely high case fatality ratios. The aim of this study was to determine whether detection of abdominal visceral abscesses can facilitate diagnosis of melioidosis in children. MethodsWe conducted a retrospective analysis of all children who had liver and/or spleen abscesses on abdominal ultrasonography admitted to Bintulu Hospital in Sarawak, Malaysia, from January 2014 until December 2018. ResultsFifty-three children had liver and/or spleen abscesses. Spleen abscesses were present in 48 (91%) cases; liver abscesses in 15 (28%). Melioidosis was confirmed by culture in 9 (17%) children; small occult splenic abscesses were present in all cases. In 78% of these cases, the lesions were detected before any positive culture (or serology) results were available. Four (8%) children had bacteriologically-confirmed tuberculosis. Two (4%) had Staphylococcus aureus infection. Of the remaining 38 (72%) culture-negative cases, 36 (95%) had clinical and imaging characteristics similar to that of children with culture-confirmed melioidosis and improved with empirical melioidosis antibiotic therapy. ConclusionsA large number of children in Bintulu Hospital in Sarawak, Malaysia, were found to have spleen abscesses. Melioidosis was the most common etiology identified in these children. Abdominal ultrasonography is extremely useful in facilitating the diagnosis of pediatric melioidosis.

Hepatic/splenic abscess and/or skin and soft tissue infection as predictors of melioidosis in children.

Melioidosis can have multiple organ involvement which can then mimic other infections. The aim of this study was to determine if there are any factors significantly associated with melioidosis which can inform diagnostic evaluations before receiving the results of confirming laboratory testing. The charts of patients aged < 16 years admitted to Songklanagarind Hospital during 2002-2014 with a clinical presentation suspicious of melioidosis were reviewed. Of the 145 suspected cases, 27 patients had a confirmed diagnosis of melioidosis by either serology and/or culture. The melioidosis group had a higher proportion of patients with liver or splenic abscess (44.4% vs. 11.9%, p < 0.01) and were less likely to have splenomegaly by physical examination (3.7% vs. 22.9%, p = 0.02) than patients without melioidosis. Logistic regression analysis found that patients suspected of melioidosis who had (a) hepatic abscess or (b) splenic abscess or (c) skin or soft tissue infection were more likely to have melioidosis with likelihood ratios of 5.6, 4.0, and 2.2 respectively, and specificities of 0.94, 0.89, and 0.68 respectively. Suspected patients who did not have hepatic abscess, splenic abscess, or soft tissue infection were unlikely to have melioidosis with negative predictive value of 0.90. patients who have clinically suspected melioidosis without skin or soft tissue infection should have hepatic-splenic ultrasonography performed, and suspected patients who have one of these 3 findings should be treated initially as melioidosis while waiting for culture or serologic test results.

Melioidosis in Children from Southern Coastal India

Melioidosis is an infectious disease caused by a gram-negative bacillus, Burkholderia pseudomallei. It is known to be endemic in Southeast Asia and Northern Australia. There is a recent surge in cases from coastal India. We hereby report four episodes of Melioidosis in 3 children with one child having a recurrent episode. One child was male and two were female, with all the children aged more than ten years (range 10-14years). Fever was the most common symptom followed by abdominal and bone pain in 50% of episodes. Immunocompromised state (post-splenectomy status and steroid therapy) as a predisposing factor was present in 2 children. One child presented with septicemia and succumbed within 72 hours of admission. Ceftazidime/Meropenem and cotrimoxazole were used in intensive and eradication phase respectively. A comprehensive knowledge and high index of suspicion are required to diagnose Melioidosis. Prolonged treatment course with appropriate antibiotics would help in minimizing the mortality and morbidity in children.

Melioidosis in children: a retrospective study.

Melioidosis, caused by Burkholderia pseudomallei, is endemic in Singapore and can present as localized or disseminated disease. Demographic data, clinical features, investigation results, treatments, and outcomes in patients aged <16years diagnosed with melioidosis at KK Women's and Children's Hospital between January 2002 and January 2014 were retrospectively reviewed. Data for patients with primary skin disease and those with other organ involvement were compared. Seventeen children were diagnosed with melioidosis. Their median age was 12.5years (range: 2-15years). Nine (53%) patients presented with localized cutaneous melioidosis and five (29%) with localized lymphadenitis, pneumonia, or septic arthritis. The remaining three (18%) patients had melioidosis sepsis; two of these patients died from septic shock. Treatment included an initial 1-2weeks of IV antibiotics followed by 3-6months of oral combination antibiotics. All cases of localized cutaneous disease resolved completely with no recurrences. Three (60%) of the five patients with localized involvement of other organ systems achieved complete resolution of disease, and the remaining two were lost from follow-up. Although uncommon, melioidosis can occur in children living in endemic regions. Patients with localized skin disease have good outcomes with no recurrences. Systemic disease can be fatal, especially in the presence of underlying immunodeficiency. Diagnosis requires a high index of suspicion, and treatment requires prolonged combination antibiotic therapy.

Thalassemia major is a major risk factor for pediatric melioidosis in Kota Kinabalu, Sabah, Malaysia.

Melioidosis is an important cause of community-acquired infection in Southeast Asia and northern Australia. Studies from endemic countries have demonstrated differences in the epidemiology and clinical features among children diagnosed with melioidosis. This suggests that local data are needed to determine the risk factors and outcome in specific areas. This was a retrospective study of all children admitted to Likas Women's and Children Hospital, Kota Kinabalu, Sabah, Malaysia, with a blood or clinical sample positive for Burkholderia pseudomallei from 2001 to 2012. Of 28 children with confirmed melioidosis, 27 records were reviewed including 11 (41%) children with thalassemia major. Twenty of the children had bacteremia, and 16 (59%) had a fatal outcome. Six children had chronic disease, and none died. Empiric use of antibiotics not specific for B. pseudomallei was associated with increased risk of death (P < .001). The annual incidence of melioidosis in children with thalassemia major from 2001 to 2010 was 140 per 100 000/year vs 0.33 per 100 000/year for other children (P < .001). After institution of iron chelation therapy in 2010, no child with thalassemia major was diagnosed with melioidosis in 2011 or 2012. Pediatric melioidosis in Sabah is associated with a high proportion of bacteremia and death. Thalassemia major was a major risk factor for melioidosis among children from 2001 to 2010, but infections decreased markedly from 2011 to 2012 after universal availability of iron chelation therapy. Inappropriate empiric therapy was associated with an increased risk of death.

Seroepidemiology of melioidosis in children from a remote region of Papua New Guinea.

The Balimo region in Papua New Guinea has previously been identified as melioidosis-endemic with a predilection for children. Where health resources are scarce, seroepidemiology can be used to assess exposure to Burkholderia pseudomallei and therefore risk of acquiring melioidosis. Logistic regression was used to determine associations between indirect haemagglutination assay (IHA) seroreactivity with environmental and demographic/cultural factors to aid in determining risk factors associated with exposure to B. pseudomallei in children. Of the 968 participants, 92.9% (899/968) were children, representing the majority of the community school population in the immediate Balimo region. Of these, 24.6% (221/899) were seropositive. Bathing in the lagoon (OR=2.679), drinking from the well or lagoon (OR=1.474), and being a member of the Siboko (OR=1.914) or Wagumisi (OR=1.942) clans were significantly associated with seropositivity. In the multivariate analysis, drinking from a well or lagoon (OR=1.713), and the Siboko (OR=2.341) and Wabadala (OR=2.022) clans were associated with seropositivity. This study in children supports observations that interactions with groundwater in this region are risk factors in acquiring melioidosis. Public health measures intended to limit this exposure may help reduce the risk of acquiring melioidosis in this remote community. Associations with clan structure may provide more cultural specific insights, however this requires further elucidation.

Clinical presentation and medical management of melioidosis in children: a 24-year prospective study in the Northern Territory of Australia and review of the literature.

Melioidosis is less common in children than adults. The clinical spectrum of disease varies greatly between the 2 groups. Treatment guidelines are currently based on adult studies, and revision of existing guidelines is necessary to instruct specific pediatric management. Culture-confirmed cases of melioidosis in the Northern Territory between 1989 and 2013 were identified from the Prospective Melioidosis Study. The epidemiology and clinical spectrum of disease for children aged ≤ 16 years were analyzed and compared with the adult data. Forty-five pediatric patients were identified, representing 5% of the total 820 melioidosis cases over 24 years. Most children (84%) had no recognized risk factors for melioidosis, and 80% presented during the wet season. Primary cutaneous melioidosis was the commonest presentation in children (60% vs 13%; P < .001), whereas pneumonia predominated in adults (54% vs 20%; P < .001). Bacteremia was less common in children than in adults (16% vs 59%; P < .001). Brainstem encephalitis occurred in 3 children without risk factors. Children were more likely to report an inoculating event (42%; P < .001). There was no difference in mortality between the groups (P = .178), with 3 children dying (7%); all had identifiable risk factors. Four children with cutaneous melioidosis were successfully treated with oral therapy alone, while 2 had skin lesions that resolved spontaneously. Pediatric melioidosis commonly manifests as localized cutaneous disease in immunocompetent hosts. The disease can be fatal, especially in individuals with risk factors for disease. Melioidosis with encephalomyelitis can result in severe residual disability. Prompt diagnosis requires a high index of clinical suspicion in endemic areas.

Melioidosis: a pediatric disease.

Melioidosis is recognized as a pediatric disease in the endemic regions of tropical South East Asia and Northern Australia. Children with this potentially life-threatening infection, caused by Burkholderia pseudomallei, may also present in nonendemic areas, and thus awareness of the disease spectrum is important for all involved in pediatric acute care. This review discusses the epidemiology, range of clinical presentation and management of melioidosis in children. A comprehensive review of recent progress in the understanding of the pathogenesis and diagnostics of melioidosis is available elsewhere.

Localized Melioidosis in Children in Thailand: Treatment and Long-term Outcome

Melioidosis, an infection caused by Burkholderia pseudomallei, can present as severe septicemia or localized infection. Data on optimum antibiotic treatment regimen for localized melioidosis in children is limited. This is a report on localized melioidosis in children, regarding clinical presentation, treatment and the long-term outcomes. We reviewed 37 cases of localized melioidosis in children treated between 1994 and 2006 and followed up them prospectively until 1 October 2007. The two most common presentations were skin/soft tissue infections and suppurative parotitis. Oral eradication antibiotics after initial parenteral therapy included trimetroprim-sulfamethoxazole (10 patients) and trimetroprim-sulfamethoxazole in combination with doxycycline (four patients). Patients who did not get any parenteral antibiotics for B. pseudomallei were treated with oral trimetroprim-sulfamethoxazole (10 patients) and trimetroprim-sulfamethoxazole in combination with doxycycline (one patient). No adverse effects were reported. We were able to follow-up 32 patients, all recovered except one patient reported a history of possible relapse.

Melioidosis in children from Kuala Lumpur, Malaysia

There are few data on paediatric melioidosis in endemic areas outside rural north-eastern Thailand and northern Australia. This study reports 16 culture-confirmed cases of melioidosis in children aged < or = 15 years seen between 1976 and 2005 at an urban teaching hospital in Kuala Lumpur, Malaysia. Seven (43.8%) patients had septicaemic melioidosis (with three known deaths) and nine (56.2%) had localised disease (one death). Eleven (68.8%) patients had underlying diseases, including five with haematological malignancies. Skin, soft tissue and lymph nodes were most commonly affected. There were no cases of parotitis or pharyngocervical disease (seen in Thailand), or encephalomyelitis (seen in Australia). The differences in disease seen in this study compared with the mostly rural patients described in previous studies might be owing to a different patient population in an urban environment. Septicaemic melioidosis has a high mortality, but localised disease has a good prognosis, and selected cases may be cured without the full recommended treatment regimen.

CLINICAL EXPERIENCE WITH TREATMENT OF MELIOIDOSIS IN CHILDREN

We describe the treatment and follow-up results of 30 children with culture-proven melioidosis seen during 1994-1999. Twelve patients had septicemia, and 18 patients had localized infection. Ceftazidime with or without trimethoprim-sulfamethoxazole were used for the acute treatment of severe melioidosis. Oral trimethoprim-sulfamethoxazole was given in the eradication phase in 4 patients with septicemia and in 12 patients for the treatment of localized infection. Trimethoprim-sulfamethoxazole in combination with doxycycline were given to 4 patients, whereas doxycycline alone was given to 2 patients older than 8 years old. No serious adverse reaction was reported. Three patients died suddenly. Twenty-five patients could be followed up; 24 patients were well.

Clinical manifestations of melioidosis in children

Fifty-five children with culture-proved melioidosis treated at Srinagarind Hospital from 1979 to 1993 were retrospectively reviewed. Twenty patients had septicemia and 35 patients had localized infection. Eleven patients (55%) in the septicemic group had underlying diseases but none in the localized infection group. In the septicemic patients the most common organ involvement was the lung (75%). Shock was present in 45% and the case fatality rate was very high (60%). In localized melioidosis suppurative parotitis was the most common manifestation (40%). Other common infections included skin and subcutaneous abscesses and lymphadenitis. There was no shock or death in this group.

Acute suppurative parotitis caused by Pseudomonas pseudomallei in children.

During a prospective clinical study of melioidosis in northeast Thailand, suppurative parotitis was observed as a characteristic presentation in children. Parotitis constituted 6.3% of all culture-positive melioidosis and 38% of melioidosis in children. Nine cases are described. None had apparent predisposition to infection, although two patients developed rising mumps virus antibody titers, suggesting a possible relation between these conditions. Complications included abscess formation (nine), spontaneous rupture into the auditory canal (five), facial nerve palsy (two), and septicemia and osteomyelitis with septic arthritis (one each). All children initially responded to surgical drainage and appropriate antibiotic therapy. Pseudomonas pseudomallei parotitis should be considered in children from endemic areas with fever and facial swelling. It has a good prognosis with appropriate treatment. It may also prove to be a sensitive clinical indicator of the presence of melioidosis within a particular geographic area.