Throat swab cultures and indirect hemagglutination assay (IHA) for Pseudomonas pseudomallei were done in 1000 randomly selected children at a large hospital in northeast Thailand. During 18 months, 17 children with melioidosis were admitted (0.46% of pediatric admissions excluding neonates born in the hospital). Throat swab was positive for P. pseudomallei in 8 of these but in none of 1000 control children. IHA seroprevalence rose at a conversion rate of 24% per year, from 12% in those 1-6 months old to a plateau at approximately 80% after age 4 years. No control child < 4 had an IHA titer > 1:160. The median titer in children with melioidosis was 1:80 (range, negative [in3]-1:5120). Specificity of IHA declined with age, but high titers (> or = 1:640) remained diagnostically useful. Thus, throat carriage of P. pseudomallei indicates active melioidosis. There is no evidence for an asymptomatic carrier state in children. Environmental exposure to P. pseudomallei in endemic areas begins when the child becomes mobile.
Throat swab (TS) cultures were performed for 1,011 patients with melioidosis and 3,524 healthy subjects or patients with other diseases. The specificity of TS culture for the diagnosis of melioidosis was 100%, and the overall sensitivity was 36% (24% for sputum-negative patients and 79% for sputum-positive patients). Direct plating of the TS specimen on Ashdown's medium was rapid (colonies were usually evident within 24 h) but only 63% sensitive compared to the results of primary culture in a selective broth. A throat swab should be cultured in all cases of suspected melioidosis.Melioidosis is an infection caused by the environmental bacterium Burkholderia pseudomallei. It is an important cause of morbidity and mortality in rural communities in areas of endemicity, such as northeast Thailand, where melioidosis accounts for approximately one-fifth of all community-acquired septicemias (2). The majority of cases in adults are septicemic. The lung is the most commonly affected single organ and is either the primary focus or is where disease occurs secondary to disseminated infection. Clinical diagnosis may be difficult because of the diversity of disease presentations. Culture of B. pseudomallei from suitable specimens therefore remains the "gold standard" for the definitive diagnosis of melioidosis, although more rapid diagnostic methods have been developed (7). Throat swabs have previously been shown to be useful for the diagnosis of melioidosis in children (3). A positive throat swab culture may be the first indication that a patient has melioidosis. Retrieval of specimens on throat swabs is a simple, noninvasive method of obtaining specimens for culture, particularly if sputum is not available. The sensitivity and specificity of throat swab culture for the diagnosis of melioidosis across the full age range of the population in an area of endemicity have not been previously defined.We have therefore examined retrospectively the results of four studies that we conducted in northeast Thailand in which throat swab cultures for B. pseudomallei were performed routinely. Data from these prospective screening studies were combined. These studies were of (i) hospitalized children aged between 1 month and 14 years (1,000 patients) in Ubon Ratchathani (3) (study 1); (ii) hospitalized adults in Ubon Ratchathani with suspected melioidosis (study 2); (iii) adult volunteers who comprised 330 healthy people screened at home and 700 adults attending hospitals as outpatients (200 of whom had diabetes mellitus, the major risk factor for melioidosis) (study 3); and (iv) hospitalized adults in northeast Thailand (Ubon Ratchathani [excluding patients included in study 2], Srisaket, Surin, and Khon Kaen) as part of a case-control study of risk factors for melioidosis (4). Melioidosis was confirmed by the isolation of B. pseudomallei from any body fluid (other than throat swab specimens).(This work was presented in part at the International Congress on Melioidosis, Bangkok, Thailand, November 1998, abstr. P202.)Throat swabs were colle...
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