A retrospective analysis of melioidosis in Cambodian children, 2009–2013

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.

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

“…A large study in Cambodia has also recently reported extremely high pediatric melioidosis incidences (28–35 cases per 100,000 children) [26]. In fact, the pediatric incidence rates recorded in this Cambodian study, and in the present one, are comparable to that of adult cases in northern Australia (19.6/ 100,000) and northeast Thailand (21.3/ 100,000) [27, 28], highlighting the significant and likely unrecognized burden of melioidosis in children.…”

Neonatal melioidosis case reports—Lessons learned

“…A male‐biased incidence was found among the neonatal melioidosis cases (68%; 15/22), similar to childhood and adult melioidosis . The odds of fatal outcome were found 3.67 times higher among male than the odds were among female neonates.…”

“…Neonatal melioidosis is considered a rare infection even in endemic regions . The only children hospital in Sabah, for example, had only two confirmed cases on record in year 2000‐2012 .…”

“…Survival rate of the neonates were found very low, with case fatality rate at 73% (22/30). This was still much higher compared with childhood and adult melioidosis, in which fatality rates ranged at 7 ~ 60% …”

“…Main transmission mode is via direct contact with or ingestion of contaminated water or soil, or inhalation of contaminated dust particles . Incidence of neonatal melioidosis, therefore, tends to be rare even in endemic regions . New cases and their clinical reports are thus valuable, as they lend additional clinical and epidemiological data that could improve our understanding of the disease in neonates.…”