Melioidosis in children from Kuala Lumpur, Malaysia

Sam, I‐Ching; Sd, Puthucheary

doi:10.1179/146532806x120318

Cited by 14 publications

(10 citation statements)

References 15 publications

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“…Childhood melioidosis is predominantly a disease of apparently immunocompetent persons, which contrasts with disease in adulthood when at least 80% of those affected have at least one risk factor that affects host immunity. Our finding that two-thirds of disease was localized is consistent with the published literature from Asia,30–34 and the proportion of localized infections in the region of the head and neck is also consistent 31,33. A previous report describing acute suppurative parotitis in children caused by B. pseudomallei in northeast Thailand suggested that this syndrome may prove to be a sensitive indicator of the presence of melioidosis within a given geographic area 9.…”

Section: Discussionsupporting

confidence: 91%

Emergence of Pediatric Melioidosis in Siem Reap, Cambodia

Pagnarith¹,

Kumar²,

Thaipadungpanit³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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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.

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Section: Discussionsupporting

confidence: 91%

Emergence of Pediatric Melioidosis in Siem Reap, Cambodia

Pagnarith¹,

Kumar²,

Thaipadungpanit³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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“…Similarly, only 3% of children in the Cambodian study had significant co-morbidity [26]. In contrast, 41% of children with melioidosis in Sabah (another Malaysian Bornean state), the majority of whom were ethnic Kadazandusuns, had β-thalassemia major, while 31% of children in Kuala Lumpur (in peninsular Malaysia) had hematological malignancies [14, 32]. Five (12%) children in our study had moderate or severe anemia at presentation (hemoglobin 6.4–7.8 g/dL).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Similar paediatric case reviews have been completed, for example in Australia (45 cases between 1989 and 2013 [15] and 8 cases between 1996 and 2006 [23]), India (11 cases from 2007 to 2014 [22]) Malaysia (16 cases between 1976 and 2005 [24] and 13 cases between 2000 and 2003 [25]), Singapore (17 children between 2002 and 2014) [26] and Thailand (55 cases between 1979 and 1993 [27], 37 localised cases between 1994 and 2006 [28], and 46 cases between 1990 and 1991 [29]). Broadly the findings are similar in all studies.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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Melioidosis in children from Kuala Lumpur, Malaysia

Cited by 14 publications

References 15 publications

Emergence of Pediatric Melioidosis in Siem Reap, Cambodia

Emergence of Pediatric Melioidosis in Siem Reap, Cambodia

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

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

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