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

• Main Authors: Anand Mohan (Author), Yuwana Podin (Author), Nickson Tai (Author), Chae-Hee Chieng (Author), Vanessa Rigas (Author), Barbara Machunter (Author), Mark Mayo (Author), Desiree Wong (Author), Su-Lin Chien (Author), Lee-See Tan (Author), Charles Goh (Author), Reginal Bantin (Author), Alexander Mijen (Author), Wen-Yi Chua (Author), King-Ching Hii (Author), See-Chang Wong (Author), Hie-Ung Ngian (Author), Jin-Shyan Wong (Author), Jamilah Hashim (Author), Bart J Currie (Author), Mong-How Ooi (Author)
• Format: Book
• Published: Public Library of Science (PLoS), 2017-06-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1935-2727; 1935-2735; 10.1371/journal.pntd.0005650
• Keywords: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270
• Source: PLoS Neglected Tropical Diseases, Vol 11, Iss 6, p e0005650 (2017)

Melioidosis 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.A 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.Forty-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.Central 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.