Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics
Background 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...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | E-Article |
| Language: | English |
| Published: |
PLOS
2017
|
| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/17401/1/Pediatric%20melioidosis%20in%20Sarawak%20Malaysia%20%28abstract%29.pdf http://ir.unimas.my/id/eprint/17401/ http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005650 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| Summary: | Background
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.
Methods
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.
Findings
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.
Conclusions
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. |
|---|