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 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. © 2017 mohan et al.