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

Anand, Mohan and Yuwana, Podin and Tai, Nickson and Chieng, Chae Hee and Vanessa, Rigas and Machunter, Barbara and Mayo, Mark and Wong, Desiree and Chien, Su Lin and Tan, Lee See and Goh, Charles and Bantin, Reginal and Mijen, Alexander and Chua, Wen Yi and Hii, King Ching and Wong, See Chang and Ngian, Hie Ung and Wong, Jin Shyan and Jamilah, Hashim and Currie, Bart J. and Ooi, Mong How (2017) Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics. Neglected Tropical Diseases, 11 (6). ISSN 1935-2735

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Abstract

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.

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