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

Anand Mohan, Yuwana Podin, Nickson Tai, Chae-Hee Chieng, Vanessa Rigas, Barbara Machunter, Mark Mayo, Desiree Wong, Su-Lin Chien, Lee-See Tan, Charles Goh, Reginal Bantin, Alexander Mijen, Wen-Yi Chua, King-Ching Hii, See-Chang Wong, Hie-Ung Ngian, Jin-Shyan Wong, Jamilah Hashim, Bart J. CurrieMong How Ooi

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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.

    Original languageEnglish
    Article numbere0005650
    Pages (from-to)1-16
    Number of pages16
    JournalPLoS Neglected Tropical Diseases
    Volume11
    Issue number6
    DOIs
    Publication statusPublished - 9 Jun 2017

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    Mohan, A., Podin, Y., Tai, N., Chieng, C-H., Rigas, V., Machunter, B., ... Ooi, M. H. (2017). Pediatric melioidosis in Sarawak, Malaysia: Epidemiological, clinical and microbiological characteristics. PLoS Neglected Tropical Diseases, 11(6), 1-16. [e0005650]. https://doi.org/10.1371/journal.pntd.0005650